Objective: To explore the methodologies employed in studies assessing transition of care interventions, with the aim of defining goals for the improvement of future studies.
Conclusions: Few evaluative studies exist and their level of methodological quality is variable. The complexity of interventions, multiplicity of outcomes, difficulty of blinding and the small groups of patients have consequences on concluding on the effectiveness of interventions. The evaluation of the transition interventions requires an appropriate and common methodology which will provide access to a better level of evidence. We identified areas for improvement in terms of randomisation, recruitment and external validity, blinding, measurement validity, standardised assessment and reporting. Improvements will increase our capacity to determine effective interventions for transition care.
Abbott, J. et al. BMC Pediatrics. Published: 28 January 2017
Background: In the UK, 1–2% of infants are born very preterm (<32 weeks of gestation) or have very low birth weight (<1500 g). Very preterm infants are initially unable to be fed nutritional volumes of milk and therefore require intravenous nutrition. Milk feeding strategies influence several long and short term health outcomes including growth, survival, infection (associated with intravenous nutrition) and necrotising enterocolitis (NEC); with both infection and NEC being key predictive factors of long term disability.
Currently there is no consistent strategy for feeding preterm infants across the UK. The SIFT trial will test two speeds of increasing milk feeds with the primary aim of determining effects on survival without moderate or severe neurodevelopmental disability at 24 months of age, corrected for prematurity. The trial will also examine many secondary outcomes including infection, NEC, time taken to reach full feeds and growth.
NICE guideline [NG62] | Published date: January 2017
This guideline covers diagnosing, assessing and managing cerebral palsy in children and young people from birth up to their 25th birthday. It aims to make sure they get the care and treatment they need for the developmental and clinical comorbidities associated with cerebral palsy, so that they can be as active and independent as possible.
Ullman, F.M. et al. Journal of Pediatric Nursing. Published online: 26 January 2017
The many advantages to providing breast milk instead of engineered infant formula for both the medically fragile and healthy term infant are well documented (Lawrence & Lawrence, 2016; Mcguire, 2011). Historically, educational efforts within neonatal intensive care units (NICUs) focused on critical diseases and conditions, as well as the highly technological management of fragile neonates. The International push to promote both the value and superiority of breast milk for infant feeding began over 3 decades ago (WHO, 1981).
A report by report by the RCPCH has revealed that despite some improvements in the health of UK children over past decades, the UK has one of the highest rates of child mortality in western Europe. The BMA said the UK is failing many of its children, who should not be paying with their health for the economic downturn.
The RCPCH reported in The State of Child Health that almost one in five children in the UK is living in poverty, and that inequality is blighting their lives – deprivation is strongly associated with higher levels of child mortality, child obesity and smoking during pregnancy, and with lower rates of breastfeeding. The College report showed that:
The UK ranks 15 out of 19 western European countries on infant mortality; infant mortality is more than twice as high in the lowest socio-economic groups as in the highest.
The prevalence of smoking during pregnancy in the UK is much higher than in many European countries and strongly associated with deprivation. In Scotland, 25.9% of women in the most deprived areas acknowledged smoking following the birth of their baby, against 3.3% in the least deprived areas. Child smoking is also much more prevalent among children from the most deprived areas.
Breastfeeding rates in England and Scotland have barely improved since records began in 1975, and not at all in the past five years; they are lower than in many other comparable high-income countries. Across the UK, 46% of mothers in the most deprived areas breastfed compared with 65% in the most affluent areas.
Across England, Scotland and Wales more than one in five children in the first year of primary school are overweight or obese. In 2015-16, 40% of children in England’s most deprived areas were overweight or obese, compared with 27% in the most affluent areas.