Imperial College London

ProfessorNeenaModi

Faculty of MedicineSchool of Public Health

Vice-Dean (International Activities) Faculty of Medicine
 
 
 
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Contact

 

+44 (0)20 3315 5102n.modi Website

 
 
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Assistant

 

Miss Angela Rochester +44 (0)20 7594 0937

 
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Location

 

G4.2Chelsea and Westminster HospitalChelsea and Westminster Campus

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Summary

 

Publications

Publication Type
Year
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370 results found

Ayres-de-Campos D, Louwen F, Vivilaki V, Benedetto C, Modi N, Wielgos M, Tudose M-EP, Timonen S, Reyns M, Yli B, Stenback P, Nunes I, Yurtsal B, Vayssière C, Roth G-E, Jonsson M, Bakker P, Lopriore E, Verlohren S, Jacobsson Bet al., 2024, European Association of Perinatal Medicine (EAPM), European Board and College of Obstetricians and Gynaecologists (EBCOG), European Midwives Association (EMA). Joint position statement: Substandard and disrespectful care in labour - because words matter., Eur J Obstet Gynecol Reprod Biol, Vol: 296, Pages: 205-207

Substandard or disrespectful care during labour should be of serious concern for healthcare professionals, as it can affect one of the most important events in a woman's life. Substandard care refers to the use of interventions that are not considered best-practice, to the inadequate execution of interventions, to situations where best-practice interventions are withheld from patients, or there is lack of adequate informed consent. Disrespectful care refers to forms of verbal and non-verbal communication that affect patients' dignity, individuality, privacy, intimacy, or personal beliefs. There are many possible underlying causes for substandard and disrespectful care in labour, including difficulties in modifying behaviours, judgmental or paternalistic attitudes, personal interests and individualism, and a human tendency to make less arduous, less difficult, or less stressful clinical decisions. The term "obstetric violence" is used in some parts of the world to describe various forms of substandard and disrespectful care in labour, but suggests that it is mainly carried out by obstetricians and is a serious form of aggression, carried out with the intent to cause harm. We believe that this term should not be used, as it does not help to identify the underlying problem, its causes, or its correction. In addition, it is generally seen by obstetricians and other healthcare professionals as an unjust and offensive term, generating a defensive and less collaborative mindset. We reach out to all individuals and institutions sharing the common goal of improving women's experience during labour, to work together to address the underlying causes of substandard and disrespectful care, and to develop common strategies to deal with this problem, based on mutual comprehension, trust and respect.

Journal article

Modi N, de Castro LR, Chen R, Dar A, Wall Jet al., 2024, The health and wellbeing case for children's suffrage., Lancet Child Adolesc Health, Vol: 8, Pages: 251-252

Journal article

Burgess-Shannon J, Chehrazi M, Lanoue J, Modi N, Uthaya SNet al., 2024, Outcomes following the adoption of standard parenteral nutrition in preterm infants: a whole-population non-concurrent control study., Arch Dis Child Fetal Neonatal Ed

OBJECTIVE: To evaluate the impact of a quality improvement project of the adoption of standard parenteral nutrition (SPN) in preterm infants. DESIGN: Retrospective, multicentre, whole-population, non-concurrent control study using data from the UK National Neonatal Research Database between 1 January 2014 and 31 December 2020. SETTING: Neonatal units in London UK organised by geographical network. PATIENTS: Preterm infants <31 weeks' gestation. INTERVENTIONS: Introduction of two SPN formulations previously tested in randomised controlled trials (NEON and SCAMP). SCAMP delivers a higher target macronutrient intake. MAIN OUTCOME MEASURES: The primary outcome was survival to discharge from neonatal care without major morbidities. Secondary outcomes included the individual components of the primary outcome and a comparison of outcomes between the NEON and the SCAMP formulations. RESULTS: Of 6538 eligible infants, 4693 were admitted to neonatal care before and 1845 after the adoption of SPN. Morbidity-free survival decreased by an average of 8.6% (95% CI 5.8% to 11.4%, p<0.0001) following adoption. The effect varied by type of formulation; the cohort that adopted NEON showed no difference in morbidity-free survival, whereas the cohort that adopted SCAMP showed a statistically significant decrease in morbidity-free survival. Overall survival decreased by an average of 2.0% (95% CI 0.01% to 4.0%, p=0.048). CONCLUSIONS: Research is urgently needed to identify the optimal composition of parenteral nutrition for preterm babies. This study also adds to the growing body of evidence that suggests that early and high intakes of macronutrients in preterm babies may be harmful.

