1,721,134 research outputs found
A healthy nation: strengthening child health research in the UK
No full textDespite a general acknowledgment that research in children is necessary and ethical, the evidence base for child-specific treatments is still sparse. We investigated children's biomedical and health services research in the UK in relation to training, infrastructure and activity, research evidence, and visibility. We show that excellent opportunities for career researchers exist through a competitive, national integrated academic training programme, but that the number of academic paediatricians has decreased by 18% between 2000 and 2011, falling from 11·3% to 5·9% of the consultant workforce. The potential for rapid delivery of studies in children through the National Health Service (NHS) is not being realised: clinical trainees are poorly equipped with core research skills; most newly appointed consultant paediatricians have little or no research experience; less than 5% of contracted consultant time supports research; less than 2·5% of the 2 million children seen in the NHS every year are recruited to studies; and ten of the 20 UK children's hospitals do not have a clinical research facility. Support through National Institute for Health Research networks is good for studies into drugs, but inconsistent for non-drug research; less than 5% of registered studies involve children and only one children's biomedical research centre has been allocated funding from 2012. Of the UK annual public and charitable biomedical research expenditure of roughly £2·2 billion, about 5% is directed at child health research. The scant evidence base is impeding the development of clinical guidance and policy-less than 20% of the outputs of the National Institute for Health and Clinical Excellence are applicable to children. Paediatric representation on major research boards is weak. Parent and young people's advocacy is fragmented, and their views are insufficiently heeded by regulatory bodies. The strong UK Government commitment to biomedical research has not been translated fully to research for children. The power of research in children to turn the tide of the growing burden of non-communicable, chronic, adult diseases that have their origins in early life, to benefit the health of an ageing population and future generations, and to reduce health-care costs is inadequately recognised. On the basis of our findings, we make several recommendations to improve early-years research, including the formation of multidisciplinary, cross-institutional groups of clinical and non-clinical child health researchers and their access to diagnostic and laboratory facilities suitable for children; a unified Children's Research Network for drug studies and non-drug studies; regulatory assessment of research that is proportionate and based on consistent national criteria; an expansion of research posts; support for parents' and young people's advocacy; collaboration between children's research charities; improved research training for paediatric trainees; and closer integration of child health research with core NHS activities
Post-COVID economic recovery: women and children first … or last?
Full text linkTwenty-first century science underpinned the rapid global response to COVID-19, identifying the causal pathogen, sequencing the SARS-CoV-2 genome, developing vaccines and initiating clinical trials, within 9 months of first appearance. Although in tackling the immediate consequences of the pandemic countries responded to science in different ways, every nation now grapples with the economic consequences and the question of where to focus investment. Here, we argue that insights from 21st century science can also lead the way to economic recovery. These indicate that there should be a prime focus on healthy populations resilient to unexpected challenges and that this is to a large extent dependent on maternal, neonatal and child health (MNCH). Recovery from COVID-19 offers a unique opportunity to target investment on MNCH
Glucocorticoid exposure in preterm babies predicts saliva cortisol response to immunization at 4 months
No full textPreterm babies are exposed to multiple stressors and this may have long-term effects. In particular, high levels of endogenous cortisol might have a programming effect on the hypothalamic-pituitary-adrenal axis as may administered glucocorticoids. In this study, we aimed to test the hypothesis that the level of endogenous and exogenous glucocorticoid exposure during the neonatal period predicts the saliva cortisol response to immunization at 4 mo of age. We followed 45 babies born below 32 wk gestation. We showed that their concentration of plasma cortisol during the first 4 wk was 358, 314, 231, and 195 nmol/L cortisol, respectively (geometric mean). This is four to seven times higher than fetal levels at the same gestational age range. We used routine immunization at 4 mo and 12 mo as a stressor and measured the change in saliva cortisol as the stress response. Mean circulating cortisol in the first 4 wk predicted the cortisol response at 4 but not at 12 mo. Path analysis showed that birthweight for gestational age, therapeutic antenatal steroids, and therapeutic postnatal steroids also contributed to the magnitude of the saliva cortisol response at 4 mo. This provides evidence that the magnitude of glucocorticoid exposure, both endogenous and exogenous, may have an effect on later stress responses.Abbreviations:
CFI, comparative fit index
CRH, corticotrophin releasing factor
HPA, hypothalamus-pituitary-adrenal
RMSEA, root mean square error of approximation
SDS, standard deviation scor
A controlled trial of skin-to-skin contact in extremely preterm infants
No full textBackground: extremely preterm birth, even in the absence of significant neurological impairment, is associated with altered pain responses and impaired memory and behaviour. Preterm birth increases the risk of maternal depression and may impede the development of the mother-infant relationship, factors that in turn are also associated with impaired infant outcome. Mother-infant skin-to-skin contact has been recommended as a simple means of ameliorating these effects.
