Publications
370 results found
Hunter L, Sparrow E, Modi N, et al., 2017, Advancing child health research in the UK: the Royal College of Paediatrics and Child Health Infants' Children's and Young People's Research Charter, Archives of Disease in Childhood, Vol: 102, Pages: 299-300, ISSN: 1468-2044
Darlow BA, Lui K, Kusuda S, et 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
Ougham K, Modi N, 2017, The NDAU report 2016, The NDAU report 2016, London, UK, Publisher: The Neonatal Data Analysis Unit, Imperial College London, 5
Modi N, McColgan M, Winch R, et al., 2017, Comparison of UK paediatric consultants’ participation in child health research between 2011 and 2015, Archives of Disease in Childhood. Fetal and Neonatal Edition, Vol: 102, Pages: 702-706, ISSN: 1359-2998
Objective To identify whether there have been changes over time in the capacity of paediatric consultants to undertake research and if the activity differs between men and women.Design Comparison of data from two surveys of UK paediatric consultants.Subjects UK consultant members of the Royal College of Paediatrics and Child Health.Interventions Surveys carried out in 2011 and 2015.Main outcome measures The proportion of consultants with allocated time in job plans for research, academic appointments, postgraduate qualifications, publications, grant funding and supervision of PhD students.Results The 2015 survey demonstrated 20% of consultants had one or more programmed activities (PAs) for research, but the average paid PA for research was 0.39 PA. Between the surveys, the proportion of consultants with honorary contracts had declined, and the proportion with a PhD or MDRes was 32% in 2011 compared with 26% in 2015 (p<0.001). In 2015, only 12% of consultants had at least one current grant. In 2011 and 2015, 51% and 54% respectively of consultants had not authored a publication in the preceding 2 years. In 2015, 92% of consultants were not currently supervising a PhD student, and 88% had never supervised a PhD student. In 2015, 25% of men and 12% of women had PAs for research (p<0.001). Women were less likely to hold an honorary or primary academic contract, have authored a publication or supervised a PhD student (all p<0.001).Conclusions Research activity among paediatric consultants remains low, particularly among women.
Hanson M, Mullins E, Modi N, 2017, Time for the UK to commit to tackling child obesity, BMJ, Vol: 356, ISSN: 1756-1833
The UK government published its report Childhood Obesity: a Plan for Action, after a protracted delay, on 18 August 2016, when parliament was in recess and the nation was focused on the success of Team GB at the Rio Olympics.1 The plan received very little media coverage or public response. There was, however, an immediate outcry from the medical and public health communities, who had hoped for much more.23456 The draft version had been 50 pages in length, but the published plan ran to just 10 pages; strong actions were conspicuous by their absence, and the desired discussion of anti-obesogenic medicine had been watered down to an emphasis on voluntary actions by industry, consumers, and schools.One of the most important omissions was reference to the recommendations of the World Health Organization Commission on Ending Childhood Obesity (ECHO).7 The final ECHO report, published in January 2016, was the culmination of about 18 months of evidence review and wide consultation. It was presented at the World Health Assembly in May 2016,8 where a decision was made to request the director general to develop an implementation plan to guide further action on the recommendations, in consultation with member states. The implementation report is now available.
Hines D, Modi N, Lee SK, et 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
Achana F, Petrou S, Khan K, et 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.
