Preterm babies are often whisked away from their parents to a resuscitaire at the side of the room, but this project aims to keep them at the bedside for immediate care instead. This matters because preterm birth is the single most important determinant of adverse infant outcomes—affecting survival, quality of life, and family wellbeing—yet the research agenda has been set mainly by researchers, not parents or clinicians. The project will use a James Lind Alliance Priority Setting Partnership to identify and prioritise treatment uncertainties, ensuring that future research addresses what families and doctors actually need. If successful, the research could transform how initial care is delivered at very preterm births. Keeping babies at the bedside would make family-centred care routine, allowing parents to be present during stabilisation. It would also make deferred cord clamping feasible, which promising evidence suggests may benefit preterm infants. The project will develop a mobile newborn life support trolley, test its feasibility in a pilot trial, and lay the groundwork for a large NHS trial comparing bedside care with standard practice. Ultimately, this could improve disability-free survival and reduce the emotional and financial costs of preterm birth for families and health services.
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Aims are to improve the quality of immediate care at preterm birth, enhance family-centred care, and improve outcome for infants and their families.OBJECTIVES are to:1. Identify and prioritise treatment uncertainties for preterm birth2. Develop strategies for providing initial care at birth at the bedside for preterm babies 2.1 conduct a survey of practice 2.2 assess parents views of initial care at the bedside2.3 improve understanding of the physiology of transition from fetal to neonatal circulation2.4 systematically review strategies for initial care and assessment2.5 develop a mobile newborn life support trolley3. Generate the information to enable conduct of a large NHS trial comparing deferred cord clamping and initial care at the bedside, with immediate clamping and initial care at the side of the room, for preterm births3.1 develop the protocol for a prospective meta-analysis of such trials3.2 systematically review ethical issues in recruiting preterm or sick infants to trials 3.3 determine the best decision analytical model to inform trial design3.4 conduct a feasibility pilot trialBACKGROUNDPreterm birth is the most important single determinant of adverse infant outcome in terms of: survival; quality of life; psychosocial and emotional impact on the family; and costs for health services. The research agenda has been determined primarily by researchers, and processes for priority setting in research often lack transparency. The James Lind Alliance has developed methods for establishing Priority Setting Partnerships between clinician organisations and patient organisations, which then identify and prioritise treatment uncertainties in order to inform publicly funded research. At birth, preterm babies are usually taken to a resuscitaire at the side of the room. Providing initial care at the bedside would be more family-centred. Our proposal is to develop strategies for providing initial care and assessment at the bedside, and assess their feasibilty and their acceptablity to parents and to clinciains. Family presence has been developed in adult resuscitation; it is preferred by families, and is now in national guidelines. Experience in neonatal units suggests that whilst parents value being involved in their child’s care, some prefer not to be present during procedures on their baby. Providing initial care at the bedside would make it feasible to defer umbilical cord clamping. There is promising evidence from a Cochrane review that deferring cord clamping to allow placental transfusion for preterm births may be beneficial compared to immediate clamping. To assess whether it would be feasible to conduct a large NHS randomised trial requires a pilot study. Providing really reliable data on disability-free survival, a key outcome, requires very large numbers. To achieve this requires international collaboration, for example in a prospective meta-analysis. RESEARCH PLANThe programme has six interconnected Work Packages:1. Identifying and prioritising research gaps for preterm birth: a James Lind Alliance Priority Setting Partnership 2. Systematic reviews 2.1 initial care and stabilisation with cord intact 2.2 ethical issues in recruitment of preterm or sick infants to trials3. Developing strategies for providing initial care at the bedside3.1 survey of current practice 3.2 assessing parents' views3.3 measuring how placental transfusion varies with gestation3.4 developing a Bedside Assessment, Stabilisation and Initial Circulatory Support (BASICS) trolley3.5 evaluating BASICS trolley4. Pilot randomised trial of deferred cord clamping and initial care at the bedside for preterm births5. Prospective meta-analysis6. Economic analysisRESEARCH TEAM AND ENVIRONMENTWe have assembled a strong multi-disciplinary team with established experts in all areas of our proposed research, including service user involvement in research, Priority Setting Partnerships, perinatal trials, systematic reviews, clinical expertise, service users, medi
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