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1. Effect of national guidance on survival for babies born at 22 weeks’ gestation in England and Wales: population based cohort study

Author

Bradley N Manktelow, Stavros Petrou, Jennifer J Kurinczuk, Richard Lindley, Victoria Nesbitt, Alan C Fenton, Sanjay Salgia, Sarah E Seaton, Matthew Babirecki, Anita Mittal, Ahmed Hassan, Karin Schwarz, Stephen Brearey, Mehdi Garbash, David Gibson, Pauline Adiotomre, Cath Seagrave, Hilary Dixon, Narendra Aladangady, Hassan Gaili, Matthew James, M Lal, Khalid Mannan, Dhaval Dave, Jennifer Birch, I Misra, Richard Nicholl, Charlotte Groves, Christos Zipitis, Joanne Fedee, Richa Gupta, Salim Yasin, Carrie Heal, Chris Knight, Hari Kumar, Delyth Webb, Sankara Narayanan, Elizabeth Eyre, Caroline Sullivan, Wynne Leith, Megan Eaton, Ambalika Das, Andrew Powls, Sanjeev Bali, Katharine Mcdevitt, Anna Gregory, Donovan Duffy, Shu-Ling Chuang, Lucy K Smith, Amit Gupta, Cheryl Battersby, Imran Ahmed, Chris Warren, Laura Stewart, Igor Fierens, Tristan Bate, Mark Johnson, Rashmi Gandhi, Nitin Goel, Artur Abelian, Shakir Saeed, Cheentan Singh, Hilary Conetta, Faith Emery, Vineet Gupta, Yee Aung, Vennila Ponnusamy, Pinki Surana, Caroline Delahunty, Anand Kamalanathan, Kavi Aucharaz, Matt Nash, Alex Allwood, Nigel Brooke, Jennifer Holman, Sobia Balal, Savi Sivashankar, Michael Grosdenier, Prakash Thiagarajan, Lidia Tyszcuzk, Bushra Abdul-Malik, Dominic Muogbo, Chrissie Oliver, Lucinda Winckworth, Naveen Athiraman, Jim Baird, Akinsola Ogundiya, Pamela Cairns, Porus Bastani, Giles Kendall, Puneet Nath, Yee Mon Aung, Ros Garr, Sundeep Sandhu, Anitha James, S Kinmond, Ruchika Gupta, Rebecca Winterson, Nick Barnes, AM Heuchan, Hannah Shore, Archana Mishra, DAMIEN ARMSTRONG, Oluseun Tayo, Carolina Zorro, J Coutts, Karen Turnock, David Deekollu, Victoria Sharp, Rajiv Chaudhary, Sam Wallis, Stan Craig, Lee Abbott, Shaveta Mulla, Penny Broggio, Peter McEwan, Divyen Shah, Grenville Fox, Alison Verner, Clare Cane, Clare Irving, Shelagh Parkinson, Ghada Ramadan, Ruth J Matthews, Ian Gallimore, Nigel Ruggins, Emily van Blankenstein, Penelope Young, Ramona Onita, Toria Klutse, Sonia Spathis, Sathish Krishnan, Samar Sen, Prem Pitchaikani, Jonathan Filkin, Ashok Karupaiah, Richard Heaver, Mohammad Alam, Patricia Cowley, Shilpa Ramesh, Julia Croft, Soma Sengupta, Anitha Vayalakkad, Arun Ramachandran, Se-Yeon Park, Bharath Gowda, Eleanor Bond, Daniel Dogar, Rebecca Kettle, Rathod Poorva, Maninder Bal, Mani Kandasamy, Claire Hollinsworh, Alaa Ghoneem, Girish Gowda, Abraham Isaac, Jo Behrsin, Ather Ahmed, Surendran Chandrasekaran, Tiziana Fragapane Muthukumar, Bivan Saha, Sangeeta Tiwary, Dush Batra, Sanath Reddy, Aesha Mohammedi, Salamatu Jalloh, Kemy Naidoo, Anjali Pektar, Adedayo Owoeye, Umapathee Majuran, Helen Purves, Esther Morris, Peter Curtis, Tayyaba Aamir, Angela Yannoulias, Edward Yates, Abijeet Godhamgaonkar, Abby Parish, Mario Martínez-Jiménez, LM Wong, Dr Morris, Dr Siramhatia, Nim Subhedar, Jo MacLeod, Arin Mukherjee, Dr Bird, Saulius Satas, Andrew Eccleston, Dominic O'Reilly, Dr Bhushan, P Van Der Heide, Helen Rhodes Ben Stenson, Ambrose Onibere, and Nita Saxena