Hopkinson NS, Dacre J, Regan L, et al., 2017, The need for a new Tobacco Control Plan: an issue of justice, British Medical Journal, Vol: 356, ISSN: 1468-5833
Battersby CWS, Longford N, Costeloe K, et 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 Necrotizing enterocolitis (NEC) is a major cause of neonatal morbidity and mortality. Preventive and therapeutic research, surveillance, and quality improvement initiatives are hindered by variations in case definitions.Objective To develop a gestational age (GA)–specific case definition for NEC.Design, Setting, and Participants We conducted a prospective 34-month population study using clinician-recorded findings from the UK National Neonatal Research Database between December 2011 and September 2014 across all 163 neonatal units in England. We split study data into model development and validation data sets and categorized GA into groups (group 1, less than 26 weeks’ GA; group 2, 26 to less than 30 weeks’ GA; group 3, 30 to less than 37 weeks’ GA; group 4, 37 or more weeks’ GA). We entered GA, birth weight z score, and clinical and abdominal radiography findings as candidate variables in a logistic regression model, performed model fitting 1000 times, averaged the predictions, and used estimates from the fitted model to develop an ordinal NEC score and cut points to develop a dichotomous case definition based on the highest area under the receiver operating characteristic curves [AUCs] and positive predictive values [PPVs].Exposures Abdominal radiography performed to investigate clinical concerns.Main Outcomes and Measures Ordinal NEC likelihood score, dichotomous case definition, and GA-specific probability plots.Results Of the 3866 infants, the mean (SD) birth weight was 2049.1 (1941.7) g and mean (SD) GA was 32 (5) weeks; 2032 of 3663 (55.5%) were male. The total included 2978 infants (77.0%) without NEC and 888 (23.0%) with NEC. Infants with NEC in group 1 were less likely to present with pneumatosis (31.1% vs 47.2%; P = .01), blood in stool (11.8% vs 29.6%; P < .001), or mucus in stool (2.1% vs 5.6%; P = .048) but more likely to present with gasless abdominal radiograp
Modi N, 2017, Implementing Best Practice in Preterm Enteral Care, Publisher: KARGER, Pages: 309-310, ISSN: 1661-7800
Uthaya S, Liu X, Modi N, 2016, Nutritional Evaluation and Optimisation in Neonates trial: is the protein-to-energy ratio important? Reply, AMERICAN JOURNAL OF CLINICAL NUTRITION, Vol: 104, Pages: 1721-1722, ISSN: 0002-9165
Battersby CWS, Longford N, Mandalia S, et 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·
Battersby C, Longford N, Costeloe K, et 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
McColgan M, Winch R, Clark SJ, et al., 2016, The changing UK paediatric consultant workforce: report from the Royal College of Paediatrics and Child Health, Archives of Disease in Childhood. Fetal and Neonatal Edition, Vol: 102, Pages: 170-173, ISSN: 1359-2998
Objectives To determine if there had been changes in the size of the UK paediatric workforce and working patterns between 1999 and 2013.Design Analysis of prospectively collected datasets.Setting UK consultant paediatricians.Interventions Data from the Royal College of Paediatrics and Child Health's workforce census from 1999 to 2013 and the annual surveys of new paediatric Certificate of Completion of Training (CCT) and Certificate of Equivalence of Specialist Registration (CESR) holders between 2010 and 2013.Main outcome measures Paediatric consultant numbers, programmed activities (PAs) and resident shift working.Results The UK paediatric consultant workforce grew from 1933 in 1999 to 3718 in 2013. Over the same time period, there was a decline in the number of consultants with a primary academic contract from 210 to 143. There was an increase in the proportion of consultants who were female (40% in 1999 to 50% in 2013, p<0.01). The median number of PAs declined from 11 in 2009 to 10 in 2013 (p<0.001) as did the median number of PAs for supporting professional activities (2.5–2.3, p<0.001). In 2013, 38% of new consultants in general paediatrics or neonatology were working resident shifts. Between 2009 and 2013, the proportion of less than full-time working consultants rose from 18% to 22%, which was more common among female consultants (35% vs 9%).Conclusion The paediatric consultant workforce has doubled since 1999, but more are working less than full time. The decline in those with a primary academic contract is of concern.
Seaton SE, Barker L, Draper ES, et 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.
Kirupakaran K, Mahoney L, Patel B, et al., 2016, A 24 hour study on the stability of dopamine and dobutamine under laboratory simulated neonatal ward conditions, EAPS Congress 2016, Publisher: Springer Verlag (Germany), Pages: 1566-1567, ISSN: 1432-1076
Modi N, 2016, Junior doctors' dispute leaves big questions about state of NHS, BMJ, Vol: 355, ISSN: 0959-8138
Gale CRK, Hyde MJH, Modi N, 2016, Research Ethics Committee decision-making in relation to an efficient neonatal trial, Archives of Disease in Childhood-Fetal and Neonatal Edition, Vol: 102, Pages: F291-F298, ISSN: 1468-2052
ObjectiveRandomised controlled trials, a gold-standard approach to reduce uncertainties in clinical practice, are growing in cost and are often slow to recruit. We determined the acceptability to United Kingdom (UK) Research Ethics Committees (REC) of approaches to facilitate large, efficient clinical trials. DesignWe developed a protocol in collaboration with parents, for a comparative-effectiveness, randomised controlled trial comparing two widely used blood transfusion practices in preterm infants. We incorporated four approaches to improve recruitment and efficiency: i) point-of-care design using Electronic Patient Records for patient identification, randomisation and data acquisition, ii) short two-page information sheet; iii) explicit mention of possible inclusion benefit; iv) opt-out consent with enrollment as the default. With the support of the UK Health Research Authority, we submitted an identical protocol to 12 UK REC. SettingResearch Ethics Committees in the UKMain outcomeNumber of REC granting favourable opinions.ResultsThe use of Electronic Patient Records was acceptable to all REC; one REC raised concerns about the short parent information sheet, 10 about inclusion benefit and 9 about opt-out consent. Following responses to queries 9 REC granted a favourable final opinion; 3 rejected the application because they considered the opt-out consent process invalid. ConclusionsA majority of REC in this study consider the use of Electronic Patient Record data, short information sheets, opt-out consent and mention of possible inclusion benefit to be acceptable in neonatal comparative-effectiveness research. We identified a need for guidance for REC in relation to opt-out consent processes. These methods provide opportunity to facilitate large randomised controlled trials.
