Neonatal outcomes following early fetal growth restriction: a subgroup analysis of the EVERREST study.

OBJECTIVE: To quantify the risks of mortality, morbidity and postnatal characteristics associated with extreme preterm fetal growth restriction (EP-FGR). DESIGN: The EVERREST (Do e s v ascular endothelial growth factor gene therapy saf e ly imp r ove outcome in seve r e e arly-onset fetal growth re st riction?) prospective multicentre study of women diagnosed with EP-FGR (singleton, estimated fetal weight (EFW) <3rd percentile, <600 g, 20+0-26+6 weeks of gestation). The UK subgroup of EP-FGR infants (<36 weeks) were sex-matched and gestation-matched to appropriate for age (AGA) infants born in University College London Hospital (1:2 design, EFW 25th-75th percentile). SETTING: Four tertiary perinatal units (UK, Germany, Spain, Sweden). MAIN OUTCOMES: Antenatal and postnatal mortality, bronchopulmonary dysplasia (BPD), sepsis, surgically treated necrotising enterocolitis (NEC), treated retinopathy of prematurity (ROP). RESULTS: Of 135 mothers recruited with EP-FGR, 42 had a stillbirth or termination of pregnancy (31%) and 93 had live births (69%). Postnatal genetic abnormalities were identified in 7/93 (8%) live births. Mean gestational age at birth was 31.4 weeks (SD 4.6). 54 UK-born preterm EP-FGR infants (<36 weeks) were matched to AGA controls. EP-FGR was associated with increased BPD (43% vs 26%, OR 3.6, 95% CI 1.4 to 9.4, p=0.01), surgical NEC (6% vs 0%, p=0.036) and ROP treatment (11% vs 0%, p=0.001). Mortality was probably higher among FGR infants (9% vs 2%, OR 5.0, 95% CI 1.0 to 25.8, p=0.054). FGR infants more frequently received invasive ventilation (65% vs 50%, OR 2.6, 95% CI 1.1 to 6.1, p=0.03), took longer to achieve full feeds and had longer neonatal stays (median difference 6.1 days, 95% CI 3.8 to 8.9 and 19 days, 95% CI 9 to 30 days, respectively, p<0.0001). CONCLUSIONS: Mortality following diagnosis of EP-FGR is high. Survivors experience increased neonatal morbidity compared with AGA preterm infants. TRIAL REGISTRATION NUMBER: NCT02097667.

Pregnant women's experiences and perceptions of participating in the EVERREST prospective study; a qualitative study.

BACKGROUND: The EVERREST Prospective Study is a multicentre observational cohort study of pregnancies affected by severe early-onset fetal growth restriction. The study recruits women with singleton pregnancies where the estimated fetal weight is less than the 3rd centile and below 600 g, between 20 + 0 and 26 + 6 weeks of pregnancy, in the absence of a known chromosomal, structural or infective cause. METHOD: The reported study was retrospective descriptive qualitative interview study of women who had participated in the EVERREST Prospective Study. The aim of this study was to explore the experiences and perceptions of pregnant women taking part in research during a pregnancy affected by severe early-onset fetal growth restriction. Audio-recorded semi-structured telephone interviews were conducted with a purposive sample of 12 women, at least 1 year after delivery of their baby. Two of these pregnancies had ended in stillbirth and one in neonatal death, reflecting the outcomes seen in the EVERREST Prospective Study. Participants gave informed consent, were 16 years or older and were interviewed in English. A topic guide was used to ensure a consistent approach. Questions focused on pregnancy experiences, involvement with the EVERREST study and potential involvement in future research. Recordings were transcribed verbatim for thematic analysis using NVivo10. RESULTS: Four broad themes were identified; 'before joining the EVERREST Prospective Study', 'participating in research', 'information and support' and 'looking back and looking forwards'. Each broad theme incorporated several subthemes. All participants recalled their reaction to being told their baby was smaller than expected. The way this news was given had a lasting impact. A range of benefits of participation in the EVERREST Prospective Study were described and the participants were positive about the way it was conducted. As a consequence, they were receptive to participating in future research. However, the findings suggest that research teams should be sensitive when approaching families at a difficult time or when they are already participating in other research. CONCLUSIONS: This study highlights the willingness of pregnant women to participate in research and identifies strategies for researchers to engage participants.

Hepatitis C education and support in Australian prisons: preliminary findings of a nationwide survey.

ISSUE ADDRESSED: Rates of hepatitis C infection are up to 60 times higher in correctional facilities than in the general population, yet prisoners have limited access to many methods of blood-borne virus prevention. The aim of this study was therefore to explore the efficiency of hepatitis C education and support services available in custodial settings, from the perspective of health educators and policy makers. METHODS: Semi-structured interviews were conducted with 23 health professionals, from all states and territories of Australia, who were involved in the management or provision of hepatitis C education or support to prisoners. Results were interpreted using thematic analysis. RESULTS: Participant reports regarding the provision of hepatitis C education and support services varied considerably between prisons and across states. Interviewees identified successful services and barriers to improvement, including limited time, insufficient funding and frequent personnel changes. Many prisons were believed to have unique needs and educators from external agencies were not always aware of the medical procedures or methods of harm reduction available in particular facilities. CONCLUSIONS: Interviewee perceptions indicated that the delivery of hepatitis C education and support services in Australian custodial settings is marred by inconsistency. However, both education programs and psychological support services could be developed by external agencies wishing to reduce the impact of hepatitis C within the prison system.

How does spirituality affect physical health? A conceptual review.

Spirituality is thought to have a beneficial impact on physical health and mortality, yet experimental findings are mixed in their support of this assumption. This article examines the most persuasive experimental evidence that spiritual beliefs influence physical health and explores the mediating factors that may explain how this connection operates.