19 results on '"Draper ES"'
Search Results
2. Authors' reply to Page and Rafi.
- Author
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Zeitlin J, Manktelow BN, Piedvache A, Cuttini M, Boyle E, van Heijst A, Gadzinowski J, Van Reempts P, Huusom L, Weber T, Schmidt S, Barros H, Dillalo D, Toome L, Norman M, Blondel B, Bonet M, Draper ES, and Maier RF
- Published
- 2016
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3. Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort.
- Author
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Zeitlin J, Manktelow BN, Piedvache A, Cuttini M, Boyle E, van Heijst A, Gadzinowski J, Van Reempts P, Huusom L, Weber T, Schmidt S, Barros H, Dillalo D, Toome L, Norman M, Blondel B, Bonet M, Draper ES, and Maier RF
- Subjects
- Europe epidemiology, Female, Humans, Infant, Newborn, Pregnancy, Prospective Studies, Survival Rate, Evidence-Based Practice, Infant, Extremely Premature, Infant, Premature, Diseases mortality
- Abstract
Objectives: To evaluate the implementation of four high evidence practices for the care of very preterm infants to assess their use and impact in routine clinical practice and whether they constitute a driver for reducing mortality and neonatal morbidity., Design: Prospective multinational population based observational study., Setting: 19 regions from 11 European countries covering 850 000 annual births participating in the EPICE (Effective Perinatal Intensive Care in Europe for very preterm births) project., Participants: 7336 infants born between 24+0 and 31+6 weeks' gestation in 2011/12 without serious congenital anomalies and surviving to neonatal admission., Main Outcome Measures: Combined use of four evidence based practices for infants born before 28 weeks' gestation using an "all or none" approach: delivery in a maternity unit with appropriate level of neonatal care; administration of antenatal corticosteroids; prevention of hypothermia (temperature on admission to neonatal unit ≥36°C); surfactant used within two hours of birth or early nasal continuous positive airway pressure. Infant outcomes were in-hospital mortality, severe neonatal morbidity at discharge, and a composite measure of death or severe morbidity, or both. We modelled associations using risk ratios, with propensity score weighting to account for potential confounding bias. Analyses were adjusted for clustering within delivery hospital., Results: Only 58.3% (n=4275) of infants received all evidence based practices for which they were eligible. Infants with low gestational age, growth restriction, low Apgar scores, and who were born on the day of maternal admission to hospital were less likely to receive evidence based care. After adjustment, evidence based care was associated with lower in-hospital mortality (risk ratio 0.72, 95% confidence interval 0.60 to 0.87) and in-hospital mortality or severe morbidity, or both (0.82, 0.73 to 0.92), corresponding to an estimated 18% decrease in all deaths without an increase in severe morbidity if these interventions had been provided to all infants., Conclusions: More comprehensive use of evidence based practices in perinatal medicine could result in considerable gains for very preterm infants, in terms of increased survival without severe morbidity., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
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- 2016
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4. Understanding patterns in maternity care in the NHS and getting it right.
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Chappell LC, Calderwood C, Kenyon S, Draper ES, and Knight M
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- Data Interpretation, Statistical, England, Female, Humans, Pregnancy, Quality Control, Maternal Health Services standards, Maternal Welfare, Quality of Health Care statistics & numerical data, State Medicine standards
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- 2013
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5. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies).
