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Journal articlePatel N, NeoTRIPs CG, Evans K, et al., 2023,
How frequent is routine use of probiotics in UK Neonatal Units?
, BMJ Paediatrics Open, Vol: 7, Pages: 1-6, ISSN: 2399-9772Objective: There is a lack of UK guidance regarding routine use of probiotics in preterm infants to prevent necrotising enterocolitis, late-onset sepsis, and death. As practices can vary, we aimed to determine the current usage of probiotics within neonatal units in the United Kingdom.Design and setting: Using NeoTRIPS, a trainee-led neonatal research network, an online survey was disseminated to neonatal units of all service levels within England, Scotland, Northern Ireland, and Wales in 2022. Trainees were requested to complete one survey per unit regarding routine probiotic administration. Results: 161/188 (86%) neonatal units responded to the survey. 70/161 (44%) respondents routinely give probiotics to preterm infants. 45/70 (64%) use the probiotic product Lactobacillus acidophilus NCFM/Bifidobacterium bifidum Bb-06/Bifidobacterium infantis Bi-26 (Labinic™). 57/70 (81%) start probiotics in infants ≤32 weeks gestation. 33/70 (47%) had microbiology departments that were aware of the use of probiotics and 64/70 (91%) had a guideline available. Commencing enteral feeds was a prerequisite to starting probiotics in 62/70 (89%) units. The majority would stop probiotics if enteral feeds were withheld (59/70; 84%) or if the infant was being treated for necrotising enterocolitis (69/70; 99%). 24/91 (26%) units that did not use probiotics at the time of the survey were planning to introduce them within the next 12 months. Conclusion: More than 40% of all UK neonatal units that responded are now routinely administering probiotics, with variability in the product used. With increased probiotic usage in recent years, there is a need to establish whether this translates to improved clinical outcomes.
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Journal articleMitra S, Whitehead L, Smith K, et al., 2023,
Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in extremely preterm infants: a clinical practice guideline incorporating family values and preferences
, Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN: 1359-2998Importance: Prophylactic cyclooxygenase inhibitors (COX-Is) such as indomethacin, ibuprofen and acetaminophen may prevent morbidity and mortality in extremely preterm infants (born ≤28 weeks’ gestation). However, there is controversy around which COX-I, if any, is the most effective and safest, which has resulted in considerable variability in clinical practice. Objective: To develop rigorous and transparent clinical practice guideline recommendations for the prophylactic use of COX-I drugs for the prevention of mortality and morbidity in extremely preterm infants.Methods: The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence-to-Decision framework for multiple comparisons was used to develop the guideline recommendations. A 12-member panel, including five experienced neonatal care providers, two methods experts, one pharmacist, two parents of former extremely preterm infants and two adults born extremely preterm, was convened. A rating of the most important clinical outcomes was established a priori. Evidence from a Cochrane network meta-analysis, and a cross-sectional mixed-methods study exploring family values and preferences were used as the primary sources of evidence. Recommendations: The panel recommended that prophylaxis with intravenous indomethacin may be considered in extremely preterm infants [conditional recommendation, moderate certainty in estimate of effects]. Shared decision making with parents was encouraged to evaluate their values and preferences prior to therapy. The panel recommended against routine use of ibuprofen prophylaxis in this gestational age group [conditional recommendation, low certainty in the estimate of effects]. The panel strongly recommended against use of prophylactic acetaminophen [strong recommendation, very low certainty in estimate of effects] until further research evidence is available.
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Journal articlevan Hasselt T, Webster K, Gale C, et al., 2023,
Children born preterm admitted to paediatric intensive care for bronchiolitis: a systematic review and meta-analysis
, BMC Pediatrics, Vol: 23, Pages: 1-12, ISSN: 1471-2431BackgroundTo undertake a systematic review of studies describing the proportion of children admitted to a paediatric intensive care unit (PICU) for respiratory syncytial virus (RSV) and/or bronchiolitis who were born preterm, and compare their outcomes in PICU with children born at term.MethodsWe searched Medline, Embase and Scopus. Citations and references of included articles were searched. We included studies published from the year 2000 onwards, from high-income countries, that examined children 0-18 years of age, admitted to PICU from the year 2000 onwards for RSV and/or bronchiolitis.The primary outcome was the percentage of PICU admissions born preterm, and secondary outcomes were observed relative risks of invasive mechanical ventilation and mortality within PICU.We used the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies to assess risk of bias. ResultsWe included 31 studies, from 16 countries, including a total of 18,331 children.Following meta-analysis, the pooled estimate for percentage of PICU admissions for RSV/bronchiolitis who were born preterm was 31% (95% confidence interval: 27% to 35%). Children born preterm had a greater risk of requiring invasive ventilation compared to children born at term (relative risk 1.57, 95% confidence interval 1.25 to 1.97, I2 = 38%). However, we did not observe a significant increase in the relative risk for mortality within PICU for preterm-born children (relative risk 1.10, 95% confidence interval: 0.70 to 1.72, I2 = 0%), although the mortality rate was low across both groups.The majority of studies (n=26, 84%) were at high risk of bias.ConclusionsAmong PICU admissions for bronchiolitis, preterm-born children are over-represented compared with the preterm birth rate (preterm birth rate 4.4% to 14.4% across countries included in review). Preterm-born children are at higher risk of mechanical ventilation compared to those born at term.
