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  • JOURNAL ARTICLE
    Modi N, Battersby C, Longford N, 2017,

    Proposed Definition of Necrotizing Enterocolitis May Be of Limited Value Reply

    , JAMA Pediatrics, Vol: 171, Pages: 711-712, ISSN: 2168-6203
  • JOURNAL ARTICLE
    Statnikov Y, Ibrahim B, Modi N, 2017,

    A systematic review of administrative and clinical databases of infants admitted to neonatal units

    , Archives of Disease in Childhood-Fetal and Neonatal Edition, Vol: 102, Pages: F270-F276, ISSN: 1468-2052

    Objectives:High quality information, increasingly captured in clinical databases, is a useful resource for evaluating and improving newborn care. We conducted a systematic review to identify neonatal databases, and define their characteristics. MethodsWe followed a preregistered protocol using MesH terms to search MEDLINE, EMBASE, CINAHL, Web of Science and OVID Maternity and Infant Care Databases for articles identifying patient level databases covering more than one neonatal unit. Full-text articles were reviewed and information extracted on geographic coverage, criteria for inclusion, data source, and maternal and infant characteristics. ResultsWe identified 82 databases from 2,037 publications. Of the country specific databases there were 39 regional and 39 national. Sixty databases restricted entries to neonatal unit admissions by birth characteristic or insurance cover; 22 had no restrictions. Data were captured specifically for 53 databases; 21 administrative sources; 8 clinical sources. Two clinical databases hold the largest range of data on patient characteristics, USA’s Pediatrix BabySteps Clinical Data Warehouse and UK’s National Neonatal Research Database.Conclusion A number of neonatal databases exist that have potential to contribute to evaluating neonatal care. The majority are created by entering data specifically for the database, duplicating information likely already captured in other administrative and clinical patient records. This repetitive data entry represents an unnecessary burden in an environment where electronic patient records are increasingly used. Standardisation of data items is necessary to facilitate linkage within and between countries.

  • JOURNAL ARTICLE
    Kelly LE, Shah PS, Hakansson S, Kusuda S, Adams M, Lee SK, Sjors G, Vento M, Rusconi F, Lehtonen L, Reichman B, Darlow BA, Lui K, Feliciano LS, Gagliardi L, Bassler D, Modi Net al., 2017,

    Perinatal health services organization for preterm births: a multinational comparison

    , JOURNAL OF PERINATOLOGY, Vol: 37, Pages: 762-768, ISSN: 0743-8346
  • JOURNAL ARTICLE
    Darlow BA, Lui K, Kusuda S, Reichman B, Hakansson S, Bassler D, Modi N, Lee SK, Lehtonen L, Vento M, Isayama T, Sjors G, Helenius KK, Adams M, Rusconi F, Morisaki N, Shah PSet al., 2017,

    International variations and trends in the treatment for retinopathy of prematurity

    , BRITISH JOURNAL OF OPHTHALMOLOGY, Vol: 101, Pages: 1399-1404, ISSN: 0007-1161
  • JOURNAL ARTICLE
    Hines D, Modi N, Lee SK, Isayama T, Sjors G, Gagliardi L, Lehtonen L, Vento M, Kusuda S, Bassler D, Mori R, Reichman B, Hakansson S, Darlow BA, Adams M, Rusconi F, San Feliciano L, Lui K, Morisaki N, Musrap N, Shah PSet al., 2017,

    Scoping review shows wide variation in the definitions of bronchopulmonary dysplasia in preterm infants and calls for a consensus

    , ACTA PAEDIATRICA, Vol: 106, Pages: 366-374, ISSN: 0803-5253
  • JOURNAL ARTICLE
    Achana F, Petrou S, Khan K, Gaye A, Modi N, Medicines for Neonates Investigatorset al., 2017,

    A methodological framework for assessing agreement between cost-effectiveness outcomes estimated using alternative sources of data on treatment costs and effects for trial-based economic evaluations.

