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  • Journal article
    Modi N, Hanson M, 2020,

    Maternal, neonatal, and child health is essential for meeting SDG 3.4

    , LANCET, Vol: 396, Pages: 1731-1732, ISSN: 0140-6736
  • Journal article
    Jacob CM, Briana DD, Di Renzo GC, Modi N, Bustreo F, Conti G, Malamitsi-Puchner A, Hanson Met al., 2020,

    Building resilient societies after COVID-19: the case for investing in maternal, neonatal, and child health

    , LANCET PUBLIC HEALTH, Vol: 5, Pages: E624-E627, ISSN: 2468-2667
  • Journal article
    Ewer AK, Deshpande SA, Gale C, Stenson BJ, Upton M, Evans C, Oddie SJet al., 2020,

    Potential benefits and harms of universal newborn pulse oximetry screening: response to the UK National Screening Committee public consultation

    , ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 105, Pages: 1128-+, ISSN: 0003-9888
  • Conference paper
    Modi N, 2020,

    Preterm Nutrition in 2020: Breast Milk, Probiotics and Other Components

    , Publisher: KARGER, Pages: 404-405, ISSN: 1661-7800
  • Journal article
    Yeo KT, Oei JL, De Luca D, Schmölzer GM, Guaran R, Palasanthiran P, Kumar K, Buonocore G, Cheong J, Owen LS, Kusuda S, James J, Lim G, Sharma A, Uthaya S, Gale C, Whittaker E, Battersby C, Modi N, Norman M, Naver L, Giannoni E, Diambomba Y, Shah PS, Gagliardi L, Harrison M, Pillay S, Alburaey A, Yuan Y, Zhang Het al., 2020,

    Review of guidelines and recommendations from 17 countries highlights the challenges that clinicians face caring for neonates born to mothers with COVID-19.

    , Acta Paediatrica: Nurturing the Child, Vol: 109, Pages: 2192-2207, ISSN: 1651-2227

    AIM: This review examined how applicable national and regional clinical practice guidelines and recommendations for managing neonates born to mothers with COVID-19 mothers were to the evolving pandemic. METHODS: A systematic search and review identified 20 guidelines and recommendations that had been published by 25 May 2020. We analysed documents from 17 countries: Australia, Brazil, Canada, China, France, India, Italy, Japan, Saudi Arabia, Singapore, South Africa, South Korea, Spain, Sweden, Switzerland, the UK and the USA. RESULTS: The documents were based on expert consensus with limited evidence and were of variable, low methodological rigour. Most did not provide recommendations for delivery methods or managing symptomatic infants. None provided recommendations for post-discharge assimilation of potentially-infected infants into the community. The majority encouraged keeping mothers and infants together, subject to infection control measures, but one-third recommended separation. Although breastfeeding or using breastmilk were widely encouraged, two countries specifically prohibited this. CONCLUSION: The guidelines and recommendations for managing infants affected by COVID-19 were of low, variable quality and may be unsustainable. It is important that transmission risks are not increased when new information is incorporated into clinical recommendations. Practice guidelines should emphasise the extent of uncertainty and clearly define gaps in the evidence.
  • Journal article
    Rees P, Stilwell PA, Bolton C, Akillioglu M, Carter B, Gale C, Sutcliffe Aet al., 2020,

    Childhood health and educational outcomes after neonatal abstinence syndrome: a systematic review and meta-analysis.

    , The Journal of Pediatrics, Vol: 226, Pages: 149-156.e16, ISSN: 0022-3476

    OBJECTIVE: To systematically review and meta-analyze the association between neonatal abstinence syndrome (NAS) and adverse health or educational childhood outcomes. STUDY DESIGN: An all-language search was conducted across 11 databases between 1/1/75, and 9/3/19, and 5865 titles were identified. Observational studies of children between 28 days and 16 years of age, in whom a diagnosis of NAS was documented, were included. Outcomes included reasons for hospital admissions, childhood diagnoses, developmental outcomes, and academic attainment scores. All studies underwent independent review by two trained reviewers, who extracted study data and assessed risk of bias using the Newcastle Ottawa Tool. RESULTS: Fifteen studies were included comprising 10,907 children with previous NAS and 1,730,213 children without previous NAS, aged 0-16 years. There was a strong association between NAS and subsequent child maltreatment (aOR 6.49 (4.46, 9.45, I2=52%)), injuries and poisoning (aOR 1.34 (1.21, 1.49, I2= 0%)), and a variety of mental health conditions. Studies consistently demonstrated an increased incidence of strabismus and nystagmus among those with previous NAS. Children with NAS also had lower mean academic scores than the control group in every domain of testing across age groups. CONCLUSIONS: NAS is significantly associated with future child maltreatment, mental health diagnoses, visual problems and poor school performance. Due to the necessary inclusion of non-randomized studies, incomplete reporting among studies and likely unadjusted confounding, this review does not suggest causation. However, we highlight associations requiring further investigation and targeted intervention, to positively impact the life course trajectories of this growing population of children.
  • Journal article
    Prior E, Modi N, 2020,