Journal article

Ayres-de-Campos D, Simon A, Modi N, Tudose M, Saliba E, Wielgos M, Reyns M, Athanasiadis A, Stenback P, Verlohren S, Nikolova G, Lopriore E, Yurtsal B, Pellicer A, Ramenghi L, Jacobsson Bet al., 2024, EUROPEAN ASSOCIATION OF PERINATAL MEDICINE (EAPM) EUROPEAN MIDWIVES ASSOCIATION (EMA) Joint position statement: Caesarean delivery rates at a country level should be in the 15-20 % range., Eur J Obstet Gynecol Reprod Biol, Vol: 294, Pages: 76-78

While cesarean deliveries performed for health indications can save lives, unnecessary cesareans cause unjustifiable health risks for the mother, newborn, and for future pregnancies. Previous recommendations for cesarean delivery rates at a country level in the 10-15% range are currently unrealistic, and the proposed concept that striving to achieve specific rates is not important has resulted in a confusing message reaching healthcare professionals and the public. It is important to have a clear understanding of when cesarean delivery rates are deviating from internationally acceptable ranges, to trigger the implementation of healthcare policies needed to correct this problem. Based on currently existing scientific evidence, we recommend that cesarean delivery rates at a country level should be in the 15-20% range. This advice is based on the demonstration of decreased maternal and neonatal mortalities when national cesarean delivery rates rise to circa 15%, but values exceeding 20% are not associated with further benefits. It is also based on real-world experiences from northern European countries, where cesarean delivery rates in the 15-20% range are associated with some of the best maternal and perinatal quality indicators in the world. With the increase in cesarean delivery rates projected for the coming years, experience in provision of intrapartum care may come under threat in many hospitals, and recovering from this situation is likely to be a major challenge. Professional and scientific societies, together with healthcare authorities and governments need to prioritize actions to reverse the upward trend in cesarean delivery rates observed in many countries, and to strive to achieve values as close as possible to the recommended range.

Journal article

Chehrazi M, Uthaya S, Modi N, 2024, Response to the Letter to the Editor by Dr. Keith Barrington., Early Hum Dev, Vol: 190

Journal article

van Blankenstein E, Sodiwala T, Lanoue J, Modi N, Uthaya S, Battersby Cet al., 2024, Two-year neurodevelopmental data for preterm infants born over an 11-year period in England and Wales, 2008–2018: a retrospective study using the National Neonatal Research Database, Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol: 109, Pages: 143-150, ISSN: 1359-2998

Objective United Kingdom guidelines recommend all infants born <30 weeks’ gestation receive neurodevelopmental follow-up at 2 years corrected age. In this study, we describe completeness and results of 2-year neurodevelopmental records in the National Neonatal Research Database (NNRD).Design This retrospective cohort study uses data from the NNRD, which holds data on all neonatal admissions in England and Wales, including 2year follow-up status.Patients We included all preterm infants born <30 weeks’ gestation between 1 January 2008 and 31 December 2018 in England and Wales, who survived to discharge from neonatal care.Main outcome measures Presence of a 2-year neurodevelopmental assessment record in the NNRD, use of standardised assessment tools, results of functional 2-year neurodevelopmental assessments (visual, auditory, neuromotor, communication, overall development).Results Of the 41 505 infants included, 24 125 (58%) had a 2-year neurodevelopmental assessment recorded. This improved over time, from 32% to 71% for births in 2008 and 2018, respectively.Of those with available data: 0.4% were blind; 1% had a hearing impairment not correctable with aids; 13% had <5 meaningful words, vocalisations or signs; 8% could not walk without assistance and 9% had severe (≥12 months) developmental delay.Conclusions The proportion of infants admitted to neonatal units in England and Wales with a 2-year neurodevelopmental record has improved over time. Rates of follow-up data from recent years are comparable to those of bespoke observational studies. With continual improvement in data completeness, the potential for use of NNRD as a source of longer-term outcome data can be realised.