Methods: we conducted a pragmatic, prospective, controlled, intention-to-treat trial in two neonatal intensive care units. Infants born below 32 weeks gestation were recruited within the first week after birth and assigned to a control group receiving standard care, or an intervention group in which mothers were encouraged to provide a session of skin-to-skin contact once daily for 4 weeks. We assessed infant behaviour at time of discharge from hospital, responses to immunisation at 4 and 12 months of age, and memory, behaviour and development at 1 year corrected (postmenstrual) age. Indices of maternal depression, stress, anxiety, lactation performance and infant interaction were assessed at time of infant discharge, 4 months and 1 year.
Results: no significant difference was identified in any infant or maternal measure at any time point.
Conclusions: mother-infant skin-to-skin contact after extremely preterm birth results in neither benefit nor adverse consequences. Although there is no reason to dissuade mothers who wish to provide STS contact, we are unable to recommend resource allocation for the implementation of STS programmes for extremely preterm infants in a neonatal intensive care unit settin
Projected health and economic effects of the increase in childhood obesity during the COVID-19 pandemic in England: the potential cost of inaction.
No full textPreterm formula, human donor milk, and breast milk fortification for preterm infants
Full text linkEvidence is lacking to inform on optimal very preterm diet and growth in relation to functional outcomes. Early adiposity is a potential biomarker of later metabolic disease, but its modification by early nutrition is unknown. The aims of the thesis were to (i) investigate relationships between early diet, macronutrient intake, growth, body composition, and insulin sensitivity, and (ii) evaluate the feasibility of a larger randomised controlled trial powered to detect differences in functional health outcomes. Infants <32 weeks gestation were randomised within 48 hours of birth to receive unfortified human milk (UHM) (unfortified mother’s own milk [MOM] +/- unfortified pasteurised donor milk [pHDM]) supplement), fortified human milk (FHM) (fortified MOM +/- fortified pHDM supplement), and unfortified MOM +/- preterm formula (PTF) supplement from birth to 35+0 weeks post-menstrual age (PMA). Primary outcome was total adipose tissue (TAT) volume at term, measured by whole body magnetic resonance imaging. Secondary outcomes were regional adipose tissue volumes and anthropometry at term and term plus 6 weeks, and quantitative insulin sensitivity check index at 35 weeks PMA. Thirty-five infants were randomised to UHM, 34 to FHM, and 34 to PTF groups, of which 21, 19, and 24 infants completed imaging at term, and 14, 5, and 19 respectively, at term plus 6 weeks. There were no significant between-group differences in TAT at term (mean (sd): UHM: 0.870L (0.35L); FHM: 0.889L (0.31L); PTF: 0.809L (0.25L), p=0.66) or in any other outcome. Agreement to participate in the feeding intervention using an opt-out process was 62%, and 55% consented to imaging using an opt-in approach. Two infants developed severe necrotising enterocolitis, and 2 met a predefined weight gain threshold to receive rescue fortifier/formula. Early macronutrient intake had no persistent effect on body composition, with an early preferential adipose tissue deposition changing to non-adipose tissue mass gains by 35 weeks PMA. Very preterm infants fed UHM, FHM, or PTF as supplements to MOM have comparable body composition and growth at term and term plus 6 weeks. Trial design and feeding interventions were safe, feasible, and acceptable to parents and clinical teams. Modification of body composition by prolonged, or later in-hospital use of fortifier, and relation to functional outcomes are important research questions.Open Acces
Developing, implementing and disseminating a core outcome set for neonatal medicine
No full textBackground: In high resource settings, 1 in 10 newborn babies require admission to a neonatal unit. Research evaluating neonatal care involves recording and reporting many different outcomes and outcome measures. Such variation limits the usefulness of research as studies cannot be compared or combined. To address these limitations, we aim to develop, disseminate and implement a core outcome set for neonatal medicine.Methods: A steering group that includes parents and former patients, healthcare professionals and researchers has been formed to guide the development of the core outcome set. We will review neonatal trials systematically to identify previously reported outcomes. Additionally, we will specifically identify outcomes of importance to parents, former patients and healthcare professionals through a systematic review of qualitative studies. Outcomes identified will be entered into an international, multi-perspective eDelphi survey. All key stakeholders will be invited to participate. The Delphi method will encourage individual and group stakeholder consensus to identify a core outcome set. The core outcome set will be mapped to existing, routinely recorded data where these exist.Discussion: Use of a core set will ensure outcomes of importance to key stakeholders, including former patients and parents, are recorded and reported in a standard fashion in future research. Embedding the core outcome set within future clinical studies will extend the usefulness of research to inform practice, enhance patient care and ultimately improve outcomes. Using routinely recorded electronic data will facilitate implementation with minimal addition burden
Building resilient societies after COVID-19 requires multifaceted investment targeting maternal, neonatal and child health
No full text- …
