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Khan KA, Petrou S, Dritsaki M, Johnson SJ, Manktelow B, Draper ES, Smith LK, Seaton SE, Marlow N, Dorling J, Field DJ, Boyle EM. Economic costs associated with moderate and late preterm birth: a prospective population-based study. BJOG 2015. [PMID: 26219352 DOI: 10.1111/1471-0528.13515] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to determine the economic costs associated with moderate and late preterm birth. DESIGN An economic study was nested within a prospective cohort study. SAMPLE Infants born between 32(+0) and 36(+6) weeks of gestation in the East Midlands of England. A sample of infants born at ≥37 weeks of gestation acted as controls. METHODS Data on resource use, estimated from a National Health Service (NHS) and personal social services perspective, and separately from a societal perspective, were collected between birth and 24 months corrected age (or death), and valued in pounds sterling, at 2010-11 prices. Descriptive statistics and multivariable analyses were used to estimate the relationship between gestational age at birth and economic costs. MAIN OUTCOME MEASURES Cumulative resource use and economic costs over the first two years of life. RESULTS Of all eligible births, 1146 (83%) preterm and 1258 (79%) term infants were recruited. Mean (standard error) total societal costs from birth to 24 months were £12 037 (£1114) and £5823 (£1232) for children born moderately preterm (32(+0) -33(+6) weeks of gestation) and late preterm (34(+0) -36(+6) weeks of gestation), respectively, compared with £2056 (£132) for children born at term. The mean societal cost difference between moderate and late preterm and term infants was £4657 (bootstrap 95% confidence interval, 95% CI £2513-6803; P < 0.001). Multivariable regressions revealed that, after controlling for clinical and sociodemographic characteristics, moderate and late preterm birth increased societal costs by £7583 (£874) and £1963 (£337), respectively, compared with birth at full term. CONCLUSIONS Moderate and late preterm birth is associated with significantly increased economic costs over the first 2 years of life. Our economic estimates can be used to inform budgetary and service planning by clinical decision-makers, and economic evaluations of interventions aimed at preventing moderate and late preterm birth or alleviating its adverse consequences. TWEETABLE ABSTRACT Moderate and late preterm birth is associated with increased economic costs over the first 2 years of life.
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Affiliation(s)
- K A Khan
- University of Warwick, Coventry, UK
| | - S Petrou
- University of Warwick, Coventry, UK
| | | | | | | | | | - L K Smith
- University of Leicester, Leicester, UK
| | | | - N Marlow
- University College London, London, UK
| | - J Dorling
- University of Nottingham, Nottingham, UK
| | - D J Field
- University of Leicester, Leicester, UK
| | - E M Boyle
- University of Leicester, Leicester, UK
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Abstract
OBJECTIVE To describe simple estimates of likely duration of stay for very premature babies born in the UK and discharged home. DESIGN Statistical modelling of data from thirty neonatal units in a geographically defined region of the UK. PARTICIPANTS All babies born at 23 to 32 completed weeks of gestation in 2005, 2006 and 2007 who were discharged home with the expectation that they would survive. MAIN OUTCOME MEASURE Total duration of stay in the neonatal service. RESULTS 5528 babies were initially identified. 558 (10.1%) who died or who did not follow a normal care pathway were excluded. In a further 27, data were either missing or inadequate, leaving a study population of 4702 babies. As expected, gestation and birthweight exhibited strong influence on length of stay. Of the other variables tested, initial reason for admission (need for early respiratory support) showed the most consistent association. These factors were combined to produce predictive tables. The predictive performance of the tables was found to fit the data well for various groups, with the exception of multiple births who tended to have longer stays. However, when tested against individual units, much greater variation was seen independent of unit size and case mix. CONCLUSION The prediction tables should permit parents to make sensible estimates about the duration of their baby's stay in the neonatal service; however, there appear to be important differences between units. The variation noted in length of stay between otherwise similar units merits further investigation.