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Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, and Draper ES
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- Cohort Studies, England epidemiology, Female, Gestational Age, Guideline Adherence, Humans, Infant, Newborn, Infant, Premature, Diseases etiology, Infant, Premature, Diseases therapy, Intensive Care, Neonatal methods, Intensive Care, Neonatal statistics & numerical data, Kaplan-Meier Estimate, Linear Models, Logistic Models, Male, Obstetric Labor Complications epidemiology, Outcome Assessment, Health Care, Patient Discharge, Practice Guidelines as Topic, Pregnancy, Pregnancy Outcome, Prospective Studies, Risk Factors, Infant Mortality trends, Infant, Extremely Premature, Infant, Premature, Diseases epidemiology, Intensive Care, Neonatal trends
- Abstract
Objective: To determine survival and neonatal morbidity for babies born between 22 and 26 weeks' gestation in England during 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks' gestation., Design: Prospective national cohort studies., Setting: Maternity and neonatal units in England., Participants: 3133 births between 22 and 26 weeks' gestation in 2006; 666 admissions to neonatal units in 1995 and 1115 in 2006 of babies born between 22 and 25 weeks' gestation., Main Outcome Measures: Survival to discharge from hospital, pregnancy and delivery outcomes, infant morbidity until discharge., Results: In 2006, survival of live born babies was 2% (n=3) for those born at 22 weeks' gestation, 19% (n=66) at 23 weeks, 40% (n=178) at 24 weeks, 66% (n=346) at 25 weeks, and 77% (n=448) at 26 weeks (P<0.001). At discharge from hospital, 68% (n=705) of survivors had bronchopulmonary dysplasia (receiving supplemental oxygen at 36 weeks postmenstrual age), 13% (n=135) had evidence of serious abnormality on cerebral ultrasonography, and 16% (n=166) had laser treatment for retinopathy of prematurity. For babies born between 22 and 25 weeks' gestation from March to December, the number of admissions for neonatal care increased by 44%, from 666 in 1995 to 959 in 2006. By 2006 adherence to evidence based practice associated with improved outcome had significantly increased. Survival increased from 40% to 53% (P<0.001) overall and at each week of gestation: by 9.5% (confidence interval -0.1% to 19%) at 23 weeks, 12% (4% to 20%) at 24 weeks, and 16% (9% to 23%) at 25 weeks. The proportions of babies surviving in 2006 with bronchopulmonary dysplasia, major cerebral scan abnormality, or weight and/or head circumference <-2 SD were similar to those in 1995, but the proportion treated for retinopathy of prematurity had increased from 13% to 22% (P=0.006). Predictors of mortality and morbidity were similar in both cohorts., Conclusion: Survival of babies born between 22 and 25 weeks' gestation has increased since 1995 but the pattern of major neonatal morbidity and the proportion of survivors affected are unchanged. These observations reflect an important increase in the number of preterm survivors at risk of later health problems.
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- 2012
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6. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies.
- Author
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Moore T, Hennessy EM, Myles J, Johnson SJ, Draper ES, Costeloe KL, and Marlow N
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- Blindness diagnosis, Blindness epidemiology, Blindness etiology, Cerebral Palsy diagnosis, Cerebral Palsy epidemiology, Cerebral Palsy etiology, Child, Preschool, Developmental Disabilities diagnosis, Developmental Disabilities epidemiology, Developmental Disabilities etiology, England epidemiology, Female, Follow-Up Studies, Gestational Age, Hearing Loss diagnosis, Hearing Loss epidemiology, Hearing Loss etiology, Humans, Infant, Infant, Newborn, Infant, Premature, Diseases diagnosis, Infant, Premature, Diseases etiology, Intensive Care, Neonatal statistics & numerical data, Intensive Care, Neonatal trends, Logistic Models, Lost to Follow-Up, Male, Outcome Assessment, Health Care, Prevalence, Prospective Studies, Psychological Tests, Risk Factors, Infant Mortality trends, Infant, Extremely Premature, Infant, Premature, Diseases epidemiology
- Abstract
Objective: To determine outcomes at age 3 years in babies born before 27 completed weeks' gestation in 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks' gestation., Design: Prospective national cohort studies, EPICure and EPICure 2., Setting: Hospital and home based evaluations, England., Participants: 1031 surviving babies born in 2006 before 27 completed weeks' gestation. Outcomes for 584 babies born at 22-25 weeks' gestation were compared with those of 260 surviving babies of the same gestational age born in 1995., Main Outcome Measures: Survival to age 3 years, impairment (2008 consensus definitions), and developmental scores. Multiple imputation was used to account for the high proportion of missing data in the 2006 cohort., Results: Of the 576 babies evaluated after birth in 