    , European Journal of Health Economics, Vol: 19, Pages: 75-86, ISSN: 1618-7601

    A new methodological framework for assessing agreement between cost-effectiveness endpoints generated using alternative sources of data on treatment costs and effects for trial-based economic evaluations is proposed. The framework can be used to validate cost-effectiveness endpoints generated from routine data sources when comparable data is available directly from trial case report forms or from another source. We illustrate application of the framework using data from a recent trial-based economic evaluation of the probiotic Bifidobacterium breve strain BBG administered to babies less than 31 weeks of gestation. Cost-effectiveness endpoints are compared using two sources of information; trial case report forms and data extracted from the National Neonatal Research Database (NNRD), a clinical database created through collaborative efforts of UK neonatal services. Focusing on mean incremental net benefits at £30,000 per episode of sepsis averted, the study revealed no evidence of discrepancy between the data sources (two-sided p values >0.4), low probability estimates of miscoverage (ranging from 0.039 to 0.060) and concordance correlation coefficients greater than 0.86. We conclude that the NNRD could potentially serve as a reliable source of data for future trial-based economic evaluations of neonatal interventions. We also discuss the potential implications of increasing opportunity to utilize routinely available data for the conduct of trial-based economic evaluations.

  • JOURNAL ARTICLE
    Battersby CWS, Longford N, Costeloe K, Modi Net al., 2017,

    Development of a gestational age–specific case definition for neonatal necrotizing enterocolitis

    , JAMA Pediatrics, Vol: 171, Pages: 256-263, ISSN: 2168-6211

    Importance:NecrotisingEnterocolitis(NEC)isamajorcauseofneonatalmorbidityandmortality.Preventiveandtherapeuticresearch,surveillanceandqualityimprovementinitiatives,arehinderedbyvariationsincase-definitions.Objective:Todevelopagestationalage(GA)specificcase-definitionforNEC.Design,Setting,andParticipants:Weconductedaprospective34monthpopulationstudyusingclinician-recordedfindingsbetweenDecember2011andSeptember2014acrossall163neonatalunitsinEngland.Exposure:AbdominalX-ray(AXR)performedtoinvestigateclinicalconcerns.Mainoutcomesandmeasures:OrdinalNEClikelihoodscore,dichotomouscase-definition,andGA-specificprobabilityplots.Wesecuredcliniciancommitmenttorecorddataprospectivelyintoeachinfant’sElectronicPatientRecord(EPR).WeobtainedstudydatafromtheUKNationalNeonatalResearchDatabasethatholdsinformationextractedregularlyfromtheneonatalEPR.Wesplitstudydataintotestandvalidationdatasets.WeenteredGA,birth-weightzscore,clinicalandAXRfindingsascandidatevariablesinalogisticregressionmodel,performedmodelfitting1000times,averagedthepredictions,andusedestimatesfromthefittedmodeltodevelopanordinalNECscore,andcut-pointstodevelopadichotomouscase-definitionbaseduponthehighestareaunderthereceiveroperatingcharacteristiccurvesandpositivepredictivevalues.Results:Weincludeddatafrom3866infants(2978withoutand888withNEC).Lessmatureinfantswerelesslikelytopresentwithpneumatosis,bloodormucusinstools,andweremorelikelytohaveagaslessAXR.IntheordinalNECscoreanalysisweallocatedthreepointstopneumatosis,twopointstobloodinstools.Onepointeachwasallocatedto:abdominaltenderness;abdominaldiscolouration;thecompositeofincreasedand/orbiliousaspiratesANDabdominaldistension;oneormoreofpneumoperitoneum,fixedloopandportalvenousgas.Thecut-offscoresforthedichotomousgestationalage-specificcase-definitionwere≥2(<30weeksGA);≥3(30to<37weeks);≥4(≥37weeks).TheordinalNECscoreanddichotomouscase-definitiondiscriminatedwellbetweeninfantswithandwithoutNEC(AUC87%and80%respectively).Conclusionsandrelevance:NECr

  • JOURNAL ARTICLE
    Battersby CWS, Longford N, Mandalia S, Costeloe K, Modi Net al., 2016,