Fitchett EJA, Seale AC, Vergnano S, et al., 2016, Strengthening the Reporting of Observational Studies in Epidemiology for Newborn Infection (STROBE-NI): an extension of the STROBE statement for neonatal infection research, Lancet Infectious Diseases, Vol: 16, Pages: E202-E213, ISSN: 1473-3099
Neonatal infections are estimated to account for a quarter of the 2·8 million annual neonatal deaths, as well as approximately 3% of all disability-adjusted life-years. Despite this burden, few data are available on incidence, aetiology, and outcomes, particularly regarding impairment. We aimed to develop guidelines for improved scientific reporting of observational neonatal infection studies, to increase comparability and to strengthen research in this area. This checklist, Strengthening the Reporting of Observational Studies in Epidemiology for Newborn Infection (STROBE- NI), is an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. STROBE-NI was developed following systematic reviews of published literature (1996–2015), compilation of more than 130 potential reporting recommendations, and circulation of a survey to relevant professionals worldwide, eliciting responses from 147 professionals from 37 countries. An international consensus meeting of 18 participants (with expertise in infectious diseases, neonatology, microbiology, epidemiology, and statistics) identified priority recommendations for reporting, additional to the STROBE statement. Implementation of these STROBE-NI recommendations, and linked checklist, aims to improve scientific reporting of neonatal infection studies, increasing data utility and allowing meta-analyses and pathogen-specific burden estimates to inform global policy and new interventions, including maternal vaccines.
Gemmell L, Martin L, Murphy KE, et al., 2016, Hypertensive disorders of pregnancy and outcomes of preterm infants of 24 to 28 weeks' gestation., Journal of Perinatology, ISSN: 1476-5543
OBJECTIVE: To examine the relationship between hypertensive disorders of pregnancy (HDPs) and mortality and major morbidities in preterm neonates born at 24 to 28 weeks of gestation. STUDY DESIGN: Using an international cohort, we retrospectively studied 27 846 preterm neonates born at 24(0) to 28(6) weeks of gestation during 2007 to 2010 from 6 national neonatal databases. The incidence of HDP was compared across countries, and multivariable logistic regression analyses were conducted to examine the association of HDP and neonatal outcomes including mortality to discharge, bronchopulmonary dysplasia, severe brain injury, necrotizing enterocolitis and treated retinopathy of prematurity. RESULTS: The incidence of HDP in the entire cohort was 13% (range 11 to 16% across countries). HDP was associated with reduced odds of mortality (adjusted odds ratio (aOR) 0.77; 95% confidence interval (CI) 0.67 to 0.88), severe brain injury (aOR 0.74; 95% CI 0.62 to 0.89) and treated retinopathy (aOR 0.82; 95% CI 0.70 to 0.96), but increased odds of bronchopulmonary dysplasia (aOR 1.16; 95% CI 1.05 to 1.27). CONCLUSIONS: In comparison with neonates born to mothers without HDP, neonates of HDP mothers had lower odds of mortality, severe brain injury and treated retinopathy, but higher odds of bronchopulmonary dysplasia. The impact of maternal HDP on newborn outcomes was inconsistent across outcomes and among countries; therefore, further international collaboration to standardize terminology, case definition and data capture is warranted.Journal of Perinatology advance online publication, 1 September 2016; doi:10.1038/jp.2016.133.