2006, 13.4% (n=77) were categorised as having severe impairment and 11.8% (n=68) moderate impairment. The prevalence of neurodevelopmental impairment was significantly associated with length of gestation, with greater impairment as gestational age decreased: 45% at 22-23 weeks, 30% at 24 weeks, 25% at 25 weeks, and 20% at 26 weeks (P<0.001). Cerebral palsy was present in 83 (14%) survivors. Mean developmental quotients were lower than those of the general population (normal values 100 (SD 15)) and showed a direct relation with gestational age: 80 (SD 21) at 22-23 weeks, 87 (19) at 24 weeks, 88 (19) at 25 weeks, and 91 (18) at 26 weeks. These results did not differ significantly after imputation. Comparing imputed outcomes between the 2006 and 1995 cohorts, the proportion of survivors born between 22 and 25 weeks' gestation with severe disability, using 1995 definitions, was 18% (95% confidence interval 14% to 24%) in 1995 and 19% (14% to 23%) in 2006. Fewer survivors had shunted hydrocephalus or seizures. Survival of babies admitted for neonatal care increased from 39% (35% to 43%) in 1995 to 52% (49% to 55%) in 2006, an increase of 13% (8% to 18%), and survival without disability increased from 23% (20% to 26%) in 1995 to 34% (31% to 37%) in 2006, an increase of 11% (6% to 16%)., Conclusion: Survival and impairment in early childhood are both closely related to gestational age for babies born at less than 27 weeks' gestation. Using multiple imputation to account for the high proportion of missing values, a higher proportion of babies admitted for neonatal care now survive without disability, particularly those born at gestational ages 24 and 25 weeks.
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- 2012
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7. Gastroschisis: one year outcomes from national cohort study.
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Bradnock TJ, Marven S, Owen A, Johnson P, Kurinczuk JJ, Spark P, Draper ES, and Knight M
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- Cohort Studies, Enteral Nutrition, Female, Gastroschisis surgery, Humans, Infant, Infant, Newborn, Ireland epidemiology, Male, Reoperation statistics & numerical data, Severity of Illness Index, Treatment Outcome, United Kingdom epidemiology, Digestive System Surgical Procedures methods, Gastroschisis mortality, Gastroschisis therapy, Length of Stay statistics & numerical data, Parenteral Nutrition, Total statistics & numerical data
- Abstract
Objective: To describe one year outcomes for a national cohort of infants with gastroschisis., Design: Population based cohort study of all liveborn infants with gastroschisis born in the United Kingdom and Ireland from October 2006 to March 2008., Setting: All 28 paediatric surgical centres in the UK and Ireland., Participants: 301 infants (77%) from an original cohort of 393., Main Outcome Measures: Duration of parenteral nutrition and stay in hospital; time to establish full enteral feeding; rates of intestinal failure, liver disease associated with intestinal failure, unplanned reoperation; case fatality., Results: Compared with infants with simple gastroschisis (intact, uncompromised, continuous bowel), those with complex gastroschisis (bowel perforation, necrosis, or atresia) took longer to reach full enteral feeding (median difference 21 days, 95% confidence interval 9 to 39 days); required a longer duration of parenteral nutrition (median difference 25 days, 9 to 46 days) and a longer stay in hospital (median difference 57 days, 29 to 95 days); were more likely to develop intestinal failure (81% (25 infants) v 41% (102); relative risk 1.96, 1.56 to 2.46) and liver disease associated with intestinal failure (23% (7) v 4% (11); 5.13, 2.15 to 12.3); and were more likely to require unplanned reoperation (42% (13) v 10% (24); 4.39, 2.50 to 7.70). Compared with infants managed with primary fascial closure, those managed with preformed silos took longer to reach full enteral feeding (median difference 5 days, 1 to 9) and had an increased risk of intestinal failure (52% (50) v 32% (38); 1.61, 1.17 to 2.24). Event rates for the other outcomes were low, and there were no other significant differences between these management groups. Twelve infants died (4%)., Conclusions: This nationally representative study provides a benchmark against which individual centres can measure outcome and performance. Stratifying neonates with gastroschisis into simple and complex groups reliably predicts outcome at one year. There is sufficient clinical equipoise concerning the initial management strategy to embark on a multicentre randomised controlled trial comparing primary fascial closure with preformed silos in infants suitable at presentation for either treatment to determine the optimal initial management strategy and define algorithms of care.
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- 2011
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8. Socioeconomic inequalities in outcome of pregnancy and neonatal mortality associated with congenital anomalies: population based study.
