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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. Accuracy of the concentration of morphine infusions prepared for patients in a neonatal intensive care unit

Author

Karen Turnock, Timothy J. Watts, Sara Arenas-Lopez, Virginia Aguado-Lorenzo, Kevin Weeks, and Paul Tunstell

Subjects
Adult, Neonatal intensive care unit, Morphine, business.industry, Syringes, Infant, Newborn, Small sample, Pharmacy, Pharmaceutical Solutions, Current practice, Intensive Care Units, Neonatal, Anesthesia, Pediatrics, Perinatology and Child Health, Humans, Medication Errors, Medicine, Patient group, Infusions, Intravenous, business, Chromatography, High Pressure Liquid, Syringe, medicine.drug
Abstract

Objective To investigate the accuracy of morphine infusions prepared for neonates in relation to the label strength and to identify the differences in deviation between infusions made in neonatal intensive care unit (NICU) and those dispensed ready-to-use from pharmacy. Methods Unused portions of morphine solution for infusion were collected over a 6-weeks period and used to determine the concentration of the drug by high-performance liquid chromatography (HPLC). Results A total of 19.2% of infusions prepared by nurses in the ward and 7.8% prepared in the pharmacy were outside the limit required by the British Pharmacopoeia (±7.5%). Moreover, a deviation in concentration of more than 20% was found in ward-prepared infusions, although this was caused by volume discrepancies of less than 0.2 mL. The frequency and magnitude of deviations found in infusions prepared in pharmacy was lower than in those prepared by NICU. The latter showed significantly higher number of out-of-specification samples (p=0.015); however, deviations from intended concentration occurred in both settings. Significant differences between pharmacy and NICU for volumes of less than 0.5 mL or for less than 1 mL were not identified probably due to small sample size, but statistical data show a trend for differences. Conclusions Current practice of preparation of infusions from strengths intended for older children and adults involves dilution of small volumes in a syringe and leads to inaccuracy in the final concentration of infusions for neonatal use. We propose the implementation of standard concentrations for this patient group to effectively eliminate these errors.

Published
2013
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3. The Exclusion of Children with Disabilities in Early Childhood Education in New Zealand: Issues and Implications for Inclusion

Author

Benita Rarere-Briggs, Robyn Stark, Karen Turnock, Diane Gordon-Burns, and Kerry Purdue

Subjects
Early childhood education, Young child, business.industry, Project commissioning, Compromise, media_common.quotation_subject, Legislation, Education, Developmental psychology, Publishing, Developmental and Educational Psychology, Sociology, business, Inclusion (education), media_common
Abstract

IN NEW ZEALAND, LEGISLATION and policy states that every young child has the right to participate in, and receive, a high-quality early childhood education. However, this is not always the case for children with disabilities and their families. This article addresses issues related to the exclusion of such children in early childhood education in New Zealand. In particular, the article highlights the exclusive cultures, policies and practices that compromise the nationally legislated policy of inclusion for children with disabilities and their families. It also offers ideas on bringing about changes in thought and practice that might help to progress inclusion.

Published
2011
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