Subjects
Medicine
Abstract

Objectives To explore the effect of changes in national clinical recommendations in 2019 that extended provision of survival focused care to babies born at 22 weeks’ gestation in England and Wales.Design Population based cohort study.Setting England and Wales, comprising routine data for births and hospital records.Participants Babies alive at the onset of care in labour at 22 weeks+0 days to 22 weeks+6 days and at 23 weeks+0 days to 24 weeks+6 days for comparison purposes between 1 January 2018 and 31 December 2021.Main outcome measures Percentage of babies given survival focused care (active respiratory support after birth), admitted to neonatal care, and surviving to discharge in 2018-19 and 2020-21.Results For the 1001 babies alive at the onset of labour at 22 weeks' gestation, a threefold increase was noted in: survival focused care provision from 11.3% to 38.4% (risk ratio 3.41 (95% confidence interval 2.61 to 4.45)); admissions to neonatal units from 7.4% to 28.1% (3.77 (2.70 to 5.27)), and survival to discharge from neonatal care from 2.5% to 8.2% (3.29 (1.78 to 6.09)). More babies of lower birth weight and early gestational age received survival focused care in 2020-21 than 2018-19 (46% to 64% at

Published
2023
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2. Comparison of diagnoses of early-onset sepsis associated with use of Sepsis Risk Calculator versus NICE CG149: a prospective, population-wide cohort study in London, UK, 2020–2021

Author

Kirsty Le Doare, Justin Richards, Paul T Heath, Justinas Teiserskas, Natasha Liow, Helen Smith, Ramnik Mathur, Ruth Shephard, Richard Nicholl, Nandiran Ratnavel, Elizabeth Eyre, Caroline Sullivan, Rie Yoshida, Maria Mendoza, Ambalika Das, Catherine Longley, Andrew Chapman, Shu-Ling Chuang, Sarah May Johnson, Christina Kortsalioudaki, Cheryl Battersby, Amit Verma, Catherine Douch, Keya Sahay, Neha Sharma, Igor Fierens, Tristan Bate, Yinru Lim, Chris Harris, Kate Ryan, Cheentan Singh, Hannah Walker, Alicia Demirjian, Theresa Lamagni, Mariam Elbakry, Neaha Patel, Giles Kendall, Ozioma Obi, Eleanor Hulse, Chloe Ann Cheang, Matthew Rubens, Katie Evans, Kazim Ghafoor, George Lawson, John Ho, Nichola Monks, Lidia Tyszczuk, Chinthika Piyasena, Anne Opute, Zainab Kassim, Sara Tho-Calvi, Erica Twum-Barimah, Divyen Shah, Sara Abdulla, Stephanie Tolan, Sophia Teoh, Siddhartha Paliwal, Uma Srirambhatla, Lucy Crossman, Rebecca Gaunt, Devangi Thakkar, Saranya Ravindran, Sara Farhat Dominguez, Sunanda Bhatia, Joana Freitas, Clare Cane, Ramyia Elangovan, Cassandra Gyamtso, Helen Nightingale, Angela De Cunto, Eleanor Duckworth, Clare Middleton, Lauren Ferretti, Catherine Warrick, Harshini Naidu, Daniel Geer, Nilmi Ekanayake, Lukas Huhn, Rita Marciano, Shivani Shah, Sonia Spathis, Jonathan Filkin, Mohammad Alam, Khadija Ben-Sasi, Julia Croft, Suzanne Sweeney, Reshmi Raychaudhuri, Evangelia Myttaraki, Ayesha Rahim, Sorana Galu, Joanna O'Sullivan, Jenni Jagodzinski, Remon Agaibi, Elmunzir Ahmed, Luvena Anthony, Luana Ayres da Silva, Nauman Balghari, Archana Bansal, Alexandra Briscoe, Sabina Checketts, Jagadish Chintapalli, Li Yan Chow, Jonathan Cookson, Daniel Crane, Andrew DeSilva, Stacey De Atougia, Mariana Gaspar Fonseca, Adeoya Gbemiga Olabamiji, Nicola Glogowski, Andrea Gronska, Jennifer Ho, Nichola Hodges, Ola Joseph, Keisha Kamalanathan, Jessica Kimpton, Niamh Langasco, Rosalie Lear, Amanda Moules, Rajvi Nagrecha, Noor Nusair, Chisaraokwu Nwachukwu, Felicity Ockelford, Chineze Okorowo, Yujing Ooi, Evgenia Panagiotopoulou, Nadia Saleem, Miriam Sanderson, Mashal Shamsuddin, Ana Silva Ferreira, Srikanthy Sivakanthan, Devika Thakur, Naomi Tobi, Madduka Umeh, Benjamin Ummat, Rebecca Unwin, Aarti Verma, Rebecca Wesson, Adelene Wong, Zijian (Chris) Zhang, Juliet Banya, Eleanor Bond, Rina Chotai, Hayley Clements, Alka Desai, Simon Drysdale, Lydia Eze, Laura Govender, Sophie Griffiths, Michela Groppo, Gopinathannair Harikumar, Linda Machakaire, Joselyn Morris, Amisha Singh, Maria Symeonaki, Mercy Ughwujabo, Kirsty Watts, Louis Yee, and Jenny Ziprin