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Smith LK, Budd JL, Field DJ, and Draper ES
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- Abortion, Induced mortality, Congenital Abnormalities diagnosis, England epidemiology, Female, Healthcare Disparities statistics & numerical data, Humans, Infant, Infant Mortality, Pregnancy, Prenatal Diagnosis mortality, Prenatal Diagnosis statistics & numerical data, Retrospective Studies, Socioeconomic Factors, Congenital Abnormalities mortality, Pregnancy Outcome epidemiology
- Abstract
Objectives: To investigate socioeconomic inequalities in outcome of pregnancy and neonatal mortality associated with congenital anomalies., Design: Retrospective population based registry study., Setting: East Midlands and South Yorkshire regions of England (representing about 10% of births in England and Wales)., Participants: All registered cases of nine selected congenital anomalies with poor prognostic outcome audited as part of the United Kingdom's fetal anomaly screening programme with an end of pregnancy date between 1 January 1998 and 31 December 2007., Main Outcome Measures: Socioeconomic variation in the risk of selected congenital anomalies; outcome of pregnancy; incidence of live birth and neonatal mortality over time. Deprivation measured with the index of multiple deprivation 2004 at super output area level., Results: There were 1579 fetuses registered with one of the nine selected congenital anomalies. There was no evidence of variation in the overall risk of these anomalies with deprivation (rate ratio for the most deprived 10th with the least deprived 10th: 1.05, 95% confidence interval 0.89 to 1.23). The rate ratio varied with type of anomaly and maternal age (deprivation rate ratio adjusted for maternal age: 1.43 (1.17 to 1.74) for non-chromosomal anomalies; 0.85 (0.63 to 1.15) for chromosomal anomalies). Of the nine anomalies, 86% were detected in the antenatal period, and there was no evidence that this varied with deprivation (rate ratio 0.99, 0.84 to 1.17). The rate of termination after antenatal diagnosis of a congenital anomaly was lower in the most deprived areas compared with the least deprived areas (63% v 79%; rate ratio 0.80, 0.65 to 0.97). Consequently there were significant socioeconomic inequalities in the rate of live birth and neonatal mortality associated with the presence of any of these nine anomalies. Compared with the least deprived areas, the most deprived areas had a 61% higher rate of live births (1.61, 1.21 to 2.15) and a 98% higher neonatal mortality rate (1.98, 1.20 to 3.27) associated with a congenital anomaly., Conclusions: Antenatal screening for congenital anomalies has reduced neonatal mortality through termination of pregnancy. Socioeconomic variation in decisions regarding termination of pregnancy after antenatal detection, however, has resulted in wide socioeconomic inequalities in liveborn infants with a congenital anomaly and subsequent neonatal mortality.
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- 2011
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9. Nature of socioeconomic inequalities in neonatal mortality: population based study.
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Smith LK, Manktelow BN, Draper ES, Springett A, and Field DJ
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- Cause of Death trends, Congenital Abnormalities mortality, England epidemiology, Humans, Infant, Newborn, Infant, Premature, Retrospective Studies, Socioeconomic Factors, Infant Mortality trends
- Abstract
Objective: To investigate time trends in socioeconomic inequalities in cause specific neonatal mortality in order to assess changing patterns in mortality due to different causes, particularly prematurity, and identify key areas of focus for future intervention strategies., Design: Retrospective cohort study., Setting: England., Participants: All neonatal deaths in singleton infants born between 1 January 1997 and 31 December 2007., Main Outcome Measure: Cause specific neonatal mortality per 10 000 births by deprivation tenth (deprivation measured with UK index of multiple deprivation 2004 at super output area level)., Results: 18 524 neonatal deaths occurred in singleton infants born in the 11 year study period. Neonatal mortality fell between 1997-9 and 2006-7 (from 31.4 to 25.1 per 10 000 live births). The relative deprivation gap (ratio of mortality in the most deprived tenth compared with the least deprived tenth) increased from 2.08 in 1997-9 to 2.68 in 2003-5, before a fall to 2.35 in 2006-7. The most common causes of death were immaturity and congenital anomalies. Mortality due to immaturity before 24 weeks' gestation did not decrease over time and showed the widest relative deprivation gap (2.98 in 1997-9; 4.14 in 2003-5; 3.16 in 2006-7). Mortality rates for all other causes fell over time. For congenital anomalies, immaturity, and accidents and other specific causes, the relative deprivation gap widened between 1997-9 and 2003-5, before a slight fall in 2006-7. For intrapartum events and sudden infant deaths (only 13.5% of deaths) the relative deprivation gap narrowed slightly., Conclusions: Almost 80% of the relative deprivation gap in all cause mortality was explained by premature birth and congenital anomalies. To reduce socioeconomic inequalities in mortality, a change in focus is needed to concentrate on these two influential causes of death. Understanding the link between deprivation and preterm birth should be a major research priority to identify interventions to reduce preterm birth.