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Affiliation(s)
- B Manktelow
- Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK
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Kamoji VM, Dorling JS, Manktelow B, Draper ES, Field DJ. Antenatal umbilical Doppler abnormalities: an independent risk factor for early onset neonatal necrotizing enterocolitis in premature infants. Acta Paediatr 2008; 97:327-31. [PMID: 18298781 DOI: 10.1111/j.1651-2227.2008.00671.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is the most common gastrointestinal (GI) emergency seen in neonatal units. Many factors have been considered as potentially important aetiologically, including gut ischaemia, sepsis and feeding. However, evidence remains equivocal. OBJECTIVE This study investigated whether preterm babies born to mothers with abnormal antenatal umbilical Dopplers (absent or reversed end diastolic flow--AREDF), that is exposed to antenatal gut ischaemia, are at an identical risk of developing NEC early in life, compared to babies born to mothers with normal Dopplers. METHODS All preterm (<or=32+6 week gestation) babies with no congenital anomaly, born to mothers resident in the county of Leicestershire in United Kingdom in 2001 and 2002 were identified using the Trent Neonatal Survey (TNS). Clinical data including the presence and severity of any NEC were extracted from the notes. RESULTS Two hundred forty-three preterm babies who met the criteria were identified during the period. Babies in whom umbilical Dopplers were not available and babies that died in the first 48 h were excluded. Complete data was thus available for 206 of these babies. A strong relation between AREDF and subsequent development of NEC was noted in these babies (OR: 5.88, 95% CI: 2.41 to 14.34, p<0.0001). This association still held after adjustment for gestational age at birth (OR: 7.64, 95% CI: 2.96 to 19.70, p<0.0001) and after adjustment for birthweight for gestational age z-score (OR: 6.72, 95% CI: 2.23 to 20.25, p=0.0007). CONCLUSIONS This study, based on a neonatal cohort, indicates that AREDF is an important independent risk factor for the production of NEC.
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Affiliation(s)
- V M Kamoji
- Neonatal Unit, Leicester Royal Infirmary, Leicester, and Department of Health Sciences, University of Leicester, Leicester, UK
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Tiruvoipati R, Pandya H, Manktelow B, Smith J, Dodkins I, Elbourne D, Field D. Referral pattern of neonates with severe respiratory failure for extracorporeal membrane oxygenation. Arch Dis Child Fetal Neonatal Ed 2008; 93:F104-7. [PMID: 17595202 DOI: 10.1136/adc.2006.113167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) remains the mainstay of management in neonates with severe but potentially reversible respiratory failure. In the UK, ECMO is available only as a supraregional service at four centres. OBJECTIVE To explore regional variations in ECMO referrals and neonatal deaths due to severe respiratory failure in England, Wales and Northern Ireland. METHODS In this retrospective study, data regarding ECMO referrals due to neonatal respiratory failure from January to December 2002 were obtained from the four UK ECMO centres and then subdivided according to the Government Office Regions. Anonymised data regarding neonatal deaths was obtained from Confidential Enquiry into Maternal and Child Health. Neonatal deaths were classified into four groups (group 1: deaths potentially avoidable by ECMO; group 2: deaths where it was unclear whether ECMO would have been of benefit; group 3: neonates not eligible for ECMO; and group 4: data inadequate to classify deaths). RESULTS There was significant regional variation in the rates of both ECMO referral (0.10 to 0.46 per 1000 live births; (p<0.001)) and neonatal deaths (groups 1 and 2) (0.09 to 0.32 per 1000 live births; (p<0.001)). Regions with high referral rates for ECMO tended towards having higher group 1 plus group 2 neonatal death rates (correlation coefficient = 0.75). CONCLUSION It is possible that there are significant regional variations in the uptake of ECMO and in neonatal mortality due to severe respiratory failure. A confidential prospective study may further clarify these observations and identify the factors that might lead to these variations.