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Journal articleModi N, Ribas R, Johnson S, et al., 2023,
Pilot feasibility study of a digital technology approach to the systematic electronic capture of parent-reported data on cognitive and language development in children aged 2 years
, BMJ Health & Care Informatics, Vol: 30, Pages: 1-5, ISSN: 2632-1009Background The assessment of language and cognition in children at risk of impaired neurodevelopment following neonatal care is a UK standard of care but there is no national, systematic approach for obtaining these data. To overcome these challenges, we developed and evaluated a digital version of a validated parent questionnaire to assess cognitive and language development at age 2 years, the Parent Report of Children’s Abilities-Revised (PARCA-R).Methods We involved clinicians and parents of babies born very preterm who received care in north-west London neonatal units. We developed a digital version of the PARCA-R questionnaire using standard software. Following informed consent, parents received automated notifications and an invitation to complete the questionnaire on a mobile phone, tablet or computer when their child approached the appropriate age window. Parents could save and print a copy of the results. We evaluated ease of use, parent acceptability, consent for data sharing through integration into a research database and making results available to the clinical team.Results Clinical staff approached the parents of 41 infants; 38 completed the e-registration form and 30 signed the e-consent. The digital version of the PARCA-R was completed by the parents of 21 of 23 children who reached the appropriate age window. Clinicians and parents found the system easy to use. Only one parent declined permission to integrate data into the National Neonatal Research Database for approved secondary purposes.Discussion This electronic data collection system and associated automated processes enabled efficient systematic capture of data on language and cognitive development in high-risk children, suitable for national delivery at scale.
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Journal articleSakonidou S, Kotzamanis S, Tallett A, et al., 2023,
Parents’ Experiences of Communication in neonatal care (PEC): a neonatal survey refined for real-time parent feedback
, Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol: 108, Pages: 416-420, ISSN: 1359-2998Objective Assessing parent experiences of neonatal services can help improve quality of care; however, there is no formally evaluated UK instrument available to assess this prospectively. Our objective was to refine an existing retrospective survey for ‘real-time’ feedback.Methods Co-led by a parent representative, we recruited a convenience sample of parents of infants in a London tertiary neonatal unit. Our steering group selected questions from the existing retrospective 61-question Picker survey (2014), added and revised questions assessing communication and parent involvement. We established face validity, ensuring questions adequately captured the topic, conducted parent cognitive interviews to evaluate parental understanding of questions,and adapted the survey in three revision cycles. We evaluated survey performance.Results The revised Parents’ Experiences of Communication in Neonatal Care (PEC) survey contains 28 questions (10 new) focusing on communication and parent involvement. We cognitively interviewed six parents, and 67 parents completed 197 PEC surveys in the survey performance evaluation. Missing entries exceeded 5% for nine questions; we removed one and format-adjusted the rest as they had performed well during cognitive testing. There was strong inter-item correlation between two question pairs; however, all were retained as they individually assessed important concepts.Conclusion Revised from the original 61-question Picker survey, the 28-question PEC survey is the first UK instrument formally evaluated to assess parent experience while infants are still receiving neonatal care. Developed with parents, it focuses on communication and parent involvement, enabling continuous assessment and iterative improvement of family-centred interventions in neonatal care.
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Journal articleGoulding A, McQuaid F, Lindsay L, et al., 2023,
Confirmed SARS-CoV-2 infection in Scottish neonates 2020-2022: a national, population-based cohort study
, Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol: 108, Pages: 367-372, ISSN: 1359-2998Objectives: To examine neonates in Scotland aged 0–27 days with SARS-CoV-2 infection confirmed by viral testing; the risk of confirmed neonatal infection by maternal and infant characteristics; and hospital admissions associated with confirmed neonatal infections.Design: Population-based cohort study.Setting and population: All live births in Scotland, 1 March 2020–31 January 2022.Results: There were 141 neonates with confirmed SARS-CoV-2 infection over the study period, giving an overall infection rate of 153 per 100 000 live births (141/92 009, 0.15%). Among infants born to women with confirmed infection around the time of birth, the confirmed neonatal infection rate was 1812 per 100 000 live births (15/828, 1.8%). Two-thirds (92/141, 65.2%) of neonates with confirmed infection had an associated admission to neonatal or (more commonly) paediatric care. Six of these babies (6/92, 6.5%) were admitted to neonatal and/or paediatric intensive care; however, none of these six had COVID-19 recorded as their main diagnosis. There were no neonatal deaths among babies with confirmed infection.Implications and relevance: Confirmed neonatal SARS-CoV-2 infection was uncommon over the first 23 months of the pandemic in Scotland. Secular trends in the neonatal confirmed infection rate broadly followed those seen in the general population, although at a lower level. Maternal confirmed infection at birth was associated with an increased risk of neonatal confirmed infection. Two-thirds of neonates with confirmed infection had an associated admission to hospital, with resulting implications for the baby, family and services, although their outcomes were generally good. Ascertainment of confirmed infection depends on the extent of testing, and this is likely to have varied over time and between groups: the extent of unconfirmed infection is inevitably unknown.