    Adult outcomes after preterm birth

    , POSTGRADUATE MEDICAL JOURNAL, Vol: 96, Pages: 619-622, ISSN: 0032-5473
  • Journal article
    Webbe J, Gale C, 2020,

    NICE guidelines on neonatal parenteral nutrition: a step towards standardised care but evidence is scarce

    , The Lancet Child and Adolescent Health, Vol: 4, Pages: 645-646, ISSN: 2352-4642

    Globally, neonatal conditions are the leading cause of reductions in disability-adjusted life-years and affect outcomes that extend throughout life. Providing neonatal care to optimise such long-term outcomes is challenging because short-term research outcomes might conflict, even within individual trials. Evidence-based guidelines are a welcome tool to translate research into practice and reduce variation in care. Such standardisation of care can improve outcomes for patients. For example, adherence to a standardised guideline for enteral feeding is protective against necrotising enterocolitis, despite the heterogeneity in the content of the individual guidelines. The latest guideline by the UK's National Institute for Health and Care Excellence (NICE) on neonatal parenteral nutrition is a welcome addition to neonatal practice, and is particularly important given the deficiencies frequently found in the provision of neonatal nutritional care in the UK.
  • Journal article
    Haumont D, Modi N, Saugstad OD, Antetere R, Cuong N, Turner M, Costeloe K, Aelvoet Wet al., 2020,

    Evaluating preterm care across Europe using the eNewborn European Network database

    , Pediatric Research, Vol: 88, Pages: 484-495, ISSN: 0031-3998

    BackgroundThe inefficiency of recording data repeatedly limits the number of studies conducted. Here we illustrate the wider use of data captured as part of the European eNewborn benchmarking programme.MethodsWe extracted data on 39,529 live-births from 22 weeks 0 days to 31 weeks 6 days gestational age (GA) or ≤1500 g birth weight. We explored relationships between delivery room care and Apgar scores on mortality and bronchopulmonary dysplasia (BPD) and calculated the time needed for each country to detect a clinically relevant change in these outcomes following a hypothetical intervention.ResultsEarly neonatal, neonatal, and in-hospital mortality were 3.90% (95% CI 3.71, 4.09), 6.00% (5.77, 6.24) and 7.57% (7.31, 7.83), respectively. The odds of death were greater with decreasing GA, lower Apgar scores, growth restriction, male sex, multiple birth and no antenatal steroids. Relationships for BPD were similar. The time required for participating countries to achieve 80% power to detect a relevant change in outcomes following a hypothetical intervention in 23–25 weeks’ GA infants ranged from 12 years for neonatal mortality and 22 years for BPD compared to 1 year for the whole network.ConclusionsThe eNewborn platform offers opportunity to drive efficiencies in benchmarking, quality control and research.
  • Journal article
    Dorling J, Tume LN, Arch B, Woolfall K, Latten L, Roper L, Deja E, Pathan N, Eccleson H, Hickey H, Brown M, Beissel A, Andrzejewska A, Valla FV, Gale Cet al., 2020,

    Gastric residual volume measurement in British neonatal intensive care units: a survey of practice

    , BMJ Paediatrics Open, Vol: 4, ISSN: 2399-9772

    Objective: Despite little evidence, the practice of routine gastric residual volume (GRV) measurement to guide enteral feeding in neonatal units is widespread. Due to increased interest in this practice, and to examine trial feasibility, we aimed to determine enteral feeding and GRV measurement practices in British neonatal units.Design & Setting: An online survey was distributed via email to all neonatal units and networks in England, Scotland and Wales. A clinical nurse, senior doctor and dietitian were invited to collaboratively complete the survey and submit a copy of relevant guidelines. Results: 95/184 (51.6%) approached units completed the survey, 81/95 (85.3%) reported having feeding guidelines and 28 guidelines were submitted for review. The majority of units used intermittent (90/95) gastric feeds as their primary feeding method. 42/95 units reported specific guidance for measuring and interpreting GRV. 20/90 units measured GRV before every feed, 39/90 at regular time-intervals (most commonly 4-6 hourly 35/39) and 26/90 when felt to be clinically indicated. Most units reported uncertainty on the utility of aspirate volume for guiding feeding decisions; 13/90 reported that aspirate volume affected decisions ‘very much’. In contrast, aspirate colour was reported to affect decisions ‘very much’ by 37/90 of responding units. Almost half, 44/90, routinely returned aspirates to the stomach. Conclusions: Routine GRV measurement is part of standard practice in British neonatal units, although there was inconsistency in how frequently to measure or how to interpret the aspirate. Volume was considered less important than colour of the aspirate.

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