Analysis of neonatal mortality data for year 2016

This report presents an analysis of neonatal mortality in infants born in 2016 at a gestational age (GA) less that 32 weeks, and who were admitted to neonatal units that form the UK Neonatal Collaborative in England, Wales and Scotland (part). Every neonatal unit was informed of the analysis in advance and was requested to confirm the accuracy and completeness, or make amendments, in the data they had entered on the Badger.Net platform. The analysis in this report is based on these data, held in the National Neonatal Research Database (NNRD)

Outcomes following early parenteral nutrition use in preterm neonates: Protocol for an observational study

Introduction Preterm babies are among the highest users of parenteral nutrition (PN) of any patient group, but there is wide variation in commencement, duration, and composition of PN and uncertainty around which groups will benefit from early introduction. Recent studies in critically unwell adults and children suggest that harms, specifically increased rates of nosocomial infection, outweigh the benefits of early administration of PN. In this study, we will describe early PN use in neonatal units in England, Wales and Scotland. We will also evaluate if this is associated with differences in important neonatal outcomes in neonates born between 30+0 and 32+6 weeks+days gestation. Methods and analysis We will use routinely collected data from all neonatal units in England, Wales and Scotland, available in the National Neonatal Research Database (NNRD). We will describe clinical practice in relation to any use of PN during the first 7 postnatal days among neonates admitted to neonatal care between 1 January 2012 and 31 December 2017. We will compare outcomes in neonates born between 30+0 and 32+6 weeks+days gestation who did or did not receive PN in the first week after birth using a propensity score-matched approach. The primary outcome will be survival to discharge home. Secondary outcomes will include components of the neonatal core outcome set: outcomes identified as important by former patients, parents, clinicians and researchers. Ethics and dissemination We have obtained UK National Research Ethics Committee approval for this study (Ref: 18/NI/0214). The results of this study will be presented at academic conferences; the UK charity Bliss will aid dissemination to former patients and parents

Outcomes in relation to early parenteral nutrition use in preterm neonates born between 30 and 33 weeks gestation: a propensity score matched observational study

Objective To evaluate whether in preterm neonates parenteral nutrition use in the first seven postnatal days, compared with no parenteral nutrition use, is associated with differences in survival and other important morbidities. Randomised trials in critically ill older children show that harms, such as nosocomial infection, outweigh benefits of early parenteral nutrition administration; there is a paucity of similar data in neonates. Design Retrospective cohort study using propensity matching including 35 maternal, infant and organisational factors to minimise bias and confounding. Setting National, population-level clinical data obtained for all National Health Service neonatal units in England and Wales. Patients Preterm neonates born between 30+0 and 32+6 weeks+days . Interventions The exposure was parenteral nutrition administered in the first seven days of postnatal life; the comparator was no parenteral nutrition. Main outcome measures The primary outcome was survival to discharge from neonatal care. Secondary outcomes comprised the neonatal core outcome set. Results 16,292 neonates were compared in propensity score matched analyses. Compared with matched neonates not given parenteral nutrition in the first postnatal week, neonates who received parenteral nutrition had higher survival at discharge (absolute rate increase 0.91%; 95% CI 0.53% to 1.30%), but higher rates of necrotising enterocolitis (absolute rate increase 4.6%), bronchopulmonary dysplasia (absolute rate increase 3.9%), late-onset sepsis (absolute rate increase 1.5%) and need for surgical procedures (absolute rate increase 0.92%). Conclusions In neonates born between 30+0 and 32+6 weeks gestation, those given parenteral nutrition in the first postnatal week had a higher rate of survival but higher rates of important neonatal morbidities. Clinician equipoise in this area should be resolved by prospective, randomised trials

Improving small area estimation by combining surveys : new perspectives in regional statistics

A national survey designed for estimating a specific population quantity is sometimes used for estimation of this quantity also for a small area, such as a province. Budget constraints do not allow a greater sample size for the small area, and so other means of improving estimation have to be devised. We investigate such methods and assess them by a Monte Carlo study. We explore how a complementary survey can be exploited in small area estimation. We use the context of the Spanish Labour Force Survey (EPA) and the Barometer in Spain for our study

Rapid testing and treatment for sexually transmitted infections improve patient care and yield public health benefits

