http://theses.ncl.ac.uk/jspui/handle/10443/99 Tue, 03 Feb 2026 19:59:50 GMT 2026-02-03T19:59:50Z http://theses.ncl.ac.uk/jspui/handle/10443/5246 Title: A mixed methods study of the follow up of extremely preterm babies in the North East of England Authors: Popescu, Otilia-Ana-Maria Abstract: 1. Background Neonatal intensive care medicine has improved considerably over time, leading to increased neonatal survival, and improved survival of preterm babies (babies born before 37 weeks gestation). In 2012, the WHO declared their commitment to reducing the mortality and morbidity related to prematurity by several interventions, including updated approaches to community-based follow up care for preterm babies. According to the Office for National Statistics (ONS), 2,490 babies were born in England and Wales in 2018 between 23- and 27- weeks gestation, accounting for approximately 0.3% of all live births. The 2017 National Institute for Health and Care Excellence (NICE) guideline made recommendations for the developmental follow up of children and young people born preterm and acknowledged the conditions linked to preterm delivery. The follow up of preterm babies determines the baby’s outcomes, their parents’ needs, and informs planning of health and social care resources. Previous research on barriers and facilitators to neonatal follow up showed that the birth of a preterm baby is a stressful event, for both mothers and fathers. Parents develop a different pattern of parenting, stemming from the concept of increased vulnerability of the preterm baby. The communication between parents and health professionals is important, and poor communication increases parental stress levels. Studies underlined the relevance of the relationships established between parents and neonatal staff to parents’ experiences. 2. Aim This study used a mixed methods design to assess the neonatal follow up of extremely preterm babies, focusing on attendance rates in relation to morbidities and demographic characteristics, as well as parents’ and health professionals’ perceptions of the neonatal follow up.3. Methods This study involved two phases. Phase one was an analysis of demographic, morbidity, mortality, and 2- year neurodevelopmental outcomes data of a cohort of babies born before 28 weeks gestation in the North East of England, over a 12-month period between July 2015 and June 2016, recorded in the Badger database. Phase two was a qualitative study of parents’ and health professionals’ (HPs) views, perceptions, and experience of the follow up of extremely preterm babies. Parents were recruited to the study during their attendance for their baby’s follow up appointments and were interviewed using a topic guide. Seventeen semistructured interviews were carried out with 23 parents of babies born before 28 weeks completed gestation, between January and December 2018. Thematic analysis based on the Braun and Clarke model was used. Twenty one-to-one, semi-structured interviews were carried out with HPs involved in the follow up care of preterm babies, between October and December 2018. Data were analysed using thematic analysis.4. Results The recruitment rate for phase one was 61% of the eligible babies; 86.2% of the babies included were born after 24 weeks gestation, with a mean gestation age (GA) of 25+3 weeks and a mean birth weight (BW) of 805 grams. More than three quarters of babies were discharged home on oxygen. Of the cases where information was available, half of the babies showed developmental delay, with half of these cases showing moderate to severe delay. There was no formal diagnosis of cerebral palsy recorded in the Badger database. The analysis of the parents’ interviews identified two key themes: ‘Emotions’ and ‘Here and now’. The first theme, ‘Emotions’, included three subthemes: ‘The emotions related to the preterm birth - a rollercoaster’, ‘The post-traumatic stress syndrome’ and ‘The overprotective parent’. Following the birth of their preterm baby, parents experienced mixed and contradictory emotions, compared to a rollercoaster, which may contribute to developing symptoms suggestive of post-traumatic stress syndrome. Parent participants developed an overprotective type of parenting, as previously described in literature. 4. Results The recruitment rate for phase one was 61% of the eligible babies; 86.2% of the babies included were born after 24 weeks gestation, with a mean gestation age (GA) of 25+3 weeks and a mean birth weight (BW) of 805 grams. More than three quarters of babies were discharged home on oxygen. Of the cases where information was available, half of the babies showed developmental delay, with half of these cases showing moderate to severe delay. There was no formal diagnosis of cerebral palsy recorded in the Badger database. The analysis of the parents’ interviews identified two key themes: ‘Emotions’ and ‘Here and now’. The first theme, ‘Emotions’, included three subthemes: ‘The emotions related to the preterm birth - a rollercoaster’, ‘The post-traumatic stress syndrome’ and ‘The overprotective parent’. Following the birth of their preterm baby, parents experienced mixed and contradictory emotions, compared to a rollercoaster, which may contribute to developing symptoms suggestive of post-traumatic stress syndrome. Parent participants developed an overprotective type of parenting, as previously described in literature. The second theme, ‘Here and now’, included four subthemes: ‘The storytelling’, ‘The coping mechanism’, ‘The impact of being born early’ and ‘The value of the follow up’. Future parents expected a normal term pregnancy, followed by a normal birth; the normality was interrupted by the onset of preterm labour. This interruption marked the beginning of a different experience, the quality of which impacted on the bonding and relationship between baby and parents, and the relationships between parents and HPs. Parents reported that follow up offered reassurance. The analysis of the HPs’ interviews identified two key themes: ‘Communication’ and ‘The Child Not Brought’. The first theme, ‘Communication’, included two subthemes: ‘The Journey’ and ‘The multi-disciplinary team post discharge’. The HPs described the experience of the birth and the follow up of a preterm baby as a journey and continuity of care was a marker of quality. HPs understood that the follow up offers reassurance and support to parents. There was a diversity of job roles of HPs involved in the care and follow up of preterm babies, leading to the formation of a multi-disciplinary team (MDT). Communication occurred in every direction between the members of the MDT, in many ways (written/verbal, formal/informal, paper/electronic). The second theme, ‘The Child Not Brought’ included three subthemes: ‘The impact on the baby’, ‘The NHS point of view’ and ‘Why do parents not attend?’