Journal article

Amati F, McCann L, Castañeda-Gutiérrez E, Prior E, van Loo-Bouwman CA, Abrahamse-Berkeveld M, Oliveros E, Ozanne S, Symonds ME, Chang C-Y, Modi Net al., 2024, Infant fat mass and later child and adolescent health outcomes: a systematic review., Arch Dis Child, Vol: 109, Pages: 125-129

OBJECTIVE: Obesity and excess adiposity are leading causes of metabolic and cardiovascular morbidity and mortality. Early identification of individuals at risk is key for preventive strategies. We examined the relationship between infant body composition (0-2 years of age) and later (>2 years) health outcomes using a systematic review. DESIGN: We preregistered the study on PROSPERO (ID 288013) and searched Embase, PubMed and Cochrane databases for English language publications using the Medical Subject Headings (MeSH) terms 'infant' and 'body composition' and 'risk' between January 1946 and February 2022. We included studies which assessed infant body composition using predetermined in vivo methods other than body mass index (BMI). RESULTS: We identified 6015 articles. After abstract screening to assess eligibility, we reviewed 130 full text publications. 30 were included in the final assessment and narrative synthesis. Meta-analysis was not possible due to heterogeneity of results. All 30 studies were of high quality and reported associations between infant body composition and 19 different health outcomes after 2 years of age. Outcome measurements ranged from 2 years to 16 years. The strongest associations were found between infant fat mass and later fat mass (7 studies), and later BMI (5 studies). For 11 of the outcomes assessed, there was no relationship to infant adiposity detected. CONCLUSIONS: Current evidence, from a small number of studies, suggests a positive association between infant adiposity and future adiposity or BMI, but the validity of infant body composition as a biomarker of future health remains inconclusive. Carefully designed, standardised studies are required to identify the value of infant body composition for predicting later health. TRIAL REGISTRATION: PROSPERO: 288013.

Journal article

Ochoa-Moreno I, Taheem R, Woods-Townsend K, Chase D, Godfrey KM, Modi N, Hanson Met al., 2024, Projected health and economic effects of the increase in childhood obesity during the COVID-19 pandemic in England: the potential cost of inaction, PLoS One, Vol: 19, ISSN: 1932-6203

BACKGROUND: The prevalence of overweight and obesity in young children rose sharply during the COVID-19 pandemic. Here we estimate the potential future health and economic effects of these trends in England. METHODS: Using publicly available annual Body Mass Index (BMI) data from 2006-2022, we calculated the increase in overweight/obesity prevalence (BMI ≥85th reference percentile) during the COVID-19 pandemic among children aged 4-5 and 10-11, and variation by deprivation and ethnicity. We projected the impact of child BMI trends on adult health measures to estimate added lifelong medical and social costs. RESULTS: During 2020-2021 there were steep increases in overweight and obesity prevalence in children. By 2022, overweight and obesity prevalence in children aged 4-5 returned to expected levels based on pre-pandemic trends. However, overweight and obesity prevalence in children aged 10-11 persisted and was 4 percentage points (p<0.001) higher than expected, representing almost 56,000 additional children. The increase was twice as high in the most compared with the least deprived areas. The additional lifelong healthcare cost in this cohort will amount to £800 million with a cost to society of £8.7 billion. We did not find an increase in maternal obesity associated with the COVID-19 pandemic, however, prevalence grew faster in the post pandemic period. DISCUSSION: The return of overweight and obesity prevalence to pre-pandemic trends in children aged 4-5 provides a clear policy target for effective intervention to tackle this growing and serious population health concern.

Journal article

Mills L, Chappell KE, Emsley R, Alavi A, Andrzejewska I, Santhakumaran S, Nicholl R, Chang J, Uthaya S, Modi Net al., 2024, Preterm Formula, Fortified or Unfortified Human Milk for Very Preterm Infants, the PREMFOOD Study: A Parallel Randomised Feasibility Trial., Neonatology, Vol: 121, Pages: 222-232