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Sabri K, Manktelow B, Anwar S, Field D, Woodruff G. Ethnic variations in the incidence and outcome of severe retinopathy of prematurity. Can J Ophthalmol 2007; 42:727-30. [PMID: 17891200 DOI: 10.3129/i07-136] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The aim of this study was to assess the incidence and outcome of severe retinopathy of prematurity (ROP) among different ethnic groups in a geographically defined population in the U.K. Severe ROP was defined as any stage 3 or worse disease. METHODS This was a retrospective study of children born over a 6-year period with a birth weight of 1250 g or less. Threshold ROP was treated with diode laser. RESULTS Severe disease developed in 37 out of 355 neonates (10.4%) who underwent ROP screening. The difference in the incidence of severe ROP between infants of Caucasian and South Asian ethnic origin was not statistically significant: 10.2% vs. 10.8% (odds ratio = 1.06; 95% confidence interval: 0.44 to 2.57). This conclusion held after single-variable adjustment for birth weight, gestational age, and score on the Clinical Risk Index for Babies. The incidence of threshold ROP was 3% among infants of both Caucasian and South Asian ethnic origin. There was no significant difference in terms of visual outcome between the Caucasian and South Asian infants. INTERPRETATION This study showed no statistical evidence for a difference in the incidence or outcome of severe ROP among infants of South Asian ethnic origin compared with those of Caucasian origin. Although the small numbers in our study mean that a clinically important difference cannot be excluded, it is very unlikely that the 5-fold higher incidence in Asian babies described in the literature is correct for the population from which our subjects were drawn.
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Affiliation(s)
- K Sabri
- Department of Ophthalmology, Leicester Royal Infirmary, UK.
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Tiruvoipati R, Bangash M, Manktelow B, Peek G. Efficacy of prone ventilation in adult patients with acute respiratory failure: a meta-analysis. Crit Care 2007. [PMCID: PMC4095240 DOI: 10.1186/cc5346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Illness severity scores have become widely used in neonatal intensive care. Primarily this has been to adjust the mortality observed in a particular hospital or population for the morbidity of their infants, and hence allow standardised comparisons to be performed. However, although risk correction has become relatively commonplace in relation to audit and research involving groups of infants, the use of such scores in giving prognostic information to parents, about their baby, has been much more limited. The strengths and weaknesses of the existing methods of disease severity correction in the newborn are presented in this review.
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Affiliation(s)
- J S Dorling
- Department of Health Sciences, University of Leicester, Neonatal Unit, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
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Affiliation(s)
- D Field
- Department of Child Health, University of Leicester, UK.
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Abstract
BACKGROUND A close association between serum lipid levels and the incidence of coronary heart disease (CHD) has been well proven in middle aged and older persons, up to the age of 70-75 years. Individual studies have shown interventions to reduce total and low density lipoprotein (LDL) cholesterol levels, especially with 3-hydroxy-3-methylglutaryl coenzyme a (HMG-CoA) reductase inhibitors (statins), to be of benefit in reducing CHD and stroke events in those with a history of coronary heart disease. However, the relation of serum cholesterol and cholesterol sub-fractions with cerebrovascular disease is less clear. It is unclear whether lipid levels in the post-stroke period are a predictor of recurrence and whether treatment to alter levels can prevent recurrence of either stroke or cardiovascular events. OBJECTIVES To investigate the effect of altering serum lipids in the prevention of cardiovascular disease and stroke recurrence in subjects with a history of stroke. SEARCH STRATEGY The Cochrane Group Trials Register was searched up to 8 May 2001 along with MEDLINE (from 1966), EMBASE (from 1980) and the Cochrane Controlled Trials Register. All pharmaceutical firms known to produce a lipid lowering agent were also contacted and asked to provide information on publications