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- 2010
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10. Socioeconomic inequalities in survival and provision of neonatal care: population based study of very preterm infants.
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Smith LK, Draper ES, Manktelow BN, and Field DJ
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- Delivery of Health Care statistics & numerical data, England, Humans, Incidence, Infant, Newborn, Intensive Care, Neonatal organization & administration, Intensive Care, Neonatal statistics & numerical data, Length of Stay, Perinatal Care statistics & numerical data, Poverty Areas, Socioeconomic Factors, Survival Analysis, Delivery of Health Care organization & administration, Infant Mortality, Infant, Premature, Perinatal Care organization & administration
- Abstract
Objectives: To assess socioeconomic inequalities in survival and provision of neonatal care among very preterm infants., Design: Prospective cohort study in a geographically defined population., Setting: Former Trent health region of the United Kingdom (covering about a twelfth of UK births)., Participants: All infants born between 22+0 and 32+6 weeks' gestation from 1 January 1998 to 31 December 2007 who were alive at the onset of labour and followed until discharge from neonatal care., Main Outcome Measures: Survival to discharge from neonatal care per 1000 total births and per 1000 very preterm births. Neonatal care provision for very preterm infants surviving to discharge measured with length of stay, provision of ventilation, and respiratory support. Deprivation measured with the UK index of multiple deprivation 2004 score at super output area level., Results: 7449 very preterm singleton infants were born in the 10 year period. The incidence of very preterm birth was nearly twice as high in the most deprived areas compared with the least deprived areas. Consequently rates of mortality due to very preterm birth per 1000 total births were almost twice as high in the most deprived areas compared with the least deprived (incidence rate ratio 1.94, 95% confidence interval 1.62 to 2.32). Mortality rates per 1000 very preterm births, however, showed little variation across all deprivation fifths (incidence rate ratio for most deprived fifth versus least deprived 1.02, 0.86 to 1.20). For infants surviving to discharge from neonatal care, measures of length of stay and provision of ventilation and respiratory support were similar across all deprivation fifths., Conclusions: The burden of mortality and morbidity is greater among babies born to women from deprived areas because of increased rates of very preterm birth. After very preterm birth, however, survival rates and neonatal care provision is similar for infants from all areas.
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- 2009
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11. Congenital abnormalities: data needed to establish causes.
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Draper ES, Rankin J, Tonks A, Boyd P, Wellesley D, Tucker D, and Budd J
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- Child, Data Collection, England epidemiology, Humans, Congenital Abnormalities etiology
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- 2009
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12. Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994-9 compared with 2000-5.
