Evaluation of the Quality of Perinatal Trials: Making the GRADE.

Background: Assessing the quality of clinical research is a key evidence-based practice skill. Clinicians, guideline producers, policy makers, service commissioners, and families need to have a sense of the validity, applicability, and certainty of research evidence when determining how it should inform their decision-making and practice.

Methods: We consider the various methodological and study design factors that contribute to the validity and applicability of clinical research findings.

Early full enteral feeding for preterm or low birth weight infants.

Background: The introduction and advancement of enteral feeds for preterm or low birth weight infants is often delayed because of concerns that early full enteral feeding will not be well tolerated or may increase the risk of necrotising enterocolitis. Early full enteral feeding, however, might increase nutrient intake and growth rates; accelerate intestinal physiological, metabolic, and microbiomic postnatal transition; and reduce the risk of complications associated with intravascular devices for fluid administration.  OBJECTIVES: To determine how early full enteral feeding, compared with delayed or progressive introduction of enteral feeds, affects growth and adverse events such as necrotising enterocolitis, in preterm or low birth weight infants.

Formula versus maternal breast milk for feeding preterm or low birth weight infants.

Background: Artificial formula can be manipulated to contain higher amounts of macro-nutrients than maternal breast milk but breast milk confers important immuno-nutritional advantages for preterm or low birth weight (LBW) infants.

Objectives: To determine the effect of feeding preterm or LBW infants with formula compared with maternal breast milk on growth and developmental outcomes.

Search Methods: We used the standard strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 9), and Ovid MEDLINE, Ovid Embase, Ovid Maternity & Infant Care Database, and CINAHL to October 2018.

Nutrient-enriched formula versus standard formula for preterm infants.

Background: Preterm infants may accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with nutrient-enriched rather than standard formula might increase nutrient accretion and growth rates and might improve neurodevelopmental outcomes.

Objectives: To compare the effects of feeding with nutrient-enriched formula versus standard formula on growth and development of preterm infants.

Immunonutrition for Preterm Infants.

Care and outcomes for very preterm infants continue to improve, but important causes of mortality and acute and long-term morbidity associated with prolonged hospitalisation remain. Necrotising enterocolitis (NEC) and late-onset infection have emerged as the major causes of death beyond the early neonatal period and of neurodisability in very preterm infants. Although the pathogenesis of these conditions is incompletely understood, it appears to be related to the content and mode of delivery of the enteral diet, particularly the impact of immunonutrients from human breast milk on the microbial and metabolic balance within the immature intestine.

Ethical Issues in Perinatal Clinical Research.

Background: Perinatal clinical research to improve the quality of care and outcomes for newborn infants relies on transparency, trust, and respect for the autonomy and well-being of study participants and their families.

Methods: Here we consider the underpinning principles of ethical research with a focus on perinatal clinical research in the acute care or emergency setting where particular challenges to parental engagement and informed consent exist.

Results: Several approaches to improving the validity of the consent process for perinatal research have been proposed and evaluated.

Iodine supplementation for the prevention of mortality and adverse neurodevelopmental outcomes in preterm infants.

Background: Parenteral nutrition solutions, artificial formulas, and human breast milk contain insufficient iodine to meet recommended intakes for preterm infants. Iodine deficiency may exacerbate transient hypothyroxinaemia in preterm infants and this may be associated with adverse neonatal and longer-term outcomes.

Objectives: To assess the evidence from randomised controlled trials that dietary supplementation with iodine reduces mortality and morbidity in preterm infants.

Mind the (support) gap: supporting academic trainees through peer networks.

Academic Foundation Programme (AFP) trainees face challenges in making the most of the research opportunities available to them. Improved support for trainees throughout the AFP may result in improved outcomes and increase retention of clinical academic trainees. Peer support may address some of the challenges faced by AFP trainees at this early stage of their careers.

Extreme warfarin hypersensitivity after oophorectomy.

We report the case of a woman who developed unexplained warfarin hypersensitivity after undergoing surgery to remove her ovaries. Presurgery, the patient's international normalised ratios (INR) control was stable and uneventful but 11 days after her operation she presented with extremely high (frequently ≥10) INR. Warfarin was discontinued on day 24 postoperation but 11 days later the plasma warfarin concentration was high at 4.