or unpublished work relevant to this review. SELECTION CRITERIA This review included unconfounded randomised trials of subjects aged 18 years and over with a history of stroke or Transient Ischaemic Attack (TIA). DATA COLLECTION AND ANALYSIS The data were extracted independently by the three reviewers. MetaView 4.1 was used for all statistical analyses. MAIN RESULTS Five studies involving 1700 patients were included in the review. The active intervention in two of the studies was Clofibrate, Pravastatin in another two and Conjugated Oestrogen in the fifth. Fixed effects analysis showed no evidence of a difference in stroke recurrence between the treatment and placebo groups for those with a previous history of stroke or TIA (odds ratio 0.96, 95% confidence interval 0.71 to 1.30). In addition there was also no evidence, based on two studies, that intervention reduced the odds of all cause mortality (odds ratio 0.87, 95% confidence interval 0.55 to 1.39) nor, from one study, that there was any effect on subsequent vascular events (odds ratio 1.27, 95% confidence interval 0.84 to 1.89). REVIEWER'S CONCLUSIONS These trials do not provide evidence for a benefit, or harm, from interventions to alter serum lipid levels in patients with a history solely of cerebrovascular disease. Their use, therefore, cannot yet be recommended routinely in this patient group, but ischaemic stroke patients with a history of myocardial infarction should receive statin therapy along the lines of the previous recommendations for those patients with a history of myocardial ischaemia. There are currently three ongoing trials which will recruit approximately 30,000 patients, including those with a history of stroke, and the results of these trials may have a significant effect on these conclusions.
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Affiliation(s)
- B Manktelow
- Dept. Epidemiology and Public Health, University of Leicester, 22-28 Princess Road West, Leicester, UK, LE1 6TP.
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Field D, Draper ES, Gompels MJ, Green C, Johnson A, Shortland D, Blair M, Manktelow B, Lamming CR, Law C. Measuring later health status of high risk infants: randomised comparison of two simple methods of data collection. BMJ 2001; 323:1276-81. [PMID: 11731389 PMCID: PMC60300 DOI: 10.1136/bmj.323.7324.1276] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2001] [Indexed: 11/03/2022]
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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Affiliation(s)
- D Field
- University of Leicester Medical School, Leicester, UK.
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Robinson TG, Dawson SL, Ahmed U, Manktelow B, Fotherby MD, Potter JF. Twenty-four hour systolic blood pressure predicts long-term mortality following acute stroke. J Hypertens 2001; 19:2127-34. [PMID: 11725154 DOI: 10.1097/00004872-200112000-00003] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effects of acute blood pressure (BP) on long-term mortality following stroke. DESIGN Prospective observational study. SETTING Leicester Teaching Hospitals. PATIENTS Two hundred and nineteen consecutive patients were recruited within 24 h of acute stroke. INTERVENTIONS Clinic and 24 h BP levels were measured. Other risk factors previously associated with stroke mortality were recorded within 24 h of admission. No specific pharmacological interventions;were made. MAIN OUTCOME MEASURES The primary outcome measure was death over a median follow-up period of over 2.5 years. The hazards ratios associated with predefined variables were assessed using Cox's proportional hazards modelling, and Kaplan-Meier survival plots were also calculated. RESULTS On multiple variable analysis, 24 h systolic BP (> or = 160 mmHg) was associated with an increased hazards ratio of 2.41 (95% confidence intervals: 1.24-4.67) for death, compared to the reference group (140-159 mmHg). The addition of 24 h heart rate was significant, with increasing heart rate (> 83 bpm) associated with an increased mortality (P = 0.006), although this effect was not constant over time. Increasing age (> 80 years) at presentation was also associated with an increased hazards ratio of 2.53 (1.14-5.62) compared to age < or = 66 years. CONCLUSIONS This study provides evidence that elevated 24 h systolic BP in the acute stroke period is associated with increased long-term mortality. This may have implications in the therapeutic management of BP following stroke, though further research is required to determine the timing, nature and effect of such an intervention.