A service evaluation of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing and result notification in patients attending a rapid testing service (Dean Street Express [DSE]) compared with those attending an existing ‘standard’ sexual health clinic (56 Dean Street [56DS]), and modelling the impact of the new service from 1 June 2014 to 31 May 2015. Primary outcome: time from patients’ sample collection to notification of test results at DSE compared with 56DS. Secondary outcomes estimated using a model: number of transmissions prevented and the number of new partner visits avoided and associated cost savings achieved due to rapid testing at DSE. In 2014/15, there were a total of 81,352 visits for CT/NG testing across 56DS (21,086) and DSE (60,266). Rapid testing resulted in a reduced mean time to notification of 8.68 days: 8.95 days for 56DS (95% CI 8.91–8.99) compared to 0.27 days for DSE (95% CI 0.26–0.28). Our model estimates that rapid testing at DSE would lead to 196 CT and/or NG transmissions prevented (2.5–97.5% centile range = 6–956) and lead to annual savings attributable to reduced numbers of partner attendances of £124,283 (2.5–97.5% centile range = £4260–590,331). DSE, a rapid testing service for asymptomatic infections, delivers faster time to result notification for CT and/or NG which enables faster treatment, reduces infectious periods and leads to fewer transmissions, partner attendances and clinic costs

Parent, patient and clinician perceptions of outcomes during and following neonatal care: a systematic review of qualitative research

ObjectiveMultiple outcomes can be measured in infants that receive neonatal care. It is unknown whether outcomes of importance to parents and patients differ from those of health professionals. Our objective was to systematically map neonatal care outcomes discussed in qualitative research by patients, parents and healthcare professionals and test whether the frequency with which outcomes are discussed differs between groups.DesignSystematic review of qualitative literature. The following databases were searched: Medline, CINAHL, EMBASE, PsycINFO and ASSIA from 1997 to 2017. Publications describing qualitative data relating to neonatal care outcomes, reported by former patients, parents or healthcare professionals, were included. Narrative text was analysed and outcomes grouped thematically by organ system. Permutation testing was applied to assess an association between the outcomes identified and stakeholder group.ResultsSixty-two papers containing the views of over 4100 stakeholders were identified; 146 discrete outcomes were discussed; 58 outcomes related to organ systems and 88 to other more global domains. Permutation testing provides evidence that parents, former patients and health professionals reported outcomes with different frequencies (p=0.037).ConclusionsParents, patients and health professionals focus on different outcomes when discussing their experience of neonatal care. A wide range of neonatal care outcomes are reported in qualitative research; many are global outcomes relating to the overall status of the infant. The views of former patients and parents should be taken into consideration when designing research; the development of a core outcomes set for neonatal research will facilitate this.</jats:sec

Developmental trajectories of externalizing behaviors in childhood and adolescence [IF: 3.3]

This article describes the average and group-based developmental trajectories of aggression, opposition, property violations, and status violations using parent reports of externalizing behaviors on a longitudinal multiple birth cohort study of 2,076 children aged 4 to 18 years. Trajectories were estimated from multilevel growth curve analyses and semiparametric mixture models. Overall, males showed higher levels of externalizing behavior than did females. Aggression, opposition, and property violations decreased on average, whereas status violations increased over time. Group-based trajectories followed the shape of the average curves at different levels and were similar for males and females. The trajectories found in this study provide a basis against which deviations from the expected developmental course can be identified and classified as deviant or nondeviant

Co-operative learning and adaptive instruction in a mathematics curriculum

The AGO 12 to 16 Project (the acronym AGO stands for the Dutch equivalent of 'Adaptive Instruction and Co-operative Learning') seeks to develop and evaluate a mathematics curriculum which is suitable for mixed-ability groups in secondary education. The research questions we will address here are, first, whether this curriculum is feasible and effective, and, second, what effects, if any, the context variables time and mean cognitive level of the class have on learning. Many mathematics programmes make insufficient allowance for the differences in intellectual ability that exist in mixed-ability classes. In order to change this situation we developed a mathematics curriculum with adaptive qualities. The evaluation of the experimental curriculum was carried out in two stages. During the first stage the curriculum was used at two schools with the aim of investigating the feasibility of the programme. Experience with the implementation of the programme led to some improvements in the experimental materials. By and large the AGO model appeared to be feasible in secondary classrooms. In the second stage, which was on a large scale, the focus was on the effectiveness of the programme. Six hundred students, 13 teachers and six schools were involved in the research. Teachers in the experimental group were trained in AGO methods and in implementing the new AGO curriculum. Teachers in the control groups worked with the existing programme following their usual methods of teaching. The main conclusion of the study is positive. The AGO model as a whole proved to be practical and effective in learning mathematics. The AGO model has a positive effect on the intercept, which means that the mean scores of AGO classes are higher than the mean scores of non-AGO classes. It may be concluded that, on the average, students benefit from learning in AGO classes as compared with non-AGO classes. AGO does not increase or decrease the differences between students in the same class. As expected, positive effects of two context variables were found: (1) the total amount of time spent in class covering the mathematical content and (2) class composition as indicated by the mean pretest score (aptitude) of the class