OBJECTIVE: Uncertainty exists regarding optimal supplemental diet for very preterm infants if the mother's own milk (MM) is insufficient. We evaluated feasibility for a randomised controlled trial (RCT) powered to detect important differences in health outcomes. METHODS: In this open, parallel, feasibility trial, we randomised infants 25+0-31+6 weeks of gestation by opt-out consent to one of three diets: unfortified human milk (UHM) (unfortified MM and/or unfortified pasteurised human donor milk (DM) supplement), fortified human milk (FHM) (fortified MM and/or fortified DM supplement), and unfortified MM and/or preterm formula (PTF) supplement from birth to 35+0 weeks post menstrual age. Feasibility outcomes included opt-outs, adherence rates, and slow growth safety criteria. We also obtained anthropometry, and magnetic resonance imaging body composition data at term and term plus 6 weeks (opt-in consent). RESULTS: Of 35 infants randomised to UHM, 34 to FHM, and 34 to PTF groups, 21, 19, and 24 infants completed imaging at term, respectively. Study entry opt-out rate was 38%; 6% of parents subsequently withdrew from feeding intervention. Two infants met predefined slow weight gain thresholds. There were no significant between-group differences in term total adipose tissue volume (mean [SD]: UHM: 0.870 L [0.35 L]; FHM: 0.889 L [0.31 L]; PTF: 0.809 L [0.25 L], p = 0.66), nor in any other body composition measure or anthropometry at either timepoint. CONCLUSIONS: Randomisation to UHM, FHM, and PTF diets by opt-out consent was acceptable to parents and clinical teams, associated with safe growth profiles and no significant differences in body composition. Our data provide justification to proceed to a larger RCT.

Journal article

Saugstad OD, Modi N, Moretti C, Obladen M, Vento M, Speer CPet al., 2024, Newborns and Children in War and Terror., Neonatology, Vol: 121, Pages: 137-140

Journal article

Chehrazi M, Lanoue J, Ougham K, Moss B, Uthaya S, Modi Net al., 2023, Outcomes in very preterm infants receiving an exclusive human milk diet, or their own mother's milk supplemented with preterm formula, Early Human Development, Vol: 187, ISSN: 0378-3782

Background: An infant's Own Mother's Milk (OMM) is the mainstay of very preterm nutrition. When a supplement is required, preterm formula and pasteurised human donor milk (pHDM), are options. Which is optimal is unknown. Aims and outcome measures: Comparison of “survival to 34 weeks postmenstrual age (PMA) without surgery for necrotising enterocolitis (NEC)” and other outcomes, in infants receiving OMM supplemented with pHDM without bovine macronutrient fortification (exclusive human milk diet), and infants receiving OMM supplemented with preterm formula. Design: Cohort analysis of observational data from the National Neonatal Research Database; data-adaptive Super Learner approach with Targeted Maximum Likelihood Estimation to calculate Adjusted Risk Differences (ARD) between the groups. Participants: Infants born below 32 weeks gestation admitted to neonatal units in England and Wales between 01 and 06-2017 and 31-05-2022. Results: Compared to the formula supplemented group (n = 7133), infants receiving an exclusive human milk diet (n = 1007), had lower survival to 34 weeks PMA without NEC surgery (ARD -9.8 %, 95%CI -11.4 to −8.2), higher all-cause (10.7 %, 9.1 to 12.2) and NEC-related mortality (1.0 %, 0.4 to 1.5), and lower rates of treated retinopathy of prematurity (−2.8 %, −3.4 to −2.3) and bronchopulmonary dysplasia (−12.1 %, −14.0 to −10.1). Conclusions: The lower survival to 34 weeks PMA without NEC surgery in infants receiving an exclusive human milk diet is unexpected. We adjusted for factors that influence outcomes but cannot exclude the possibility of confounding, hence our data justify a randomised controlled trial to identify optimal supplementary feeds for very preterm infants.

Journal article

Ramanan AV, Modi N, de Wildt SN, c4c Learning from COVID-19 Groupet al., 2023, Correction: Improving clinical paediatric research and learning from COVID-19: recommendations by the Conect4Children expert advice group., Pediatr Res, Vol: 94

Journal article

Daskalakis G, Pergialiotis V, Domellöf M, Ehrhardt H, Di Renzo GC, Koç E, Malamitsi-Puchner A, Kacerovsky M, Modi N, Shennan A, Ayres-de-Campos D, Gliozheni E, Rull K, Braun T, Beke A, Kosińska-Kaczyńska K, Areia AL, Vladareanu S, Sršen TP, Schmitz T, Jacobsson Bet al., 2023, European guidelines on perinatal care: corticosteroids for women at risk of preterm birth., J Matern Fetal Neonatal Med, Vol: 36