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Journal articleBaskaran D, Gale C, Jawad S, et al., 2023,
Kernicterus in neonates from ethnic minorities in the UK
, Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol: 108, Pages: 432-433, ISSN: 1359-2998 -
Journal articleMoore H, Battersby C, Piyasena C, et al., 2023,
Assessing variation in neonatal sepsis screening across England
, Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol: 108, Pages: 430-431, ISSN: 1359-2998 -
Journal articleConti-Ramsden F, Fleminger J, Lanoue J, et al., 2024,
The contribution of hypertensive disorders of pregnancy to late preterm and term admissions to neonatal units in the UK 2012-2020 and opportunities to avoid admission: a population-based study using the National Neonatal Research Database
, British journal of obstetrics and gynaecology, ISSN: 0306-5456Objective: To quantify maternal hypertensive disorder of pregnancy (HDP) prevalence in late preterm and term infants admitted to neonatal units (NNU) and assess opportunities to avoid admissions.Design: A retrospective population-based study using the National Neonatal Research Database.Setting: England and Wales. Population: Infants born ≥ 34 weeks’ gestation admitted to NNU between 2012 and 2020. Methods: Outcomes in HDP infants are compared to non-HDP infants using regression models. Main outcomes measures: HDP, primary reason for admission, clinical diagnoses and resource use.Results: 16,059/136,220 (11.8%) of late preterm (34+0-36+6 weeks’ gestation) and 14,885/284,646 (5.2%) of term (≥ 37 weeks’ gestation) admitted infants were exposed to maternal HDP. The most common primary reasons for HDP infant admission were respiratory disease (28.3%), prematurity (22.7%) and hypoglycaemia (16.4%). HDP infants were more likely to be admitted with primary hypoglycaemia than non-HDP infants (OR: 2.1, 95% CI 2.0-2.2, p-value < 0.0001). 64.5% of HDP infants received IV dextrose. 35.7% received mechanical or non-invasive ventilation. 8260/30,944 (26.7%) of HDP infants received intervention for hypoglycaemia alone (IV dextrose) with no other major intervention (respiratory support, parenteral nutrition, central line, arterial line or blood transfusion). Conclusions: The burden of maternal HDP on late preterm and term admissions to NNU is high with hypoglycaemia and respiratory disease being the main drivers for admission. Over one in four were admitted solely for management of hypoglycaemia. Further research should determine whether maternal antihypertensive agent choice or postnatal pathways may reduce NNU admission.Funding: Medical Research Council (MR/V006835/1).
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Journal articleRees P, Callan C, Chadda K, et al., 2023,
School-age outcomes of children after perinatal brain injury: a systematic review and meta-analysis
, BMJ Paediatrics Open, Vol: 7, Pages: 1-14, ISSN: 2399-9772Background Over 3000 children suffer a perinatal brain injury in England every year according to national surveillance. The childhood outcomes of infants with perinatal brain injury are however unknown.Methods A systematic review and meta-analyses were undertaken of studies published between 2000 and September 2021 exploring school-aged neurodevelopmental outcomes of children after perinatal brain injury compared with those without perinatal brain injury. The primary outcome was neurodevelopmental impairment, which included cognitive, motor, speech and language, behavioural, hearing or visual impairment after 5 years of age.Results This review included 42 studies. Preterm infants with intraventricular haemorrhage (IVH) grades 3–4 were found to have a threefold greater risk of moderate-to-severe neurodevelopmental impairment at school age OR 3.69 (95% CI 1.7 to 7.98) compared with preterm infants without IVH. Infants with perinatal stroke had an increased incidence of hemiplegia 61% (95% CI 39.2% to 82.9%) and an increased risk of cognitive impairment (difference in full scale IQ −24.2 (95% CI –30.73 to –17.67) . Perinatal stroke was also associated with poorer academic performance; and lower mean receptive −20.88 (95% CI –36.66 to –5.11) and expressive language scores −20.25 (95% CI –34.36 to –6.13) on the Clinical Evaluation of Language Fundamentals (CELF) assessment. Studies reported an increased risk of persisting neurodevelopmental impairment at school age after neonatal meningitis. Cognitive impairment and special educational needs were highlighted after moderate-to-severe hypoxic-ischaemic encephalopathy. However, there were limited comparative studies providing school-aged outcome data across neurodevelopmental domains and few provided adjusted data. Findings were further limited by the heterogeneity of studies.Conclusions Longitudinal population studies exploring childhood outcomes after perinatal b
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