ADEPT - Abnormal Doppler Enteral Prescription Trial

<p>Abstract</p> <p>Background</p> <p>Pregnancies complicated by abnormal umbilical artery Doppler blood flow patterns often result in the baby being born both preterm and growth-restricted. These babies are at high risk of milk intolerance and necrotising enterocolitis, as well as post-natal growth failure, and there is no clinical consensus about how best to feed them. Policies of both early milk feeding and late milk feeding are widely used. This randomised controlled trial aims to determine whether a policy of early initiation of milk feeds is beneficial compared with late initiation. Optimising neonatal feeding for this group of babies may have long-term health implications and if either of these policies is shown to be beneficial it can be immediately adopted into clinical practice.</p> <p>Methods and Design</p> <p>Babies with gestational age below 35 weeks, and with birth weight below 10th centile for gestational age, will be randomly allocated to an "early" or "late" enteral feeding regimen, commencing milk feeds on day 2 and day 6 after birth, respectively. Feeds will be gradually increased over 9-13 days (depending on gestational age) using a schedule derived from those used in hospitals in the Eastern and South Western Regions of England, based on surveys of feeding practice. Primary outcome measures are time to establish full enteral feeding and necrotising enterocolitis; secondary outcomes include sepsis and growth. The target sample size is 400 babies. This sample size is large enough to detect a clinically meaningful difference of 3 days in time to establish full enteral feeds between the two feeding policies, with 90% power and a 5% 2-sided significance level. Initial recruitment period was 24 months, subsequently extended to 38 months.</p> <p>Discussion</p> <p>There is limited evidence from randomised controlled trials on which to base decisions regarding feeding policy in high risk preterm infants. This multicentre trial will help to guide clinical practice and may also provide pointers for future research.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN: 87351483</p

From curiosity to commodity: a review of the evolution of sachet drinking water in West Africa

The private sector continues to play an important role in filling local drinking water supply gaps across the Global South. In West Africa, a perfect storm of rapid population growth, infrastructure mismanagement, and globalization of consumer markets has resulted in the advent of an entire new industry around packaged water, primarily ‘sachet water’ sold in mechanically sealed plastic sleeves. Most local governments and international development agencies have historically perceived sachet water as a passing trend, but it has quickly become a primary drinking water source for the majority of households in many urban areas and continues to spread throughout the region and world. Sachet water is now an important component of regional water security, although with attendant issues related to governance, quality control, environmental pollution, and social justice. This paper reviews the seminal literature on sachet water in West Africa, with particular emphasis on Ghana and Nigeria, where most studies have focused. This review synthesizes governance issues, consumer and industry trends, and the latest on product quality in the literature from 2011 to 2016, with 2010 approximating an inflection point for the modernization of the industry. The ability of many West African nations to achieve universal access to safe drinking water may depend on their willingness to understand and incorporate the sachet water industry into an integrated drinking water platform. WIREs Water 2017, 4:e1206. doi: 10.1002/wat2.1206 This article is categorized under: Engineering Water > Planning Water Engineering Water > Sustainable Engineering of Water Human Water > Water Governance A typical 500‐mL sachet of drinking water sold in Accra, Ghana