The results of the SIFT randomised controlled trial have been published in the New England Journal of Medicine.
Each year, over 8,000 babies are born very prematurely (more than 8 weeks before their due date) in the UK and the best way to feed these babies in early is not known. How these babies are fed affects short and long-term health outcomes, health-care costs and resources, so it’s an important issue for the NHS and other health services across the world.
The SIFT trial asked, “Does a faster increase in the daily rate of milk feeds, compared with a slower increase, result in better health outcomes and reduced use of hospital resources?”
Between June 2013 and June 2015 we recruited 2,804 infants born very preterm or with very low birth weight and followed up to 2 years of age. Half of them received faster increments of milk feeds and half of them were given slower increments.
The results showed no difference in survival without moderate or severe developmental disability at 2 years of age. The speed of increment in feeding also did not affect the risk of infection, bowel problems or growth before the babies were discharged from hospital. Faster feeding reduced the number of days to reach full milk feeding and the number of days the babies were fed through a tube, but the risk of moderate to severe motor disability was unexpectedly higher at 2 years in babies who received faster increments of milk feeds.
You can read more about the findings of the SIFT trial in the NEJM.
A study by Kate Fitzpatrick (lead author), Jennifer Kurinczuk and Maria Quigley from the NPEU, and Sohinee Bhattacharya, investigating the short-term outcomes of mothers and babies following a previous caesarean section has had quite a bit of media coverage over the past week.
From the SIFT trial, we also have a number of different posters being presented.
Madeleine Hurd will be presenting ‘Managing follow-up among parents of very pre-term infants: methods to improve questionnaire response rate’ and Ed Juszczak will present the ‘Evaluation of the effectiveness of an incentive strategy on the questionnaire response rate in parents of premature babies’.
If you are visiting the conference, do please come along and say hi. Full details of all presentations are below:
Marian Knight, Professor of Maternal and Child Population Health from the NPEU recently appeared in a BBC News feature discussing the changes that need to be made in the future following the inequalities highlighted in the recent MBRRACE-UK collaboration's annual report, Saving Lives, Improving Mothers' Care.
We know that black women are much more likely to have severe complications than white women, so it's clearly a really important area to focus on and work out why. The difficulty is that there is no one easy answer, it's acutally a very complex picture.
As part of our programme of work, the NPEU will be undertaking indepth research focusing on the underlying reasons for these recent findings.
Maria's presentation will describe methods to increase response rates in population-based surveys, based on experience from the National Maternity Survey (NMS) conducted at the NPEU. Sian will describe the prevalence of post-traumatic stress disorder and comorbidity with anxiety and depression in the NMS. Charles will present findings from a recently published study describing the role of social deprivation in explaining differences in infant birth outcomes across different ethnic groups.
If you'll be in Cork at the time, please come and say hallo.
We know that pre-eclampsia is a very common, but potentially extremely serious condition of pregnancy which can be fatal for both woman and baby. Abnormally high blood pressure affects about 10% of pregnant women. Around 2-3% of women develop pre-eclampsia, diagnosed by checking for high blood pressure and protein in the urine. If a woman develops pre-eclampsia after 37 weeks of pregnancy, then most national guidelines suggest prompt delivery. It is much less clear about how to best advise women who develop the condition between 34 and 37 weeks of pregnancy. We wanted to compare planned early delivery against usual clinical practice (which involves watching and waiting until 37 weeks of pregnancy, unless a woman or her unborn baby develops complications which means that she is offered urgent delivery sooner).
Intrahepatic cholestasis of pregnancy (ICP) is the commonest pregnancy-specific liver disorder in the UK. It affects around 5,500 women a year, causing premature birth and, in extreme cases, stillbirth. The most popular current drug used to treat ICP is called ursodeoxycholic acid (commonly known as 'urso'), but it hasn't been tested in any large clinical trials to show whether it prevents premature birth and stillbirth.
Our trial asked, "If a woman has ICP, what are the effects on the baby if she is treated with ursodeoxycholic acid (or placebo)?"
This week's The Lancet Child & Adolescent Health includes an article describing standardised scores for the Parent Report of Children's Abilities, Revised (PARCA-R) questionnaire. The PARCA-R is recommended for routine use in the UK to screen for developmental delay in children born preterm and can be completed by parents in 10 to 15 minutes.
A new website has also been lauched featuring an online version of the questionnaire and a pre-programmed calculator for deriving the standardised scores.
Dr Louise Linsell at NPEU collaborated with colleagues at the University of Leicester and other universities to standardise the scores.
We can now quantify a child’s developmental level relative to the UK population of two year olds, and identify advanced or delayed development. The standardised PARCA-R is freely available for parents to use and has been translated into 14 languages. It provides a reliable, cost-effective alternative to other developmental assessments that can be costly to administer.
