The FOUNDATION study “Follow-Up for NeuroDevelopmentally AT risk Infants Of Neonatal care”- a qualitative study on the views of parents and caregivers

Introduction: Infants born prematurely or who have had neurological complications are at increased risk of neurodevelopmental disorders. Early identification of infants with signs of neurodevelopmental delay is crucial to achieve their full developmental potentials. Currently, there is variable guidance on the follow up and referral process for such children. Little information is available on the needs of patients, families and health care of professionals regarding current practice and experience of follow-up. Aims: To understand the present situation, the perceptions, and the views of parents and professionals who look after high-risk infants discharged from the NICU in relation to neurodevelopmental follow-up. Methods: We undertook a qualitative study within the Mersey region using in-depth interviews with 23 parents of children, aged 0 to 3, born prematurely or with hypoxic ischaemic encephalopathy. We also undertook 11 in-depth interviews with doctors, nurses, and allied health professionals involved in the follow-up of at-risk infants. Results: Five themes were identified: (1) What, (2) How, (3) Who, (4) When and (5) Capacity of the health care system. Most parents wanted preparation for a diagnosis and the future, and they appreciated a realistic and honest approach by professionals. Parents perceived that neonatologists tended to focus on short-term management and were reluctant to discuss long-term developmental outcomes with parents to avoid reducing the joy of having a baby. Long-term parental emotional support was felt to be neglected and many parents wanted to be offered counselling services. The lack of a standard referral process and variable care pathways frustrated both parents and professionals. Conclusion: The quantity, content and quality of information given to parents at the hospital as well as in the community should be revised. More information on the risks of having developmental problems in high-risk children should be given. Many parents felt anxious and depressed and some mothers had mental health problems such as panic attacks and post traumatic disorders. Professionals should provide increased emotional support on the NICU and throughout follow-ups

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Validation of the OAKS prognostic model for acute kidney injury after gastrointestinal surgery

Background Postoperative acute kidney injury (AKI) is a common complication of major gastrointestinal surgery with an impact on short- and long-term survival. No validated system for risk stratification exists for this patient group. This study aimed to validate externally a prognostic model for AKI after major gastrointestinal surgery in two multicentre cohort studies.Methods The Outcomes After Kidney injury in Surgery (OAKS) prognostic model was developed to predict risk of AKI in the 7 days after surgery using six routine datapoints (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker). Validation was performed within two independent cohorts: a prospective multicentre, international study ('IMAGINE') of patients undergoing elective colorectal surgery (2018); and a retrospective regional cohort study ('Tayside') in major abdominal surgery (2011-2015). Multivariable logistic regression was used to predict risk of AKI, with multiple imputation used to account for data missing at random. Prognostic accuracy was assessed for patients at high risk (greater than 20 per cent) of postoperative AKI.Results In the validation cohorts, 12.9 per cent of patients (661 of 5106) in IMAGINE and 14.7 per cent (106 of 719 patients) in Tayside developed 7-day postoperative AKI. Using the OAKS model, 558 patients (9.6 per cent) were classified as high risk. Less than 10 per cent of patients classified as low-risk developed AKI in either cohort (negative predictive value greater than 0.9). Upon external validation, the OAKS model retained an area under the receiver operating characteristic (AUC) curve of range 0.655-0.681 (Tayside 95 per cent c.i. 0.596 to 0.714; IMAGINE 95 per cent c.i. 0.659 to 0.703), sensitivity values range 0.323-0.352 (IMAGINE 95 per cent c.i. 0.281 to 0.368; Tayside 95 per cent c.i. 0.253 to 0.461), and specificity range 0.881-0.890 (Tayside 95 per cent c.i. 0.853 to 0.905; IMAGINE 95 per cent c.i. 0.881 to 0.899).Conclusion The OAKS prognostic model can identify patients who are not at high risk of postoperative AKI after gastrointestinal surgery with high specificity.Presented to Association of Surgeons in Training (ASiT) International Conference 2018 (Edinburgh, UK), European Society of Coloproctology (ESCP) International Conference 2018 (Nice, France), SARS (Society of Academic and Research Surgery) 2020 (Virtual, UK).Nephrolog