Effect of MRI on preterm infants and their families: a randomised trial with nested diagnostic and economic evaluation

Edwards, A, David and Redshaw, Maggie E. and Kennea, Nigel and Rivero-Arias, Oliver and Gonzalez-Cinca, Nuria and Nongena, Phumza and Ederies, Moegamad and Falconer, Shona and Chew, Andrew and Omar, Omar and Hardy, Pollyanna and Harvey, M.E. and Eddama, Oya and Hayward, Naomi and Wurie, Julia and Azzopardi, Denis and Rutherford, Mary A and Counsell, Serena (2017) Effect of MRI on preterm infants and their families: a randomised trial with nested diagnostic and economic evaluation. Archives of Disease in Childhood - Fetal and Neonatal Edition. pp. 1-7. ISSN 1468-2052

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Abstract

Background We tested the hypothesis that routine
MRI would improve the care and well-being of preterm
infants and their families.
Design Parallel-group randomised trial (1.1 allocation;
intention-to-treat) with nested diagnostic and cost
evaluations (EudraCT 2009-011602-42).
Setting Participants from 14 London hospitals, imaged
at a single centre.
Patients 511 infants born before 33 weeks gestation
underwent both MRI and ultrasound around term.
255 were randomly allocated (siblings together) to
receive only MRI results and 255 only ultrasound from
a paediatrician unaware of unallocated results; one
withdrew before allocation.
Main outcome measures Maternal anxiety, measured
by the State-Trait Anxiety inventory (STAI) assessed in
206/214 mothers receiving MRI and 217/220 receiving
ultrasound. Secondary outcomes included: prediction of
neurodevelopment, health-related costs and quality of
life.
Results After MRI, STAI fell from 36.81 (95% CI 35.18
to 38.44) to 32.77 (95% CI 31.54 to 34.01), 31.87
(95% CI 30.63 to 33.12) and 31.82 (95% CI 30.65 to
33.00) at 14 days, 12 and 20 months, respectively. STAI
fell less after ultrasound: from 37.59 (95% CI 36.00
to 39.18) to 33.97 (95% CI 32.78 to 35.17), 33.43
(95% CI 32.22 to 34.63) and 33.63 (95% CI 32.49 to
34.77), p=0.02. There were no differences in health related
quality of life. MRI predicted moderate or severe
functional motor impairment at 20 months slightly
better than ultrasound (area under the receiver operator
characteristic curve (CI) 0.74; 0.66 to 0.83 vs 0.64; 0.56
to 0.72, p=0.01) but cost £315 (CI £295–£336) more
per infant.
Conclusions MRI increased costs and provided only
modest benefits.

Item Type: Article
Subjects: A300 Clinical Medicine
B700 Nursing
Divisions: Faculty of Health, Education and Life Sciences > Centre for Social Care, Health and Related Research (C-SHARR) > Family Health
UoA Collections > UoA 03: Allied Health Professions, Dentistry, Nursing & Pharmacy
Depositing User: Dr. Merryl Harvey
Date Deposited: 12 Oct 2017 21:40
Last Modified: 30 Oct 2017 13:38
URI: http://www.open-access.bcu.ac.uk/id/eprint/5215

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