Jackson FL, Georgakopoulou N, Kaluarachchi M, et al., 2016, Development of a pipeline for exploratory metabolic profiling of infant urine, Journal of Proteome Research, Vol: 15, Pages: 3432-3440, ISSN: 1535-3907
Numerous metabolic profiling pipelines have been developed to characterize the composition ofhuman biofluids and tissues, the vast majority of these being for studies in adults. To accommodatelimited sample volume and to take into account the compositional differences between adult andinfant biofluids, we developed and optimized sample handling and analytical procedures for studyingurine from newborns. A robust pipeline for metabolic profiling using NMR spectroscopy wasestablished, encompassing sample collection, preparation, spectroscopic measurement andcomputational analysis. Longitudinal samples were collected from five infants from birth until 14months of age. Methods of extraction, effects of freezing and sample dilution were assessed andurinary contaminants from breakdown of polymers in a range of diapers and cotton wool balls wereidentified and compared, including propylene glycol, acrylic acid and tert-butanol. Finally,assessment of urinary profiles obtained over the first few weeks of life revealed a dramatic change in composition, with concentrations of phenols, amino acids and betaine altering systematically overthe first few months of life. Therefore, neonatal samples require more stringent standardization ofexperimental design, sample handling and analysis compared to adult samples in order toaccommodate the variability and limited sample volume.
Wong HS, Santhakumaran S, Cowan FM, et al., 2016, Developmental Assessments in Preterm Children: A Meta-Analysis, Pediatrics, Vol: 138, ISSN: 0031-4005
CONTEXT: Developmental outcomes of very preterm (gestational age ≤32 weeks) or very low birth weight (<1500 g) children are commonly reported before age 3 years although the predictive validity for later outcomes are uncertain.OBJECTIVE: To determine the validity of early developmental assessments in predicting school-age cognitive deficits.DATA SOURCES: PubMed.STUDY SELECTION: English-language studies reporting at least 2 serial developmental/cognitive assessments on the same population, 1 between ages 1 and 3 years and 1 at ≥5 years.DATA EXTRACTION: For each study, we calculated the sensitivity, specificity, and positive and negative predictive values of early assessment for cognitive deficit (defined as test scores 1 SD below the population mean). Pooled meta-analytic sensitivity and specificity were estimated by using a hierarchical summary receiver operator characteristic curve.RESULTS: We included 24 studies (n = 3133 children). Early assessments were conducted at 18 to 40 months and generally involved the Bayley Scales of Infant Development or the Griffiths Mental Development Scales; 11 different cognitive tests were used at school-age assessments at 5 to 18 years. Positive predictive values ranged from 20.0% to 88.9%, and negative predictive vales ranged from 47.8% to 95.5%. The pooled sensitivity (95% confidence interval) of early assessment for identifying school-age cognitive deficit was 55.0% (45.7%–63.9%) and specificity was 84.1% (77.5%–89.1%). Gestational age, birth weight, age at assessment, and time between assessments did not explain between-study heterogeneity.LIMITATIONS: The accuracy of aggregated data could not be verified. Many assessment tools have been superseded by newer editions.CONCLUSIONS: Early developmental assessment has poor sensitivity but good specificity and negative predictive value for school-age cognitive deficit.
Andreas NJ, Hyde M, Herbert B, et al., 2016, Impact of maternal BMI and sampling strategy on the concentration of leptin, insulin, ghrelin and resistin in breast milk across a single feed: a longitudinal cohort study, BMJ Open, Vol: 6, ISSN: 2044-6055
Objectives: We tested the hypothesis that there is a positive association between maternal BMI and the concentration of appetite-regulating hormones leptin, insulin, ghrelin and resistin in breast milk. We also aimed to describe the change in breast milk hormone concentration within each feed, and over time.Setting: Mothers were recruited from the post-partum ward at a university hospital in London. Breast milk samples were collected in the participants homes.Participants: We recruited 120 healthy, primiparous, breastfeeding mothers, over 18 years old. Mothers who smoked, had multiple births, or had diabetes were excluded. Fore and hind milk samples were collected from 105 women at one week post-partum and 92 women at three months post-partum. Primary and secondary outcome measures: We recorded maternal and infant anthropometric measurements at each sample collection and measured hormone concentrations using a multiplex assay.Results: The concentration of leptin in fore milk correlated with maternal BMI at time of sample collection, at seven days (r=0.31, p=0.02), and three months post-partum (r=0.30, p=<0.00). Fore milk insulin correlated with maternal BMI at three months post-partum (r=0.22, p=0.04). Breast milk ghrelin and resistin were not correlated with maternal BMI. Ghrelin concentrations at three months post-partum were increased in fore milk compared to hind milk (p=0.01). Concentrations of ghrelin were increased in hind milk collected at one week post-partum compared to samples collected at three months post-partum (p=0.03). A trend toward decreased insulin concentrations in hind milk was noted. Concentrations of leptin and resistin were not seen to alter over a feed.
