Economic evaluation alongside the Speed of Increasing milk Feeds Trial (SIFT)

Tahir, Warda; Monahan, Mark; Dorling, Jon; Hewer, Oliver; Bowler, Ursula; Linsell, Louise; Partlett, Christopher; Berrington, Janet; Boyle, Elaine M.; Embleton, Nicolas; Johnson, Samantha; Leaf, Alison; McCormick, Kenny; McGuire, William; Stenson, Ben J; Juszczak, Ed; Roberts, Tracy

doi:10.1136/archdischild-2019-318346

Cited by 4 publications

(1 citation statement)

References 30 publications

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“…However, faster feeding was associated with an increased risk of moderate or severe motor impairment (adjusted effect 1.48, CI 1.02 to 2.14). An associated cost analysis identified that this excess of motor impairment meant that faster feeds are both clinically and economically undesirable 32…”

Section: Barriers To Achieving Nutritional Targetsmentioning

confidence: 99%

Optimising growth in very preterm infants: reviewing the evidence

Young

Beattie

Johnson

2022

Arch Dis Child Fetal Neonatal Ed

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Infants born before 32 weeks’ postmenstrual age are at a high risk of growth failure. International guidelines have long recommended that they match the growth of an equivalent fetus, despite the challenges posed by ex utero life and comorbidities of prematurity. Several groups have recently questioned the necessity or desirability of this target, shifting attention to aiming for growth which optimises important long-term outcomes. Specifically, recent research has identified the neurodevelopmental benefits of enhanced growth during the neonatal period, but work in term infant suggests that rapid growth may promote the metabolic syndrome in later life. In this context, defining a pattern of growth which optimises outcomes is complex, controversial and contested. Even if an optimal pattern of growth can be defined, determining the nutritional requirements to achieve such growth is not straightforward, and investigations into the nutritional needs of the very preterm infant continue. Furthermore, each infant has individual nutritional needs and may encounter a number of barriers to achieving good nutrition. This article offers a narrative review of recent evidence for the competing definitions of optimal growth in this cohort. It examines recent advances in the determination of macronutrient and micronutrient intake targets along with common barriers to achieving good nutrition and growth. Finally, key implications for clinical practice are set out and a recommendation for structured multidisciplinary management of nutrition and growth is illustrated.

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Section: Barriers To Achieving Nutritional Targetsmentioning

confidence: 99%

Optimising growth in very preterm infants: reviewing the evidence

Young

Beattie

Johnson

2022

Arch Dis Child Fetal Neonatal Ed

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Costs and cost-effectiveness of treatment setting for children with wasting, oedema and growth failure/faltering: A systematic review

Mdege,

Masuku,

Musakwa

et al. 2023

PLOS Glob Public Health

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This systematic review aimed to address the existing evidence gaps, and guide policy decisions on the settings within which to treat infants <12 months of age with growth faltering/failure, and infants and children aged <60 months with moderate wasting or severe wasting and/or bilateral pitting oedema. Twelve electronic databases were searched for studies published before 10 December 2021. The searches yielded 16,709 records from which 31 studies were eligible and included in the review. Three studies were judged as low quality, whilst 14 were moderate and the remaining 14 were high quality. We identified very few cost and cost-effectiveness analyses for most of the models of care with the certainty of evidence being judged at very low or low. However, there were 17 cost and 6 cost-effectiveness analyses for the initiation of treatment in outpatient settings for severe wasting and/or bilateral pitting oedema in infants and children <60 months of age. From this evidence, the costs appear lowest for initiating treatment in community settings, followed by initiating treatment in community and transferring to outpatient settings, initiating treatment in outpatients then transferring to community settings, initiating treatment in outpatient settings, and lastly initiating treatment in inpatient settings. In addition, the evidence suggested that initiation of treatment in outpatient settings is highly cost-effective when compared to doing nothing or no programme implementation scenarios, using country-specific WHO GDP per capita thresholds. The incremental cost-effectiveness ratios ranged from $20 to $145 per DALY averted from a provider perspective, and $68 to $161 per DALY averted from a societal perspective. However, the certainty of the evidence was judged as moderate because of comparisons to do nothing/ no programme scenarios which potentially limits the applicability of the evidence in real-world settings. There is therefore a need for evidence that compare the different available alternatives.