of recommendationsCorticosteroids should be administered to women at a gestational age between 24+0 and 33+6 weeks, when preterm birth is anticipated in the next seven days, as these have been consistently shown to reduce neonatal mortality and morbidity. (Strong-quality evidence; strong recommendation). In selected cases, extension of this period up to 34+6 weeks may be considered (Expert opinion). Optimal benefits are found in infants delivered within 7 days of corticosteroid administration. Even a single-dose administration should be given to women with imminent preterm birth, as this is likely to improve neurodevelopmental outcome (Moderate-quality evidence; conditional recommendation).Either betamethasone (12 mg administered intramuscularly twice, 24-hours apart) or dexamethasone (6 mg administered intramuscularly in four doses, 12-hours apart, or 12 mg administered intramuscularly twice, 24-hours apart), may be used (Moderate-quality evidence; Strong recommendation). Administration of two "all" doses is named a "course of corticosteroids".Administration between 22+0 and 23+6 weeks should be considered when preterm birth is anticipated in the next seven days and active newborn life-support is indicated, taking into account parental wishes. Clear survival benefit has been observed in these cases, but the impact on short-term neurological and respiratory function, as well as long-term neurodevelopmental outcome is still unclear (Low/moderate-quality evidence; Weak recommendation).Administration between 34 + 0 and 34 + 6 weeks should only be offered to a few selected cases (Expert opinion). Administration between 35+0 and 36+6 weeks should be restricted to prospective randomized trials. Current evidence suggests that although corticosteroids reduce the incidence of transient tachypnea of the newborn, they do not affect the incidence of respiratory distres

Journal article

Malamitsi-Puchner A, Addati L, Eydal GB, Briana DDD, Bustreo F, Di Renzo GC, O'Brien M, Hanson M, Modi Net al., 2023, Paid leave to support parenting-A neglected tool to improve societal well-being and prosperity, ACTA PAEDIATRICA, Vol: 112, Pages: 2045-2049, ISSN: 0803-5253

Journal article

Yuan J-M, Nugent C, Wilson A, Verlander NQ, Alexander E, Fleming P, Modi N, Oughham K, Ratnaraja N, Wan Y, Thorn L, Felgate H, Webber MA, Ogundipe E, Brown CS, Paranthaman K, Demirjian Aet al., 2023, Clinical outcomes of <i>Staphylococcus capitis</i> isolation from neonates, England, 2015-2021: a retrospective case-control study, ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, ISSN: 1359-2998

Journal article

Harnden F, Lanoue J, Modi N, Uthaya S, Battersby Cet al., 2023, A data-driven approach to understanding neonatal palliative care needs in England and Wales: a population based study 2015-2020, Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol: 108, Pages: 540-544, ISSN: 1359-2998

ObjectiveTo quantify admissions to neonatal units in England and Wales with potential need for palliative care. Design, setting, and patientsDiagnoses and clinical attributes indicating a high likelihood of requiring palliative care were mapped to categories within the British Association of Perinatal Medicine’s (BAPM) framework on palliative care. We extracted data from the National Neonatal Research Database on all babies born and admitted to neonatal units in England and Wales 2015-2020.OutcomesThe number and proportion of babies meeting BAPM categories, their discharge outcomes, and the characteristics of babies who died during neonatal care but did not fulfil any BAPM category.Results12,123/574,954 (2.1%) babies met one or more BAPM category: 6,239/12,123 (51%) conformed to BAPM category 4 (postnatal conditions with high risk of severe impairment), 3,796 (31%) to category 2 (antenatal/postnatal diagnosis with high risk of significant morbidity or death), 1,399 (12%) to category 3 (born at margin of viability), and 288 (2%) to category 1 (antenatal/postnatal diagnosis not compatible with long-term survival); 401 babies (3%) met criteria for multiple categories. 6,814/12,123 (56%) were discharged home, 2,385 (20%) were discharged to other settings and 2,914 (24%) died before neonatal discharge. 3,000/5,914 (51%) babies who died during neonatal care did not conform to any BAPM category. Of these, 2,630/3,000 (88%) were born preterm.ConclusionsAt least 2% of babies admitted to neonatal units had palliative care needs according to existing BAPM categories; most survived to discharge. Of deaths, 51% were not captured by the BAPM categories; most were extremely preterm.