Andreas NJ, Al-Khalidi A, Jaiteh M, et al., 2016, Role of human milk oligosaccharides in Group B Streptococcus colonisation, Clinical and Translational Immunology, Vol: 5, ISSN: 2050-0068
Group B Streptococcus (GBS) infection is a major cause of morbidity and mortality in infants. The major risk factor for GBSdisease is maternal and subsequent infant colonisation. It is unknown whether human milk oligosaccharides (HMOs) protectagainst GBS colonisation. HMO production is genetically determined and linked to the Lewis antigen system. We aimed toinvestigate the association between HMOs and infant GBS colonisation between birth and postnatal day 90. Rectovaginal swabswere collected at delivery, as well as colostrum/breast milk, infant nasopharyngeal and rectal swabs at birth, 6 days and days60–89 postpartum from 183 Gambian mother/infant pairs. GBS colonisation and serotypes were determined using culture andPCR. 1H nuclear magnetic resonance spectroscopy was used to characterise the mother’s Lewis status and HMO profile in breastmilk. Mothers who were Lewis-positive were significantly less likely to be colonised by GBS (X2 = 12.50, Po0.001). Infants ofLewis-positive mothers were less likely GBS colonised at birth (X2 = 4.88 P = 0.03) and more likely to clear colonisation betweenbirth and days 60–89 than infants born to Lewis-negative women (P = 0.05). There was no association between Secretor statusand GBS colonisation. In vitro work revealed that lacto-N-difucohexaose I (LNDFHI) correlated with a reduction in the growth ofGBS. Our results suggest that HMO such as LNDFHI may be a useful adjunct in reducing maternal and infant colonisation andhence invasive GBS disease. Secretor status offers utility as a stratification variable in GBS clinical trials.
Mann JP, Statnikov E, Modi N, et al., 2016, Management and outcomes of neonates with down syndrome admitted to neonatal units, Birth Defects Research Part A-Clinical and Molecular Teratology, Vol: 106, Pages: 468-474, ISSN: 1542-9768
BackgroundStudies have reported that advanced maternal age is a risk factor for congenital heart disease (CHD), but none of these have been performed in the United Kingdom. Currently, women in the United Kingdom are not referred for specialist fetal echocardiography based on maternal age alone. The aim of this study is to examine the association between maternal age at delivery and CHD prevalence in the North of England.MethodsSingleton cases of CHD notified to the Northern Congenital Abnormality Survey and born between January 1, 1998, to December 31, 2013, were included. Cases with chromosomal anomalies were excluded. The relative risk (RR) of CHD according to maternal age at delivery was estimated using Poisson regression.ResultsThere were 4024 singleton cases of nonchromosomal CHD, giving a prevalence of 8.1 (95% confidence interval [CI], 7.8–8.3) per 1000 live and stillbirths. There was no association between maternal age at delivery and CHD prevalence (p = 0.97), with no evidence of an increased risk of CHD in mothers aged ≥35 compared to aged 25 to 29 (RR = 0.99; 95% CI, 0.89–1.09). There were no significant associations between maternal age at delivery and severity III CHD (p = 0.84), severity II CHD (p = 0.74), or severity I CHD (p = 0.66), although there was a slight increased risk of severity I CHD in mothers aged ≥35 (RR = 1.27; 95% CI, 0.83–1.95).ConclusionWe found little evidence that advanced maternal age is a risk factor for CHD. There is no evidence that women in the United Kingdom should be referred for specialist prenatal cardiac screening based on their age.