Subjects
Medicine
Abstract

Objective We sought to compare the incidence of early-onset sepsis (EOS) in infants ≥34 weeks’ gestation identified >24 hours after birth, in hospitals using the Kaiser Permanente Sepsis Risk Calculator (SRC) with hospitals using the National Institute for Health and Care Excellence (NICE) guidance.Design and setting Prospective observational population-wide cohort study involving all 26 hospitals with neonatal units colocated with maternity services across London (10 using SRC, 16 using NICE).Participants All live births ≥34 weeks’ gestation between September 2020 and August 2021.Outcome measures EOS was defined as isolation of a bacterial pathogen in the blood or cerebrospinal fluid (CSF) culture from birth to 7 days of age. We evaluated the incidence of EOS identified by culture obtained >24 hours to 7 days after birth. We also evaluated the rate empiric antibiotics were commenced >24 hours to 7 days after birth, for a duration of ≥5 days, with negative blood or CSF cultures.Results Of 99 683 live births, 42 952 (43%) were born in SRC hospitals and 56 731 (57%) in NICE hospitals. The overall incidence of EOS (24 hours was 2.3/100 000 (n=1) for SRC vs 7.1/100 000 (n=4) for NICE (OR 0.5, 95% CI (0.1 to 2.7)). This corresponded to (1/20) 5% (SRC) vs (4/45) 8.9% (NICE) of EOS cases (χ=0.3, p=0.59). Empiric antibiotics were commenced >24 hours to 7 days after birth in 4.4/1000 (n=187) for SRC vs 2.9/1000 (n=158) for NICE (OR 1.5, 95% CI (1.2 to 1.9)). 3111 (7%) infants received antibiotics in the first 24 hours in SRC hospitals vs 8428 (15%) in NICE hospitals.Conclusion There was no significant difference in the incidence of EOS identified >24 hours after birth between SRC and NICE hospitals. SRC use was associated with 50% fewer infants receiving antibiotics in the first 24 hours of life.

Published
2023
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3. Postnatal corticosteroid use for prevention or treatment of bronchopulmonary dysplasia in England and Wales 2012–2019: a retrospective population cohort study