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Two speeds of increasing milk feeds for very preterm or very low-birthweight infants: the SIFT RCT

Dorling

Hewer

Hurd

et al. 2020

Health Technol Assess

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Background Observational data suggest that slowly advancing enteral feeds in preterm infants may reduce necrotising enterocolitis but increase late-onset sepsis. The Speed of Increasing milk Feeds Trial (SIFT) compared two rates of feed advancement. Objective To determine if faster (30 ml/kg/day) or slower (18 ml/kg/day) daily feed increments improve survival without moderate or severe disability and other morbidities in very preterm or very low-birthweight infants. Design This was a multicentre, two-arm, parallel-group, randomised controlled trial. Randomisation was via a web-hosted minimisation algorithm. It was not possible to safely and completely blind caregivers and parents. Setting The setting was 55 UK neonatal units, from May 2013 to June 2015. Participants The participants were infants born at < 32 weeks’ gestation or a weight of < 1500 g, who were receiving < 30 ml/kg/day of milk at trial enrolment. Interventions When clinicians were ready to start advancing feed volumes, the infant was randomised to receive daily feed increments of either 30 ml/kg/day or 18 ml/kg/day. In total, 1400 infants were allocated to fast feeds and 1404 infants were allocated to slow feeds. Main outcome measures The primary outcome was survival without moderate or severe neurodevelopmental disability at 24 months of age, corrected for gestational age. The secondary outcomes were mortality; moderate or severe neurodevelopmental disability at 24 months corrected for gestational age; death before discharge home; microbiologically confirmed or clinically suspected late-onset sepsis; necrotising enterocolitis (Bell’s stage 2 or 3); time taken to reach full milk feeds (tolerating 150 ml/kg/day for 3 consecutive days); growth from birth to discharge; duration of parenteral feeding; time in intensive care; duration of hospital stay; diagnosis of cerebral palsy by a doctor or other health professional; and individual components of the definition of moderate or severe neurodevelopmental disability. Results The results showed that survival without moderate or severe neurodevelopmental disability at 24 months occurred in 802 out of 1224 (65.5%) infants allocated to faster increments and 848 out of 1246 (68.1%) infants allocated to slower increments (adjusted risk ratio 0.96, 95% confidence interval 0.92 to 1.01). There was no significant difference between groups in the risk of the individual components of the primary outcome or in the important hospital outcomes: late-onset sepsis (adjusted risk ratio 0.96, 95% confidence interval 0.86 to 1.07) or necrotising enterocolitis (adjusted risk ratio 0.88, 95% confidence interval 0.68 to 1.16). Cost–consequence analysis showed that the faster feed increment rate was less costly but also less effective than the slower rate in terms of achieving the primary outcome, so was therefore found to not be cost-effective. Four unexpected serious adverse events were reported, two in each group. None was assessed as being causally related to the intervention. Limitations The study could not be blinded, so care may have been affected by knowledge of allocation. Although well powered for comparisons of all infants, subgroup comparisons were underpowered. Conclusions No clear advantage was identified for the important outcomes in very preterm or very low-birthweight infants when milk feeds were advanced in daily volume increments of 30 ml/kg/day or 18 ml/kg/day. In terms of future work, the interaction of different milk types with increments merits further examination, as may different increments in infants at the extremes of gestation or birthweight. Trial registration Current Controlled Trials ISRCTN76463425. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 18. See the NIHR Journals Library website for further project information.

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Economic evaluation alongside the Speed of Increasing milk Feeds Trial (SIFT)

Cited by 4 publications

References 30 publications

Optimising growth in very preterm infants: reviewing the evidence

Optimising growth in very preterm infants: reviewing the evidence

Costs and cost-effectiveness of treatment setting for children with wasting, oedema and growth failure/faltering: A systematic review

Two speeds of increasing milk feeds for very preterm or very low-birthweight infants: the SIFT RCT

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