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Affiliation(s)
- T G Robinson
- Department of Medicine, Division of Medicine for the Elderly, Leicester Warwick Medical School, University Hospitals of Leicester NHS Trust, Leicester, UK.
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Abstract
AIM To study the experience of, training in, and confidence in the transportation of critically ill neonates amongst paediatric trainees in one UK region. DESIGN An anonymized questionnaire was sent to all middle grades with paediatrics National Training Numbers from the Trent region. RESULTS The response rate was 78%. Less than half (45%) of the respondents reported receiving any training in the transportation of neonates, either in the UK or abroad; 45% (30/66) of the trainees reported having performed 10 or fewer neonatal transfers. The self-perceived confidence for transporting neonates was scored on a 10-point scale, to produce a "confidence score", the median score being 7 (IQ range 5, 8). Both as a group and individually, the trainee paediatricians were more confident in transporting neonates than older infants or children (p < 0.0001). Using multiple analysis of covariance, it was found that the most important and significant variables affecting the "confidence scores" for the inter-hospital transportation of critically ill neonates were receipt of any relevant transport training, and the current frequency of transports performed. CONCLUSIONS Many training-grade paediatricians lack both the experience and training in transporting critically ill neonates, factors that were found to affect their confidence in transferring sick neonates. As the overwhelming majority of neonatal transports in the UK are still arranged by individual units and performed by training-grade paediatricians, concerns regarding both the safety and effectiveness of the current service provision for the inter-hospital transfer of critically ill neonates remain valid.
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Affiliation(s)
- P J Davis
- Children's Hospital, Leicester Royal Infirmary, UK
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Draper ES, Manktelow B, Field DJ, James D. Prediction of survival for preterm births. BMJ 2000; 321:237. [PMID: 10979676 PMCID: PMC1118228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Draper ES, Manktelow B, Field DJ, James D. Prediction of survival for preterm births by weight and gestational age: retrospective population based study. BMJ 1999; 319:1093-7. [PMID: 10531097 PMCID: PMC28258 DOI: 10.1136/bmj.319.7217.1093] [Citation(s) in RCA: 160] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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.
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Affiliation(s)
- E S Draper
- Department of Epidemiology, Leicester University Medical School, Leicester LE1 6TP.
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Abstract
BACKGROUND Background The reproducibility of postural changes in blood pressure of a healthy elderly population determined using standard clinical measurements is not known. OBJECTIVE To assess the differences in reproducibility of postural changes in blood pressure in healthy elderly subjects 1 and 3 min after standing within a day and between visits spaced 6 weeks apart. METHODS Casual readings of blood pressures of supine and standing subjects were measured twice during the day by the same observer on two occasions 6 weeks apart using a semi-automatic syphgmomanometer. Twenty-two subjects with no known risk factors for orthostatic hypotension (13 men) aged 69+/-3 years (mean+/-SD) with a mean initial screening supine blood pressure of 153+/-19/88+/-11 mmHg were recruited. RESULTS There were significant differences(P<0.001) between the postural changes both for systolic and for diastolic blood pressure between 1 and 3 min of standing, the largest falls occurring after 1 min of standing, though we found no variation between morning and afternoon measurements and between visits. The coefficients of reproducibility between visits for the postural changes in blood pressure after 1 and 3 min of standing were large both for systolic and for diastolic blood pressure, ranging from 9.8 to 29.3 mmHg. CONCLUSIONS There was a consistent and significant difference between the postural changes in blood pressure after 1 and 3 min of standing for this healthy elderly population, but there was no significant difference between the postural changes in morning and afternoon measurements and between visits. This marked variability in the postural change in blood pressure with duration of standing must be taken into account when assessing the prevalence of orthostatic hypotension and the effects of treatment in patients with orthostatic falls in blood pressure.
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Affiliation(s)
- J H Youde
- Department of Medicine for the Elderly, The Glenfield Hospital, Leicester, UK
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