New research by Yangmei Li, Maria Quigley, Nirupa Dattani, Ron Gray, Hiranthi Jayaweera, Jenny Kurinczuk, Alison Macfarlane, and Jennifer Hollowell describes ethnic variations in infant mortality and explores the contribution of area deprivation, mother’s country of birth, and prematurity to these variations.
Using routine birth and death data on more than 4.6 million singleton live births in England and Wales, 2006-2012, they found that crude infant mortality rates were higher in Pakistani, Black Caribbean, Black African, and Bangladeshi infants (6.92, 6.00, 5.17 and 4.40 per 1,000 live births, respectively vs. 2.87 in White British infants). Adjustment for sociodemographic characteristics changed the results little. Further adjustment for gestational age strongly attenuated the risk in Black Caribbean (odds ratio 1.02, 95% CI 0.89-1.17) and Black African infants (1.17, 1.06-1.29) but not in Pakistani (2.32, 2.15-2.50), Bangladeshi (1.47, 1.28-1.69), and Indian infants (1.24, 1.11-1.38).
These results suggest that higher proportions of very premature infants appear to explain increased risks in Black infants but not in South Asian groups.
Read the research in full in the PLOS ONE journal.
New research by Maria Quigley, Claire Carson and Yvonne Kelly helps shed light on why the association between breastfeeding and childhood wheeze varies in previous studies.
Using data on 10,126 children, they found that the association between breastfeeding and childhood wheeze (in the past year) varies according to the age at which wheezing is assessed. For example, babies who were breastfed for 6-9 months were less likely to experience wheezing at age 9 months, 3, and 5 years, but this ‘protective’ effect was less apparent at age 7 and 11 years (adjusted odds ratios 0.73, 0.78, 0.79, 0.84, 1.06 respectively). The pattern of wheeze throughout childhood can be described as the ‘wheezing phenotype’. Breastfeeding was also associated with a lower odds of an ‘early transient’ phenotype (where the child had wheezing at any age up to 5 years but not thereafter) but not with other wheezing phenotypes such as ‘late onset’ (any time from age 7 but not beforehand) or ‘persistent’ (any time up to age 5 and any time from age 7). These results suggest that the association between breastfeeding and subsequent wheeze varies according to age at which wheezing is assessed, and underlying wheezing phenotype.
Following Professor Juszczak's talk at NeoCARD Conference in October 2017, we are excited to share with you his paper on "Continued uncertainty regarding treatment of patent ductus arteriosus in premature infants and the role of clinical trials"
For more details you can read the full article in Seminar in Fetal and Neonatal Medicine.
The Human Fertilisation and Embryology Authority (HFEA) data shows live birth rates for frozen embryo transfer rising above fresh embryo transfer in the latest published report.
The success rates for frozen embryo transfer have steadily been improving for frozen embryo transfer and now exceed fresh embryo transfer live birth rates; which the HFEA has described as an ‘important milestone in the development of IVF’. The latest 2016 data shows a live birth rate per embryo transfer of 22% for frozen, compared to 21% for fresh transfers.
On 29th March 2018, Senior Health Economist Oliver Rivero-Arias will be presenting an OHE Lunchtime Seminar: Valuing Children’s Health for Economic Evaluation.
Economic evaluations of treatments for children have primarily used adult preferences when estimating health benefits. Recent work has demonstrated that using adult values to inform preferences for health states experienced by children or adolescents is not appropriate, and this has raised doubts about the validity of such economic evaluations. Eliciting preferences to be used to inform decisions about health care for younger populations is challenging and presents the questions of whose values should be collected and from which perspective.
In this presentation, Oliver will report the results of two valuation exercises for a child-specific health-related quality of life instrument, comparing preferences elicited from adolescents and adults in the UK and Spain.
A study by Maggie Redshaw and Jane Henderson shows that women living in the most deprived areas in England, who are most at risk of stillbirth, perceived their care more negatively than other women.
In this study, women who had suffered a stillbirth were asked nine months later about their care around the time of the stillbirth. Women resident in the most deprived areas were significantly less likely to feel spoken to so that they could understand and treated with respect. Free text comments indicated that these women had difficulty accessing care, that communication was poor, many of them did not feel cared for, and felt that more could have been done to save their baby.
The study is published in the Birth journal and you can read it here.
New research comparing fresh and frozen embryo transfer by Shi, Y. et. al. (2018) has found that live birth rates are equivalent between the two types of embryo transfer but that frozen embryo transfer significantly lowers the risk of ovarian hyperstimulation syndrome (OHSS).
In this multi-centre randomised controlled trial, 2157 who were undergoing their first IVF were randomly allocated to receive either fresh or frozen embryo transfer. The live birth rate did not differ significantly between the two groups. However, frozen embryo transfer resulted in significantly lower risk of OHSS than fresh embryo transfer (0.6% vs 2.0% relative risk). The risk of other adverse maternal and neonatal outcomes did not differ significantly between the 2 groups.
For more details you can read the full article in The New England Journal of Medicine.