Focus on health and care of mothers and infants ChiMat conference, 2009 Professor Mary Renfrew Mother and Infant Research Unit

Mother and Infant Research Unit: MIRU Aim: to contribute to improvement in health and wellbeing of childbearing women, their babies and families Strategies to address inequalities in health Research Evidence-informed policy and practice

Mother and Infant Research Unit: MIRU Collaboration and involvement of academic, service user, NHS colleagues Main themes Care and service provision for childbearing women Maternal and infant nutrition Psychosocial aspects of care

Health and care of mothers and infants: Outline Potential contribution of ChiMat Overview of recent studies Focus on breastfeeding in neonatal units

Health and care of mothers and infants: Outline Potential contribution of ChiMat Overview of recent studies Focus on breastfeeding in neonatal units

Recent MIRU studies: Methods to evaluate Healthy Start Aim: to inform DH on approaches to monitoring and evaluation of Healthy Start scheme Identified key indicators/outcomes Examined existing data sources Identified possible options for evaluation design Funded by DH, Policy Research Programme

Methods to evaluate Healthy Start: Potential for ChiMat contribution Develop systems to monitor impact of national policy Potential to adapt and develop existing routine data systems, eg eligibility status on Maternal and Child Health datasets modify existing surveys Advocate for major change Eg enable record linkage Inform/simplify evaluation options

Recent MIRU studies: PREview study Aim to develop evidence-based tool to inform Child Health Promotion Programme Factors associated with child health and wellbeing Physical, psychological, education, social outcomes Make optimal use of existing information systems Act as a planning tool for service investment Funded by Department of Health

PREview study: Benefits of ChiMat involvement Inform data collection processes to underpin new strategies Familiarity with existing data systems Defining data items needed Avoid duplication Funded by Department of Health

Recent MIRU studies: Maternal and child nutrition reviews Promotion and support of breastfeeding Cochrane reviews on support, initiation NICE Evidence into Practice Briefing Maternal and child nutrition NICE public health guidance NIHR HTA, NICE, Cochrane

Maternal and child nutrition reviews: Potential for ChiMat contribution Is policy making a difference? Monitoring of infant feeding rates Advising improvement of local data quality Analysis of sub-groups

Health and care of mothers and infants: Outline Potential contribution of ChiMat Overview of recent studies Focus on breastfeeding in neonatal units

Breastfeeding in neonatal units Breastfeeding high profile public health issue No policy initiative to support breastfeeding in neonatal units Potential to address inequalities in health

Breastfeeding in neonatal units Breastfeeding/breastmilk feeding vital to short and long term health significantly improved mortality and morbidity, and associated health care outcomes Eg x5 increase in NEC (Boyd et al 2006) reduced procedural pain (Shah et al 2006) enhanced maternal involvement (Flacking et al 2007)

Breastfeeding in neonatal units Bolling et al 2007

Breastfeeding in neonatal units Aim: To evaluate interventions that promote or inhibit breastfeeding or feeding with breastmilk for infants admitted to neonatal units NIHR Health Technology Assessment programme

Breastfeeding in neonatal units Systematic review of clinical, public health, health promotion interventions Concurrent economic analysis Evidence gaps, research agenda NIHR Health Technology Assessment programme

Breastfeeding in neonatal units Collaboration between Mother and Infant Research Unit Centre for Reviews and Dissemination St George’s Hospital Medical School University of Plymouth Advisory Group, clinical experts Academic, voluntary sector, NHS (ChiMat) UK, US, Sweden NIHR Health Technology Assessment programme

Breastfeeding in neonatal units: review findings 48 controlled studies, 17 countries 8 UK studies 31 (65%) RCTs Quality: 7 good, 28 moderate Heterogenous in design, intervention, participants and outcomes Narrative synthesis

Breastfeeding in neonatal units: review findings Most studies examined clinically stable babies ‘Standard care’ usually involved limited contact and limited breastfeeding/breastmilk feeding Very few reported psycho-social, economic, or health/wellbeing outcomes for babies or mothers

Breastfeeding in neonatal units: economic analysis findings No existing economic studies identified Available evidence on resource use and costing very poor Model based on limited literature plus input from experts

Breastfeeding in neonatal units: Findings Effective clinical and public health interventions identified additional trained professional support likely to be cost-effective Not in current routine practice in UK units (BLISS 2008, Redshaw 2006)

Breastfeeding in neonatal units: Developments needed Workload Staff training Design of facilities, parent accommodation Management of networks, transport Include in current public health policy developments

Breastfeeding in neonatal units: Potential role of ChiMat National and local surveillance Appropriate definitions Feeding, disease, length of stay, resource use Maternal health and wellbeing

Health and care of mothers and infants: Outline Potential contribution of ChiMat Overview of recent studies Focus on breastfeeding in neonatal units

Focus on mother and infant health: benefits of ChiMat involvement National and local surveillance and reporting to inform research, policy, commissioning Drive up quality of current data Improved systems Consistent definitions Adapt data to policy priorities New indicators

Focus on mother and infant health: benefits of ChiMat involvement Advocate for major change Identify and inform issues ethics duplication Tackling health inequalities through improved information on vulnerable sub-groups

Focus on mother and infant health: benefits of ChiMat involvement Getting research into policy and practice Better value research

Professor Mary Renfrew Mother and Infant Research Unit