Journal article

Modi N, 2023, Protecting patients against clinician bias, ARCHIVES OF DISEASE IN CHILDHOOD, ISSN: 0003-9888

Journal article

Grantham-Hill S, Eyre M, Ramanan AV, Modi N, de Wildt SN, Lim Met al., 2023, Global Association of the COVID-19 Pandemic With Pediatric Clinical Trial Publication, JAMA NETWORK OPEN, Vol: 6, ISSN: 2574-3805

Journal article

Modi N, Ribas R, Johnson S, Lek E, Godambe S, Fukari-Irvine E, Ogundipe E, Tusor N, Das N, Udayakumaran A, Moss B, Banda V, Ougham K, Cornelius V, Arasu A, Wardle S, Battersby C, Bravery Aet 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: 2632-1009

Background 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.

Journal article

Sakonidou S, Kotzamanis S, Tallett A, Poots AJ, Modi N, Bell D, Gale Cet 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: 1359-2998

Objective 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.

Journal article

Klerk DHH, van Varsseveld OCC, Offringa M, Modi N, Lacher M, Zani A, Pakarinen MPP, Koivusalo A, Jester I, Spruce M, Derikx JPM, Bakx R, Ksia A, Vermeulen MJJ, Kooi EMW, Hulscher JBFet al., 2023, Development of an international core outcome set for treatment trials in necrotizing enterocolitis-a study protocol, TRIALS, Vol: 24

Journal article

Webbe J, Allin B, Knight M, Modi N, Gale Cet al., 2023, How to reach agreement: the impact of different analytical approaches to Delphi process results in core outcomes set development, Trials, Vol: 24, ISSN: 1745-6215

Background: Core outcomes sets are increasingly used to define research outcomes that are most important for a condition. Different consensus methods are used in the development of core outcomes sets; the most common is the Delphi process. Delphi methodology is increasingly standardised for core outcomes set development, butuncertainties remain. We aimed to empirically test how the use of different summary statistics and consensus criteria impact Delphi process results.Methods: Results from two unrelated child health Delphi processes were analysed. Outcomes were ranked by mean, median, or rate of exceedance, and then pairwisecomparisons were undertaken to analyse whether the rankings were similar. The correlation coefficient for each comparison was calculated, and Bland-Altman plotsproduced. Youden’s index was used to assess how well the outcomes ranked highest by each summary statistic matched the final core outcomes sets. Consensus criteria identified in a review of published Delphi processes were applied to the results of the two child-health Delphi processes. The size of the consensus setsproduced by different criteria was compared, and Youden’s index was used to assess how well the outcomes that met different criteria matched the final core outcomes sets.Results: Pairwise comparisons of different summary statistics produced similar correlation coefficients. Bland-Altman plots showed that comparisons involving ranked medians had wider variation in the ranking. No difference in Youden’s index for the summary statistics was found.Different consensus criteria produced widely different sets of consensus outcomes (Range: 5-44 included outcomes). They also showed differing abilities to identify core outcomes (Youden’s index Range: 0.32-0.92). The choice of consensus criteria had a large impact on Delphi results.Discussion: The use of different summary statistics is unlikely to affect how outcomes are ranked during a Delphi process: mean, media

Journal article

Yuill C, Harkness M, Wallace C, Cheyne H, Black M, Modi N, Pasupathy D, Sanders J, Stock SJ, McCourt Cet al., 2023, Clinicians' perspectives and experiences of providing cervical ripening at home or in-hospital in the United Kingdom, PLOS ONE, Vol: 18, ISSN: 1932-6203

Journal article

Yang M, Campbell H, Pillay T, Boyle EM, Modi N, Rivero-Arias Oet al., 2023, Neonatal health care costs of very preterm babies in England: a retrospective analysis of a national birth cohort, BMJ PAEDIATRICS OPEN, Vol: 7

Journal article

Moss B, Lammons W, Geiger I, Koestenzer J, Mader S, Coutinho E, Kamphuis J, Soiron S, Bergmuller E, Modi Net al., 2023, A pressing need for research to reduce nutritional uncertainties in preterm infant care: Findings from a European roundtable discussion with parent representatives, EARLY HUMAN DEVELOPMENT, Vol: 179, ISSN: 0378-3782

Journal article

Meka K, Jacob CM, Modi N, Bustreo F, Di Renzo GC, Malamitsi-Puchner A, Briana D, Iaia DG, Fogstad H, Tamvada JP, Moreno IO, Hanson Met al., 2023, Valuing maternal, newborn, child and adolescent health for societal progress - Going beyond the economic orthodoxy of gross domestic product, ACTA PAEDIATRICA, Vol: 112, Pages: 630-634, ISSN: 0803-5253