    Incidence and enteral feed antecedents of severe neonatal necrotising enterocolitis across neonatal networks in England, 2012-13: a whole-population surveillance study

    , Lancet Gastroenterology and Hepatology, Vol: 2, Pages: 43-51, ISSN: 2468-1253

    BackgroundNecrotising enterocolitis is a neonatal gastrointestinal inflammatory disease with high mortality and severe morbidity. This disorder is growing in global relevance as birth rates and survival of babies with low gestational age improve. Population data are scant and pathogenesis is incompletely understood, but enteral feed exposures are believed to affect risk. We aimed to quantify the national incidence of severe necrotising enterocolitis, describe variation across neonatal networks, and investigate enteral feeding-related antecedents of severe necrotising enterocolitis.MethodsWe undertook a 2-year national surveillance study (the UK Neonatal Collaborative Necrotising Enterocolitis [UKNC-NEC] Study) of babies born in England to quantify the burden of severe or fatal necrotising enterocolitis confirmed by laparotomy, leading to death, or both. Data on all liveborn babies admitted to neonatal units between Jan 1, 2012, and Dec 31, 2013, were obtained from the National Neonatal Research Database. In the subgroup of babies born before a gestational age of 32 weeks, we did a propensity score analysis of the effect of feeding in the first 14 postnatal days with own mother’s milk, with or without human donor milk and avoidance of bovine-origin formula, or milk fortifier, on the risk of developing necrotising enterocolitis.FindingsDuring the study period, 118 073 babies were admitted to 163 neonatal units across 23 networks, of whom 14 678 were born before a gestational age of 32 weeks. Overall, 531 (0·4%) babies developed severe necrotising enterocolitis, of whom 247 (46·5%) died (139 after laparotomy). 462 (3·2%) of 14 678 babies born before a gestational age of 32 weeks developed severe necrotising enterocolitis, of whom 222 (48·1%) died. Among babies born before a gestational age of 32 weeks, the adjusted network incidence of necrotising enterocolitis ranged from 2·51% (95% CI 1·13–3·60) to 3·

  • CONFERENCE PAPER
    Battersby C, Longford N, Costeloe K, Modi Net al., 2016,

    The effect of early enteral feed exposures on severe necrotising enterocolitis in very preterm infants: a propensity score matched study

    , EAPS Congress 2016, Publisher: Springer Verlag, Pages: 1558-1558, ISSN: 0340-6199
  • JOURNAL ARTICLE
    Seaton SE, Barker L, Draper ES, Abrams KR, Modi N, Manktelow BNet al., 2016,

    Modelling Neonatal Care Pathways for Babies Born Preterm: An Application of Multistate Modelling

    , PLoS ONE, Vol: 11, ISSN: 1932-6203

    Modelling length of stay in neonatal care is vital to inform service planning and the counsellingof parents. Preterm babies, at the highest risk of mortality, can have long stays in neonatalcare and require high resource use. Previous work has incorporated babies that dieinto length of stay estimates, but this still overlooks the levels of care required during theirstay. This work incorporates all babies, and the levels of care they require, into length ofstay estimates. Data were obtained from the National Neonatal Research Database for singletonbabies born at 24–31 weeks gestational age discharged from a neonatal unit inEngland from 2011 to 2014. A Cox multistate model, adjusted for gestational age, wasused to consider a baby’s two competing outcomes: death or discharge from neonatal care,whilst also considering the different levels of care required: intensive care; high dependencycare and special care. The probabilities of receiving each of the levels of care, orhaving died or been discharged from neonatal care are presented graphically overall andadjusted for gestational age. Stacked predicted probabilities produced for each week ofgestational age provide a useful tool for clinicians when counselling parents about length ofstay and for commissioners when considering allocation of resources. Multistate modellingprovides a useful method for describing the entire neonatal care pathway, where rates ofin-unit mortality can be high. For a healthcare service focussed on costs, it is important toconsider all babies that contribute towards workload, and the levels of care they require.

This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.

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