Best KE, Rankin J, 2016, Is advanced maternal age a risk factor for congenital heart disease?, Birth Defects Res A Clin Mol Teratol, Vol: 106, Pages: 461-467
BACKGROUND: Studies have reported that advanced maternal age is a risk factor for congenital heart disease (CHD), but none of these have been performed in the United Kingdom. Currently, women in the United Kingdom are not referred for specialist fetal echocardiography based on maternal age alone. The aim of this study is to examine the association between maternal age at delivery and CHD prevalence in the North of England. METHODS: Singleton cases of CHD notified to the Northern Congenital Abnormality Survey and born between January 1, 1998, to December 31, 2013, were included. Cases with chromosomal anomalies were excluded. The relative risk (RR) of CHD according to maternal age at delivery was estimated using Poisson regression. RESULTS: There were 4024 singleton cases of nonchromosomal CHD, giving a prevalence of 8.1 (95% confidence interval [CI], 7.8-8.3) per 1000 live and stillbirths. There was no association between maternal age at delivery and CHD prevalence (p = 0.97), with no evidence of an increased risk of CHD in mothers aged ≥35 compared to aged 25 to 29 (RR = 0.99; 95% CI, 0.89-1.09). There were no significant associations between maternal age at delivery and severity III CHD (p = 0.84), severity II CHD (p = 0.74), or severity I CHD (p = 0.66), although there was a slight increased risk of severity I CHD in mothers aged ≥35 (RR = 1.27; 95% CI, 0.83-1.95). CONCLUSION: We found little evidence that advanced maternal age is a risk factor for CHD. There is no evidence that women in the United Kingdom should be referred for specialist prenatal cardiac screening based on their age. Birth Defects Research (Part A) 106:461-467, 2016. © 2016 Wiley Periodicals, Inc.
Logan K, Gale C, Hyde M, et al., 2016, Diabetes in pregnancy and infant adiposity: systematic review and meta-analysis, Archives of Disease in Childhood-Fetal and Neonatal Edition, Vol: 102, Pages: F65-F72, ISSN: 1468-2052
Objective: Maternal glycaemia and anthropometry-derived newborn adiposity are stronglycorrelated. The children of mothers with diabetes are at greater risk of adverse metabolichealth, and increased adiposity is a plausible mediator. We undertook a systematic review andmeta-analysis to compare adiposity in infants of mothers with (IDM) and without diabetes(NIDM).Design: We identified observational studies reporting adiposity in IDM and NIDM. We searchedreferences, traced forward citations and contacted authors for additional data. We consideredall body composition techniques and compared fat mass, fat-free mass, body fat % and skinfoldthickness. We used random effects meta-analyses and performed subgroup analyses bymaternal diabetes type (type 1, type 2, gestational) and infant sex. We examined the influenceof pre-pregnancy BMI and conducted sensitivity analyses.Results: We included data from 35 papers and over 24,000 infants. IDM have greater fatmass than NIDM (mean difference [95% CI]); 83g [49, 117]. Fat mass is greater in infants ofmothers with gestational diabetes; 62g [29, 94] and type 1 diabetes; 268g [139, 397].Insufficient studies reported data for type 2 diabetes separately. Compared with NIDM, fatmass was greater in IDM boys; 87g [30, 145], but not significantly different in IDM girls; 42g [-33, 116]. There was no attenuation after adjustment for maternal BMI.Conclusions: IDM have significantly greater adiposity in comparison to NIDM. These findingsare justification for studies to determine whether measures to reduce infant adiposity willimprove later health.
Shah PS, Lui K, Sjors G, et al., 2016, Neonatal Outcomes of Very Low Birth Weight and Very Preterm Neonates: An International Comparison, Journal of Pediatrics, Vol: 177, Pages: 144-152.e6, ISSN: 0022-3476
ObjectiveTo compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes.Study designWe included 58 004 infants born weighing <1500 g at 240–316 weeks' gestation from databases in Australia/New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom. We compared a composite outcome (mortality or any of grade ≥3 peri-intraventricular hemorrhage, periventricular echodensity/echolucency, bronchopulmonary dysplasia, or treated retinopathy of prematurity) between each country and all others by using standardized ratios and pairwise using logistic regression analyses.ResultsDespite differences in population coverage, included neonates were similar at baseline. Composite outcome rates varied from 26% to 42%. The overall mortality rate before discharge was 10% (range: 5% [Japan]-17% [Spain]). The standardized ratio (99% CIs) estimates for the composite outcome were significantly greater for Spain 1.09 (1.04-1.14) and the United Kingdom 1.16 (1.11-1.21), lower for Australia/New Zealand 0.93 (0.89-0.97), Japan 0.89 (0.86-0.93), Sweden 0.81 (0.73-0.90), and Switzerland 0.77 (0.69-0.87), and nonsignificant for Canada 1.04 (0.99-1.09) and Israel 1.00 (0.93-1.07). The adjusted odds of the composite outcome varied significantly in pairwise comparisons.ConclusionsWe identified marked variations in neonatal outcomes between countries. Further collaboration and exploration is needed to reduce variations in population coverage, data collection, and case definitions. The goal would be to identify care practices and health care organizational factors, which has the potential to improve neonatal outcomes.