Journal article

Embleton ND, Sproat T, Uthaya S, Young GR, Garg S, Vasu V, Masi AC, Beck L, Modi N, Stewart CJ, Berrington JEet al., 2023, Effect of an Exclusive Human Milk Diet on the Gut Microbiome in Preterm Infants A Randomized Clinical Trial, JAMA NETWORK OPEN, Vol: 6, ISSN: 2574-3805

Journal article

Lammons W, Moss R, Bignell C, Gale C, MacBride A, Battersby C, Modi Net al., 2023, Involving multiple stakeholders in assessing and reviewing a novel data visualization tool for a national neonatal data asset, BMJ Health & Care Informatics, Vol: 30, Pages: 1-7, ISSN: 2632-1009

Objectives We involved public and professional stakeholders to assess a novel data interrogation tool, the Neonatal Health Intelligence Tool, for a National Data Asset, the National Neonatal Research Database.Methods We recruited parents, preterm adults, data managers, clinicians, network managers and researchers (trialists and epidemiologists) for consultations demonstrating a prototype tool and semi-structured discussion. A thematic analysis of consultations is reported by stakeholder group.Results We held nine on-line consultations (March–December 2021), with 24 stakeholders: parents (n=8), preterm adults (n=2), data managers (n=3), clinicians (n=3), network managers (n=2), triallists (n=3) and epidemiologists (n=3). We identified four themes from parents/preterm adults: struggling to consume information, Dads and data, bring data to life and yearning for predictions; five themes from data managers/clinicians/network managers: benchmarking, clinical outcomes, transfers and activity, the impact of socioeconomic background and ethnicity, and timeliness of updates and widening availability; and one theme from researchers: interrogating the data.Discussion Other patient and public involvement (PPI) studies have reported that data tools generate concerns; our stakeholders had none. They were unanimously supportive and enthusiastic, citing visualisation as the tool’s greatest strength. Stakeholders had no criticisms; instead, they recognised the tool’s potential and wanted more features. Parents saw the tool as an opportunity to inform themselves without burdening clinicians, while clinicians welcomed an aid to explaining potential outcomes to parents.Conclusion All stakeholder groups recognised the need for the tool, praising its content and format. PPI consultations with all key groups, and their synthesis, illustrated desire for additional uses from it.

Journal article

Shah PS, Isayama T, Helenius KK, Feliciano LS, Beltempo M, Bassler D, Håkansson S, Rusconi F, Modi N, Battin M, Vento M, Adams M, Lehtonen L, Norman M, Kusuda S, Reichman B, Lui K, Lee SKet al., 2022, International network for evaluating outcomes of neonates: outputs and future directions, Pediatric Medicine, Vol: 5

Ten neonatal networks from 11 countries—Australia, New Zealand, Canada, Finland, Israel, Japan, Spain, Sweden, Switzerland, the Tuscany region of Italy, and the UK—came together in 2012 to form the International Network for Evaluating Outcomes of Neonates (iNeo): an international collaboration of population-representative, national neonatal datasets. The result has been a powerful platform for epidemiological, outcomes-based, and applied health services and policy research. The network has successfully collaborated to evaluate variations in health service organization, practices, and outcomes, with an aim to harmonize processes and identify areas for quality improvement in the various countries. We have identified marked variations in outcomes such as mortality, severe neurological injury, and treated retinopathy of prematurity; and highlighted the important need for the neonatal community to harmonize criteria for diagnosing bronchopulmonary dysplasia. Despite marked changes in the respiratory management of extremely preterm neonates with the aim to avoid mechanical ventilation, judicious use of oxygen, and less invasive administration of surfactant, rates of bronchopulmonary dysplasia have continued to rise in most countries. This may be due to marked discrepancies in the diagnostic criteria for bronchopulmonary dysplasia in extremely preterm neonates. We were able to conduct a detailed survey of more than 300 neonatal units worldwide and link the responses with actual patient data to generate hypotheses to evaluate in future studies. Specific areas of investigation have included preventing necrotizing enterocolitis, managing patent ductus arteriosus, and managing neonates with critical events such as severe intraventricular hemorrhage. In addition, we studied the physical design of neonatal units from family-centered care delivery point of view and multidisciplinary team inclusion in care of neonates. In this review, we summarize our opportunities for

Journal article

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