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

What topics should we teach the parents of admitted neonates in the newborn care unit in the resource-limited setting - a Delphi study

BACKGROUND: In resource-limited settings, such as Rwanda, health care profession (HCP) to neonate ratios are low, and therefore caregivers play a significant role in providing care for their admitted neonates. To provide such Family Integrated Care, caregivers need knowledge, skills, and confidence. The objective of this study was to identify consensus from key stakeholders regarding the priority topics for a "parental neonatal curriculum." METHODS: A three-round Delphi-study was conducted. During Round-1, face-to-face interviews were undertaken and responses coded and categorized into themes. In Round-2, participants were presented with Round-1 feedback and asked to provide additional topics in respective themes. In Round-3, respondents were asked to rank the importance of these items using a 9-point Likert scale. RESULTS: Ten, 36 and 40 stakeholders participated in Rounds-1, - 2 and - 3 respectively, including parents, midwives, nurses and physicians. Twenty and 37 education topics were identified in Rounds-1 and -2 respectively. In Round-3 47 of the 57 presented outcomes met pre-defined criteria for inclusion in the "parental neonatal curriculum." CONCLUSION: We describe a "parental neonatal curriculum," formed using robust consensus methods, describing the core topics required to educate parents of neonates admitted to a newborn care unit. The curriculum has been developed in Rwanda and is relevant to other resource-limited settings

The importance of core outcome sets and developing one for neonatal care

It has been estimated that 85% of all clinical research is wasted. Suboptimal outcome selection is an important cause of waste because it leads to research that cannot be compared and may not be clinically relevant. A solution to this problem is the use of a core outcome set, a standardised set of outcomes recorded whenever research in a specific field is carried out. The methodology behind developing a core outcome set and how this is being applied in the Core Outcomes in Neonatology (COIN) project is described

Calculations of net present value for a small modular fusion power plant under a range of scenarios

If, as suggested by proponents, fusion small modular reactors (SMRs) can be developed faster than envisaged by the multi-national ITER/DEMO programme, the question remains as to whether such reactors will be a viable commercial proposition. Such viability will depend on a range of factors, including capital costs, income from the sale of electricity and the cost of capital. To investigate these effects, Net Present Values (NPVs) were calculated for a range of scenarios for both First of a Kind (FOAK) and Nth of a Kind (NOAK) plants supplying electricity to the United Kingdom grid commencing in 2040. Calculations have also been carried out to delineate the “space” in which positive NPVs would be obtained. These calculations show that there are combinations of capital costs, electricity prices and costs of capital in which a fusion SMR plant would be financially viable. These calculations, being based on uncertain costs and incomes, are necessarily uncertain. The calculations show that minimisation of capital costs must be a key goal for those seeking to develop a fusion SMR as a commercial proposition

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

The Options Value of Blue Hydrogen in a Low Carbon Energy System

A developer considering the construction of a Steam Methane Reforming facility for the production of hydrogen from natural gas faces the decision as to whether to incorporate and operate a Carbon Capture and Storage (CCS) unit, as part of the facility, in an environment where the costs of inputs and the price of hydrogen are uncertain. Conventional valuation methodologies such as Discounted Cash Flow (DCF) cannot systematically integrate uncertainty from changing market and regulatory conditions. Such methods are also unable to account for the ability of management to make use of flexibility to respond as the uncertainties are progressively resolved proactively. Consequently, an Engineering Flexibility / Real Options approach has been developed to allow the calculation of the additional value that the developer might obtain if a CCS unit is not fitted at the time of construction of the SMR plant. Instead, the plant is constructed so that the CCS unit can be retrofitted during the plant’s lifetime if the economic conditions are such that it appears that this will increase the value of the SMR plant. Application of this approach has shown that, for this example, the Net Present Values are increased in a range of energy price and cost of CO2 release scenarios, i.e. the Real Option has a positive value. These findings hold for a range of discount rates. Similarly, the approach improves the Value at Risk and the Value at Gain. Whilst in this work, the approach has been applied to the example of the decision of whether to fit a CSS unit to an SMR plant for the production of blue hydrogen, it is believed that a similar approach can be applied to other situations

National priority setting partnership using a Delphi consensus process to develop neonatal research questions suitable for practice-changing randomised trials in the UK

BACKGROUND: The provision of neonatal care is variable and commonly lacks adequate evidence base; strategic development of methodologically robust clinical trials is needed to improve outcomes and maximise research resources. Historically, neonatal research topics have been selected by researchers; prioritisation processes involving wider stakeholder groups have generally identified research themes rather than specific questions amenable to interventional trials. OBJECTIVE: To involve stakeholders including parents, healthcare professionals and researchers to identify and prioritise research questions suitable for answering in neonatal interventional trials in the UK. DESIGN: Research questions were submitted by stakeholders in population, intervention, comparison, outcome format through an online platform. Questions were reviewed by a representative steering group; duplicates and previously answered questions were removed. Eligible questions were entered into a three-round online Delphi survey for prioritisation by all stakeholder groups. PARTICIPANTS: One hundred and eight respondents submitted research questions for consideration; 144 participants completed round one of the Delphi survey, 106 completed all three rounds. RESULTS: Two hundred and sixty-five research questions were submitted and after steering group review, 186 entered into the Delphi survey. The top five ranked research questions related to breast milk fortification, intact cord resuscitation, timing of surgical intervention in necrotising enterocolitis, therapeutic hypothermia for mild hypoxic ischaemic encephalopathy and non-invasive respiratory support. CONCLUSIONS: We have identified and prioritised research questions suitable for practice-changing interventional trials in neonatal medicine in the UK at the present time. Trials targeting these uncertainties have potential to reduce research waste and improve neonatal care

Epidemiological Interactions between Urogenital and Intestinal Human Schistosomiasis in the Context of Praziquantel Treatment across Three West African Countries

© 2015 Knowles et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The attached file is the published version of the article

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

Estimation of changes in the force of infection for intestinal and urogenital schistosomiasis in countries with Schistosomiasis Control Initiative-assisted programmes

The last decade has seen an expansion of national schistosomiasis control programmes in Africa based on large-scale preventative chemotherapy. In many areas this has resulted in considerable reductions in infection and morbidity levels in treated individuals. In this paper, we quantify changes in the force of infection (FOI), defined here as the per (human) host parasite establishment rate, to ascertain the impact on transmission of some of these programmes under the umbrella of the Schistosomiasis Control Initiative (SCI)