Martin LJ, Sjörs G, Reichman B, et al., 2016, Country-Specific vs. Common Birthweight-for-Gestational Age References to Identify Small for Gestational Age Infants Born at 24–28 weeks: An International Study, Paediatric and Perinatal Epidemiology, Vol: 30, Pages: 450-461, ISSN: 0269-5022
BACKGROUND: Controversy exists as to whether birthweight-for-gestational age references used to classify infants as small for gestational age (SGA) should be country specific or based on an international (common) standard. We examined whether different birthweight-for-gestational age references affected the association of SGA with adverse outcomes among very preterm neonates. METHODS: Singleton infants (n = 23 788) of 24(0) -28(6) weeks' gestational age in nine high-resource countries were classified as SGA (<10th centile) using common and country-specific references based on birthweight and estimated fetal weight (EFW). For each reference, the adjusted relative risk (aRR) for the association of SGA with composite outcome of mortality or major morbidity was estimated. RESULTS: The percentage of infants classified as SGA differed slightly for common compared with country specific for birthweight references [9.9% (95% CI 9.5, 10.2) vs. 11.1% (95% CI 10.7, 11.5)] and for EFW references [28.6% (95% CI 28.0, 29.2) vs. 24.6% (95% CI 24.1, 25.2)]. The association of SGA with the composite outcome was similar when using common or country-specific references for the total sample for birthweight [aRRs 1.47 (95% CI 1.43, 1.51) and 1.48 (95% CI 1.44, 1.53) respectively] and for EFW references [aRRs 1.35 (95% CI 1.31, 1.38) and 1.39 (95% CI 1.35, 1.43) respectively]. CONCLUSION: Small for gestational age is associated with higher mortality and morbidity in infants born <29 weeks' gestational age. Although common and country-specific birthweight/EFW references identified slightly different proportions of SGA infants, the risk of the composite outcome was comparable.
Logan K, Emsley RJ, Jeffries S, et al., 2016, Development of Early Adiposity in Infants of Mothers With Gestational Diabetes Mellitus, Diabetes Care, Vol: 39, Pages: 1045-1051, ISSN: 0149-5992
OBJECTIVEInfants born to mothers with gestational diabetes mellitus (GDM) are at greaterrisk of later adverse metabolic health. We examined plausible candidate mediators;adipose tissue (AT) quantity and distribution, and intrahepatocellular lipid(IHCL) content, comparing infants of mothers with GDM and without GDM (controlgroup) over the first 3 postnatal months.RESEARCH DESIGN AND METHODSWe conducted a prospective longitudinal study using MRI and spectroscopy toquantify whole-body and regional AT volumes, and IHCL content, within 2 weeksand 8–12 weeks after birth. We adjusted for infant size and sex, and maternalprepregnancy BMI. Values are reported as the mean difference (95% CI).RESULTSWe recruited 86 infants (GDM group 42 infants; control group 44 infants). Motherswith GDM had good pregnancy glycemic control. Infants were predominantlybreast fed up to the time of the second assessment (GDM group 71%; controlgroup 74%). Total AT volumes were similar in the GDM group compared with thecontrol group at a median age of 11 days (228 cm3 [95% CI 2121, 65], P = 0.55), butwere greater in the GDM group at a median age of 10 weeks (247 cm3 [56, 439], P =0.01). After adjustment for size, the GDM group had significantly greater total ATvolume at 10 weeks than control group infants (16.0% [6.0, 27.1], P = 0.002). ATdistribution and IHCL content were not significantly different at either time point.CONCLUSIONSAdiposity in GDM infants is amplified in early infancy, despite good maternalglycemic control and predominant breast-feeding, suggesting a potential causalpathway to later adverse metabolic health. Reduction in postnatal adiposity maybe a therapeutic target to reduce later health risks.
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