Chronic lung disease is an ongoing challenge for neonatal medicine, affecting around 1450 preterm babies every year in the UK. High doses of dexamethasone (a corticosteroid) have been shown to improve lung function, but may be associated with longer term neurodevelopmental problems. The effectiveness of lower doses of dexamethasone is unknown.
Dr Helen Yates, lead clinician for the Minidex trial, has recently published an article exploring this controversial topic and discussing the role of the Minidex trial in resolving this debate. The Minidex trial will examine the efficacy of very low dose dexamethasone therapy, to explore whether a minimal dose can still provide improvements in lung function without the short term side effects associated with standard dose therapy. Read the abstract.
A collaborative study between the NPEU and an Indian University has shown the feasibility of using methods developed for the UK Obstetric Surveillance System (UKOSS) to establish a simple anonymous hospital-based obstetric surveillance and research system in the Indian state of Assam (IndOSS-Assam). This pilot study, published in BMJ Global Health, is a first step towards estimating the incidence and case-fatality of severe life-threatening complications during pregnancy and childbirth in Assam and showed a high incidence of eclampsia, postpartum haemorrhage, puerperal sepsis, septic abortion, uterine rupture and anaemic heart failure, along with a high case fatality rate. This suggests the need to focus research and policies to improve management of these conditions to reduce the burden of maternal mortality and morbidity in the state. For more details read the paper.
As maternal deaths become rarer, monitoring near-miss or severe maternal morbidity becomes important as a tool to measure changes in care quality. It has been suggested that routinely available hospital administration data could be used to monitor the quality of maternity care.
NPEU researchers Manisha Nair, Jenny Kurinczuk and Marian Knight carried out a study to investigate the feasibility of creating a National Maternal Morbidity Outcome Indicator using routinely available hospital maternity data in England. The study, published in PLoS One, used Health and Social care Information Centre (HSCIC) in-patient data from 6.39 million women giving birth in England from April 2003 to March 2013 and showed that a composite indicator to monitor trends in maternal morbidity outcomes during childbirth can be generated using routine English hospital data, but the quality and reliability of this monitoring indicator is dependent on the quality of the hospital data, which is currently inadequate.
New results from a large UK study, conducted by Sarah Payne and Maria Quigley, show that breastfeeding for at least 3 months may reduce the risk of hospitalisation for infection in babies. This reduction of risk was larger in babies who were initially exclusively breastfed. In settings such as the UK, where few babies are exclusively breastfed for 6 months, these results show that shorter durations of breastfeeding may still confer significant health benefits. For more details, read the abstract of the paper.
A systematic review of studies reporting risk factors for cerebral palsy and motor impairment in very preterm children has been published in Developmental Medicine & Child Neurology. The review, by NPEU researchers Louise Linsell, Reem Malouf, Jenny Kurinczuk and others, identified 28 articles published over two decades. The primary prognostic risk factors identified were major brain ultrasound abnormalities, male sex, antenatal corticosteroids (which predicts a lower risk) and postnatal steroids (which predicts a higher risk). Read the paper and the related editorial.
A systematic review reporting long term cognitive problems and school outcomes in children born just a few weeks early has been published in Child: Care Health and Development. The review, led by a team including NPEU researchers Maria Quigley and Reem Malouf, included fourteen studies of children who were born late preterm (34-36 weeks' gestation) and eight studies of children born early term (37-37 weeks' gestation), and identified multiple, small, adverse differences between children born late preterm or early term compared with those born at term. Read the abstract of the paper.
The long awaited results from the landmark BOOST-II UK trial have been published in the New England Journal of Medicine. The article, entitled "Outcomes of Two Trials of Oxygen-Saturation Targets in Preterm Infants” reports the outcomes at 2 years (after their expected date of delivery) for babies who participated in the BOOST-II UK and the BOOST-II Australia trials. Read the paper.
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.