Author

Neena Modi, Chris Gale, Iyad Al-Muzaffar, Jonathan Cusack, Victoria Nesbitt, Sanjay Salgia, Matthew Babirecki, Aashish Gupta, L M Wong, Anita Mittal, Ahmed Hassan, Karin Schwarz, Graham Whincup, Abdul Hasib, Mehdi Garbash, David Gibson, Pauline Adiotomre, Abby Deketelaere, Stanley Zengeya, Cath Seagrave, Hilary Dixon, Narendra Aladangady, Hassan Gaili, Matthew James, M Lal, Lawrence Miall, Venkatesh Kairamkonda, J Kefas, Jennifer Birch, Gail Whitehead, I Misra, Subodh Gupta, Steven Wardle, Eleri Adams, Minesh Khashu, Charlotte Groves, Christos Zipitis, Peter De Halpert, Joanne Fedee, Stephen Jones, Kirsten Mack, Charlotte Huddy, Salim Yasin, Ngozi Edi-osagie, Carrie Heal, Jacqeline Birch, Hari Kumar, Chris Rawlingson, Delyth Webb, Sankara Narayanan, Elizabeth Eyre, Caroline Sullivan, Wynne Leith, Vimal Vasu, Katia Vamvakiti, Megan Eaton, Ambalika Das, Katharine Mcdevitt, Anna Gregory, Shu-Ling Chuang, Sabita Uthaya, Cheryl Battersby, Imran Ahmed, Chris Warren, Tristan Bate, Mark Johnson, Sunil Reddy, Rashmi Gandhi, Nitin Goel, Richard Hearn, Cheentan Singh, Faith Emery, Vineet Gupta, Yee Aung, Vennila Ponnusamy, Pinki Surana, Anand Kamalanathan, Kavi Aucharaz, Lindsay Halpern, Matt Nash, Alex Allwood, Nigel Brooke, Jennifer Holman, Geraint Lee, Sobia Balal, Poornima Pandey, Ravindra Bhat, Simon Rhodes, Savi Sivashankar, Michael Grosdenier, Ajay Reddy, Prakash Thiagarajan, Chinnappa Reddy, Lidia Tyszcuzk, Glynis Rewitzky, Bushra Abdul-Malik, Dominic Muogbo, Angela D'Amore, John McIntyre, Lucinda Winckworth, Jim Baird, Akinsola Ogundiya, Pamela Cairns, Porus Bastani, Marice Theron, Siba Paul, Giles Kendall, Puneet Nath, Ros Garr, Sundeep Sandhu, Michael Cronin, Alison Bedford Russell, Ruchika Gupta, Archana Mishra, Oluseun Tayo, Priya Muthukumar, Brendan Harrington, Victoria Sharp, Nicola Johnson, Sam Wallis, Prashanth Bhat, Lee Abbott, Raju Narasimhan, Kate Creese, Divyen Shah, Clare Cane, Ghada Ramadan, Sijia Yao, Alistair Ewing, Penelope Young, Ramona Onita, Joanne Dangerfield, Jocelyn Morris, Toria Klutse, Sonia Spathis, Sathish Krishnan, Samar Sen, Jez Jones, Geedi Farah, Prem Pitchaikani, Jonathan Filkin, Ashok Karupaiah, Richard Heaver, Mohammad Alam, Tiziana Fragapane, Jess Reynolds, Khadija Ben-Sasi, Patricia Cowley, Shilpa Ramesh, Julia Croft, Soma Sengupta, Nagendra Venkata, Anitha Vayalakkad, Ben Obi, Anjali Petkar, Arun Ramachandran, Se-Yeon Park, Sue Bird, Jageer Mohammed, and Sanjay Jaisal

Subjects
Medicine
Abstract

Objective Describe the population of babies who do and do not receive postnatal corticosteroids for prevention or treatment of bronchopulmonary dysplasia (BPD).Design Retrospective cohort study using data held in the National Neonatal Research Database.Setting National Health Service neonatal units in England and Wales.Patients Babies born less than 32 weeks gestation and admitted to neonatal units from 1 January 2012 to 31 December 2019.Main outcomes Proportion of babies given postnatal corticosteroid; type of corticosteroid; age at initiation and duration, trends over time.Secondary outcomes Survival to discharge, treatment for retinopathy of prematurity, BPD, brain injury, severe necrotising enterocolitis, gastrointestinal perforation.Results 8% (4713/62019) of babies born

Published
2022
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4. Optimization and characterization of levamisole-loaded chitosan nanoparticles by ionic gelation method using 23 factorial design by Minitab® 15

Author

Divyen Shah and Vaishali Londhe

Subjects
Anthelmintics, Chitosan, Materials science, Calorimetry, Differential Scanning, Sodium, Analytical chemistry, Pharmaceutical Science, Nanoparticle, chemistry.chemical_element, Ionic bonding, Factorial experiment, Hydrogen-Ion Concentration, chemistry.chemical_compound, Differential scanning calorimetry, Levamisole, Solubility, chemistry, Chemical engineering, Transmission electron microscopy, Nanoparticles, Particle size
Abstract

Background: The purpose of the present study is to investigate the combined influence of three independent variables on two dependent variables for the preparation of nanoparticles. The three independent variables are the chitosan/sodium tripolyphosphate ratio, pH of sodium tripolyphosphate and levamisole concentration; while particle size and percentage drug entrapment were dependent variables. Discussion: The nanoparticles were prepared by using 23 factorial design to obtain high entrapment efficiency and small size. The polynomial equation can be used to predict the responses. Conclusion: The prepared nanoparticles show busted release for the first 2 h and then show sustained release. The differential scanning calorimetry graphs indicate that drug is completely entrapped in nanoparticles and transmission electron microscopy images show that nanoparticles are spherical in shape and dense solid in nature. The mathematical model obtained by 23 factorial design shows good relationship between independent variables and dependent variables for prediction.

Published
2011

5. Neonatology

Author

Divyen Shah and Michael Harrison

Subjects
General Medicine
Published
2002

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