Infant pain has both immediate and long-term negative consequences, yet in clinical practice it is often under-treated and very few pain-relieving drugs have been tested in babies. The Poppi Trial has been designed to test whether morphine can provide effective pain relief in babies during invasive medical procedures. Led by Dr Rebeccah Slater in collaboration with the NPEU and the Paediatric and Infant Pain & Anaesthesia (PiPA) group, the trial is due to start recruitment at the John Radcliffe Hospital in Oxford in Spring 2016. Read the summary protocol published in the Lancet for more information.
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The NPEU Clinical Trials Unit is collaborating with the University of Aberdeen on a large-scale multi-centre trial comparing the use of ‘fresh’ and frozen embryos for IVF, the first of its kind in the UK. E-Freeze, funded by the NIHR Health Technology Assessment (HTA) Programme will recruit 1,086 couples to see which method produces the greatest number of healthy babies, as well as considering the health of the mother and costs to the health services and longer-term societal costs. News about the trial has featured in The Scotsman and The Herald newspapers. Read more about E-Freeze.
A systematic review of studies reporting models for predicting behavioural problems or psychiatric disorders in very preterm children has been published in the Journal of Developmental and Behavioral Pediatrics. The review, by NPEU researchers Louise Linsell, Reem Malouf, Jenny Kurinczuk and others identified 15 articles published over two decades, but revealed a lack of evidence for any risk factors. The review concluded that there is a need for further research using large, well-conducted studies with standard diagnostic evaluations in school-age children and adolescents born very preterm. Read the abstract of the paper.
A paper exploring the risk of psychological stress in parents of babies born preterm has been published in BMJ Open. The study, by Claire Carson, Maggie Redshaw, Ron Gray and Maria Quigley, analysed data on 12,100 families recruited into the Millennium Cohort Study, including 7% who had experienced a preterm birth. Overall, 12% of mothers and 9% of fathers showed signs of psychological distress at 9 months postpartum. These prevalences were increased in parents of very preterm infants and mothers of infants born at early term (gestation 37-38 weeks). Full details can be found on the BMJ website.
Babies born at 36 weeks’ gestation or more, who had signs of moderate or severe neonatal encephalopathy following lack of oxygen, were eligible for this trial, which recruited from February 2012 to September 2014. All babies were treated with moderate hypothermia, which had to start within 6 hours of age. Parental consent was sought to allow randomisation by 12 hours of age to standard cooling treatment alone or standard cooling treatment plus inhaled 30% xenon gas, delivered via a neonatal ventilator for 12 hours. Cooling treatment lasted for 72 hours followed by gradual rewarming.
Adding inhaled xenon treatment to moderate cooling for term infants who have experienced lack of oxygen at birth, was shown to be safe during this phase II clinical trial. However, xenon plus cooling treatment did not provide added neuroprotective benefit over cooling treatment alone.
The TOBY Xenon Study was funded by the Medical Research Council, and its sponsor was Imperial College London.
New report from MBRRACE-UK presents perinatal mortality figures for all UK NHS Trusts & Health Boards
"Perinatal Mortality Surveillance Report - UK Perinatal Deaths for Births from January to December 2013: Supplementary Report UK Trusts and Health Boards"
A Supplementary Report for UK NHS Trusts and Health Boards is published today by MBRRACE-UK. This report presents the first UK published perinatal mortality figures for Trusts and Health Boards for perinatal deaths in 2013.
The purpose of this Supplementary Report is to enable individual Trusts and Health Boards to understand their local stillbirth, neonatal death and extended perinatal death mortality rates and to give local teams an insight into clinical performance based not just on crude mortality rates, but also having taken account of at least some of the important socio-demographic factors that influence pregnancy outcomes.
Importantly the figures for individual Trusts and Health Boards are compared with other Trusts and Health Boards which provide care to women with similarly high or low risk pregnancies. This is based on the highest level of complex neonatal care provision, and for those organisations which do not provide high level complex neonatal care it is based on the number of women who deliver each year in their organisation. NHS Trusts and Health Boards have then been rated within these groups, comparing their mortality rate to the group average using the traffic light system used in the main report published in June. Guidance is provided to Trusts and Health Boards as to the action they should take based on their rating.
A paper exploring the mechanisms of resilience in children exposed postnatally to depressive symptoms has been published in PlosOne. The study, co-authored by a team of researchers including NPEU researchers Emily Savage-McGlynn, Maggie Redshaw, and Ron Gray, used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), specifically focusing on the mother’s views of parenting and experience of interacting with her child during the first 2 postnatal years and later behaviour at 8 years of age.
Symptoms of maternal postnatal depression have previously been associated with an increased risk of adverse effects on child development, including behavioural problems, cognitive difficulties, and attachment issues. This study found that resilience (or positive adaptation to adversity) was associated with two factors: 1) the mother’s positive feelings about parenting, and 2) the child’s nonverbal communication at 15 months. The identification of these factors provides insight about opportunities for early intervention with women identified with postnatal depression that can potentially support mother-child interaction, fostering child development and later child resilience. Read the paper in Plos One.
“Saving Lives, Improving Mothers’ Care - Surveillance of maternal deaths in the UK 2011-13 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-13”
The second report of the Confidential Enquiry into Maternal Deaths issued by the MBRRACE-UK collaboration is published today.
Led by the MBRRACE-UK team at the National Perinatal Epidemiology Unit at the University of Oxford this report details the findings of maternal mortality surveillance 2011 to 2013 in the UK and the lessons learned from the confidential enquiries into maternal deaths of women with mental health-related problems, substance misuse, cancer and blood clots and women who died by homicide.
Overall, the maternal mortality rate in the UK continues to fall largely as a result of a reduction in deaths from ‘direct’ pregnancy causes. However the rate of deaths from ‘indirect’ causes has not reduced significantly. These are deaths from conditions not directly due to pregnancy but existing conditions which are exacerbated by pregnancy, for example, women with heart problems. More of these deaths will need to be prevented in the future to reach the UK Government target of a 50% reduction in maternal deaths by 2030.
The care of more than 100 women who died by suicide during pregnancy or in the year after giving birth between 2009 and 2013 was reviewed in detail. One in eleven of the women who died during or up to six weeks after pregnancy died from mental health-related causes. However, almost a quarter of all maternal deaths between six weeks and a year after birth are related to mental health problems, and one in seven of the women who died in this period died by suicide. Although severe maternal mental illness is uncommon, it can develop very quickly in women after birth; the woman, her family and mainstream mental health services may not recognise this or move fast enough to take action.
The care for women with substance misuse problems and those living socially complex lives was also reviewed. The messages for future care echoed those for women with mental health problems, including the need for joined up multi-agency care to ensure that these women do not fall through the cracks between services. The report also contains messages for the future care of women with cancer and those at risk of blood clots, which is the primary cause of ‘direct’ maternal deaths.
Clear pointers for improving services and care by individual practitioners were identified and these are discussed in detail alongside the findings in the full report which is available to download.
Follow us on Twitter @mbrrace for updates on MBRRACE-UK.
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