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Field DJ, Dorling JS, Manktelow BN, and Draper ES
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- Abortion, Spontaneous mortality, England epidemiology, Epidemiologic Methods, Gestational Age, Humans, Infant, Newborn, Intensive Care, Neonatal statistics & numerical data, Stillbirth epidemiology, Infant Mortality, Infant, Premature
- Abstract
Objective: To assess changes in survival for infants born before 26 completed weeks of gestation., Design: Prospective cohort study in a geographically defined population., Setting: Former Trent health region of the United Kingdom., Subjects: All infants born at 22+0 to 25+6 weeks' gestation to mothers living in the region. Terminations were excluded but all other births of babies alive at the onset of labour or the delivery process were included., Main Outcome Measures: Outcome for all infants was categorised as stillbirth, death without admission to neonatal intensive care, death before discharge from neonatal intensive care, and survival to discharge home in two time periods: 1994-9 and 2000-5 inclusive., Results: The proportion of infants dying in delivery rooms was similar in the two periods, but a significant improvement was seen in the number of infants surviving to discharge (P<0.001). Of 497 infants admitted to neonatal intensive care in 2000-5, 236 (47%) survived to discharge compared with 174/490 (36%) in 1994. These changes were attributable to substantial improvements in the survival of infants born at 24 and 25 weeks. During the 12 years of the study none of the 150 infants born at 22 weeks' gestation survived. Of the infants born at 23 weeks who were admitted to intensive care, there was no significant improvement in survival to discharge in 2000-5 (12/65 (18%) in 2000-5 v 15/81 (19%) in 1994-9)., Conclusions: Survival of infants born at 24 and 25 weeks of gestation has significantly increased. Although over half the cohort of infants born at 23 weeks was admitted to neonatal intensive care, there was no improvement in survival at this gestation. Care for infants born at 22 weeks remained unsuccessful.
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- 2008
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13. A feasibility study of signed consent for the collection of patient identifiable information for a national paediatric clinical audit database.
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McKinney PA, Jones S, Parslow R, Davey N, Darowski M, Chaudhry B, Stack C, Parry G, and Draper ES
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- Adolescent, Adult, Child, Preschool, Databases, Factual statistics & numerical data, England, Feasibility Studies, Female, Humans, Infant, Infant, Newborn, Intensive Care Units, Pediatric, Male, Patient Identification Systems statistics & numerical data, Consent Forms statistics & numerical data, Data Collection methods, Third-Party Consent statistics & numerical data
- Abstract
Objectives: To investigate the feasibility of obtaining signed consent for submission of patient identifiable data to a national clinical audit database and to identify factors influencing the consent process and its success., Design: Feasibility study., Setting: Seven paediatric intensive care units in England., Participants: Parents/guardians of patients, or patients aged 12-16 years old, approached consecutively over three months for signed consent for submission of patient identifiable data to the national clinical audit database the Paediatric Intensive Care Audit Network (PICANet)., Main Outcome Measures: The numbers and proportions of admissions for which signed consent was given, refused, or not obtained (form not returned or form partially completed but not signed), by age, sex, level of deprivation, ethnicity (South Asian or not), paediatric index of mortality score, length of hospital stay (days in paediatric intensive care)., Results: One unit did not start and one did not fully implement the protocol, so analysis excluded these two units. Consent was obtained for 182 of 422 admissions (43%) (range by unit 9% to 84%). Most (101/182; 55%) consents were taken by staff nurses. One refusal (0.2%) was received. Consent rates were significantly better for children who were more severely ill on admission and for hospital stays of six days or more, and significantly poorer for children aged 10-14 years. Long hospital stays and children aged 10-14 years remained significant in a stepwise regression model of the factors that were significant in the univariate model., Conclusion: Systematically obtaining individual signed consent for sharing patient identifiable information with an externally located clinical audit database is difficult. Obtaining such consent is unlikely to be successful unless additional resources are specifically allocated to training, staff time, and administrative support.
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- 2005
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14. Paediatric cardiac surgical mortality after Bristol: details of risk adjustment tools were not given.
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Parry G, Draper ES, and McKinney P
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- Child, Data Interpretation, Statistical, England, Hospital Mortality, Humans, Wales, Cardiac Surgical Procedures mortality, Risk Assessment methods
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- 2005
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15. Tables for predicting survival for preterm births are updated.
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Draper ES, Manktelow B, Field DJ, and James D
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- Female, Humans, Infant Mortality, Infant, Newborn, Pregnancy, Reference Values, Survival Analysis, Infant, Premature
- Published
- 2003
- Full Text
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16. Measuring later health status of high risk infants: randomised comparison of two simple methods of data collection.
