ObjectiveThe objective was to describe outcomes and investigate factors affecting prognosis at 1 year post intervention for infants with surgical necrotising enterocolitis (NEC).DesignUsing the British Association of Paediatric Surgeons Congenital Anomalies Surveillance System, we conducted a prospective, multicentre cohort study of every infant reported to require surgical intervention for NEC in the UK and Ireland between 1 March 2013 and 28 February 2014. Association of independent variables with 1-year mortality was investigated using multivariable logistic regression analysis.SettingAll 28 paediatric surgical centres in the UK and Ireland.PatientsInfants were eligible for inclusion if they were diagnosed with NEC and deemed to require surgical intervention, regardless of whether that intervention was delivered.OutcomesPrimary outcome was mortality within 1 year of the decision to intervene surgically.Results236 infants were included in the study. 208 (88%) infants had 1-year follow-up. 59 of the 203 infants with known survival status (29%, 95% CI 23% to 36%) died within 1 year of the decision to intervene surgically. Following adjustment, key factors associated with reduced 1-year mortality included older gestational age at birth (adjusted OR (aOR) 0.87, 95% CI 0.78 to 0.96). Being small for gestational age (SGA) (aOR 3.6, 95% CI 1.4 to 9.5) and requiring parenteral nutrition at 28 days post-decision to intervene surgically (aOR 3.5, 95% CI 1.1 to 11.03) were associated with increased 1-year mortality.ConclusionsParents of infants undergoing surgery for NEC should be counselled that there is approximately a 1:3 risk of death in the first post-operative year but that the risk is lower for infants who are of greater gestational age at birth, who are not SGA and who do not require parenteral nutrition at 28 days post-intervention.

Measurements of the solubilities of niobium and tantalum pentachlorides in liquid titanium tetrachloride have been reported on several occasions.1-4 In one case1 the solubility of the tantalum compound was said to vary between 26 and 60 times that of the niobium compound in the range 25-100'. Such a marked difference in properties between these elements is unexpected. Subsequent reported work indicated that the solubilities of the chlorides were of the same order but there was no general agreement on values; one author4 found the solubilities to be almost identical, another3 found that the tantalum chloride was more soluble, while the third2 found that the niobium chloride was slightly more soluble. Primarily, all values were determined by analyses of the saturated solutions at specific temperatures, hut in two caseslJ were supported by heating and cooling methods. Tarasenkov and Komandinl had no direct method for the analysis of tantalum-titanium mixtures, while Ehrlich and Dietz4 were unable to analyse directly for niobium in the presence of titanium. Indirect methods based on the total chloride content of the solutions were used. Only Ehrlich and Dietz4 described a means of sampling in which a filter was used to separate the saturated solution from undissolved solute.This note reports the results of the redetermination of the solubilities of these compounds in titanium tetrachloride. Experimental MaterialsTitanium tetrachloride was purified by treatment with copper powder and distillation5 and collected in sealed ampoules. h'iobium and tantalum pentachlorides (Laboratory Grade) were supplied by Alfa Inorganics Inc., and could be used as obtained because of the solubility method employed. With the aid of a dry-box, samples were transferred into ampoules which were subsequently sealed.

Content validity:The scoring instrument was applied to infants (n = 115) by HCPs who were asked to rate each item/ domain for clinical relevance. All items/domains were assessed as relevant. However there were substantial missing data for two domains (chest auscultation/blood gas analysis) as certain HCP groups could not undertake these procedures. These two domains were consequently removed.Cognitive interviewing: HCPs (n = 15) were interviewed in order to assess comprehension, interpretation and how they arrived at their responses for each item/domain in the scoring instrument. Understanding of medical vocabulary was assessed. 'Sub-sternal recession' was removed and 'anuric' changed to 'not passed urine'. Construct validity & paediatrician inter-rater reliability:HCPs applied the scoring instrument to infants (n = 128) whilst two senior doctors assessed whether the infant had 'mild', 'moderate' or 'severe' bronchiolitis. Cut points within the score have now been established for 'mild', 'moderate' and 'severe' bronchiolitis. Conclusions We have developed and partially validated a clinical severity score for infants with bronchiolitis. Criterion and reliability testing of the score is planned for the 2013/14 bronchiolitis season. Responsiveness to change will be assessed in a future clinical trial.