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Field D, Draper ES, Gompels MJ, Green C, Johnson A, Shortland D, Blair M, Manktelow B, Lamming CR, and Law C
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- Community Health Services methods, Costs and Cost Analysis, Data Collection economics, Follow-Up Studies, Humans, Infant, Newborn, Parents, Prognosis, Reproducibility of Results, Surveys and Questionnaires, Data Collection methods, Health Status Indicators, Infant, Premature, Intensive Care, Neonatal
- Abstract
Objective: To test two methods of providing low cost information on the later health status of survivors of neonatal intensive care., Design: Cluster randomised comparison., Setting: Nine hospitals distributed across two UK health regions. Each hospital was randomised to use one of two methods of follow up., Participants: All infants born =32 weeks' gestation during 1997 in the study hospitals., Method: Families were recruited at the time of discharge. In one method of follow up families were asked to complete a questionnaire about their child's health at the age of 2 years (corrected for gestation). In the other method the children's progress was followed by clerks in the local community child health department by using sources of routine information., Results: 236 infants were recruited to each method of follow up. Questionnaires were returned by 214 parents (91%; 95% confidence interval 84% to 97%) and 223 clerks (95%; 86% to 100%). Completed questionnaires were returned by 201 parents (85%; 76% to 94%) and 158 clerks (67%; 43% to 91%). Most parents found the forms easy to complete, but some had trouble understanding the concept of "corrected age" and hence when to return the form. Community clerks often had to rely on information that was out of date and difficult to interpret., Conclusion: Neither questionnaires from parents nor routinely collected health data are adequate methods of providing complete follow up data on children who were born preterm and required neonatal intensive care, though both methods show potential.
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- 2001
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17. Prediction of survival for preterm births.
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Draper ES, Manktelow B, Field DJ, and James D
- Subjects
- Forecasting, Humans, Infant Mortality, Infant, Newborn, Survival Rate, Infant, Premature
- Published
- 2000
18. Prediction of survival for preterm births by weight and gestational age: retrospective population based study.
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Draper ES, Manktelow B, Field DJ, and James D
- Subjects
- Asia ethnology, England epidemiology, Europe ethnology, Female, Humans, Infant, Newborn, Obstetric Labor, Premature ethnology, Pregnancy, Retrospective Studies, Survival Analysis, Birth Weight, Gestational Age, Obstetric Labor, Premature mortality
- Abstract
Objective: To produce current data on survival of preterm infants., Design: Retrospective population based study., Setting: Trent health region., Subjects: All European and Asian live births, stillbirths, and late fetal losses from 22 to 32 weeks' gestation, excluding those with major congenital malformations, in women resident in the Trent health region between 1 January 1994 and 31 December 1997., Main Outcome Measures: Birth weight and gestational age specific survival for both European and Asian infants (a) known to be alive at the onset of labour, and (b) admitted for neonatal care., Results: 738 deaths occurred in 3760 infants born between 22 and 32 weeks' gestation during the study period, giving an overall survival rate of 80.4%. The survival rate for the 3489 (92.8%) infants admitted for neonatal care was 86.6%. For European infants known to be alive at the onset of labour, significant variations in gestation specific survival by birth weight emerged from 24 weeks' gestation: survival ranged from 9% (95% confidence interval 7% to 13%) for infants of birth weight 250-499 g to 21% (16% to 28%) for those of 1000-1249 g. At 27 weeks' gestation, survival ranged from 55% (49% to 61%) for infants of birth weight 500-749 g (below the 10th centile) to 80% (76% to 85%) for those of 1250-1499 g. Infants who were large for dates (>/=27 weeks' gestation) had a slightly reduced, but not significant, predicted survival. Similar survival rates were observed for Asian infants. The odds ratio for the survival of infants from a multiple birth compared with singleton infants was 1.4 (1.1 to 1.8). Survival graphs for infants admitted for neonatal care are presented by sex., Conclusion: Easy to use birth weight and gestational age specific predicted survival graphs for preterm infants facilitate decision making for clinicians and parents. It is important that these graphs are representative, are produced for a geographically defined population, and are not biased towards the outcomes of particular centres. Such graphs, produced in two stages, allow for the changing pattern of survival of infants from the start of the intrapartum period to immediately after admission for neonatal care.
- Published
- 1999
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19. Fall in birth weight of third generation Asian infants.
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Draper ES, Abrams KR, and Clarke M
- Subjects
- Asia ethnology, England, Female, Humans, Infant, Newborn, Parity, Pedigree, Birth Weight
- Published
- 1995
- Full Text
- View/download PDF
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