. HPs suggested several potential reasons why parents may not bring their child(ren) to the follow up appointments: parents may not understand the role of the follow up, especially if the child is well; parents fear bad news; families may have a busy life, have too many appointments or have just seen another HP; communication breakdown (related to system or human factors); neglect; distance and travel; psychological issues (fear to leave the house, bad memories linked to the hospital environment). 5. Discussion Findings from this research provide important insights into the views and experiences of parents of preterm babies with regards to their baby’s follow up appointments. The birth of a preterm baby is a stressful event; parents develop a different pattern of parenting, stemming from the concept of the increased vulnerability of the preterm baby. HPs described the birth and follow up of an extremely preterm baby as a journey. The continuity of care and good communication contribute to improving this journey. Due to the complexity of the team involved in the follow up of the extremely preterm baby, there were challenges in communication, at different levels. Relatively small changes in practice, such as allowing for normality by encouraging the parents to read to their baby at night-time, and ensuring adequate communication and appropriate reassurance, could improve the parents’ experience, their engagement with follow up appointments, and therefore their baby’s outcomes. NICE recommends follow up of babies born extremely preterm to school age, however there is no established referral pathway into the paediatric services. Parents value continuity of care, which may be challenging if there is no clear transition process between neonates and paediatrics. Ensuring a smooth transition at every level by designing a clear pathway for the neonatal follow up of extremely preterm babies and the transition to paediatric services may improve the follow up process, parents’ engagement with the system and their baby’s outcomes. Description: M.D Thesis Fri, 01 Jan 2021 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/5246 2021-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/5238 Title: Dietary nitrate in vascular and brain health Authors: Babateen, Abrar Mohammad Abstract: Nitric oxide (NO) is a highly reactive molecule that is essential for several biological processes, including the regulation of vascular resistance, neurotransmission and muscular energetics. Sufficient NO production is crucial for the maintenance of a healthy vascular system. With ageing, NO synthesis from arginine, catalysed by NO synthase (NOS), is reduced, which may contribute to increased blood pressure (BP), endothelial dysfunction (ED) and impaired brain function. Dietary nitrate (NO3-) is an important source of NO production via a non-enzymatic pathway involving the progressive conversion of NO3- into nitrite (NO2-) by the action of oral bacteria, and then to NO in low pH and hypoxic environments (i.e., stomach and arterial-tocapillary circulation). Whilst several clinical studies have assessed the effect of supplemental dietary NO3- intake (often supplied as beetroot juice (BJ)) on vascular and cognitive functions, there is a significant gap in the literature concerning the effects of longer-term intervention, especially in older people. This PhD investigated the effects of BJ supplementation in adult population, including healthy younger and older overweight and obese adult population who is at a higher risk of physiological dysfunctions, including cardiovascular disease and cognitive impairment. I conducted a systematic review of observational studies to assess NO3- intake by adults. The review included 55 articles and found that the median daily NO3- intakes were similar in both healthy and patient populations and below the safe upper intake of daily NO3- intake (3.7 mg/kg body weight). Then, I performed a meta-analysis of 18 randomised control trials (RCT) to examine the effect of NO3- or NO2- supplementation on cognitive function and cerebral blood flow (CBF). This meta-analysis revealed no overall effect of NO3- or NO2- supplementation on cognitive function or CBF. This meta-analysis helped to inform the design of the subsequent feasibility study. Next, I conducted a small pilot study to examine the validity and reliability of NO2- salivary strips (against reference standard laboratory measures) with and without the use of mouthwash. This study showed that these strips have a high level of reproducibility and repeatability in detecting changes in salivary NO2-. The study also indicated that the strips can be used to monitor NO3- intake in long-term dietary NO3- interventions. The final phase of this project provided evidence of the acceptability and feasibility of an intervention testing the effects of prolonged consumption of incremental doses of NO3- in overweight and obese older participants. The findings of this study showed that cognitive function and CBF were not affected by long-term BJ supplementation. However, there was a non-significant trend towards on systolic BP (SBP) reduction with lower BJ doses. Description: PhD Thesis Fri, 01 Jan 2021 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/5238 2021-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/5235 Title: Anxiety in Autism Spectrum Disorder (ASD) : the influence of executive and sensory processing dysfunctions Authors: Darus, Nooraini Abstract: Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder associated with difficulties with social communication and the presence of restricted and repetitive behaviours. There is significant heterogeneity of symptom profiles within the disorder. Anxiety is very common in individuals with ASD. Previous research suggests associations between executive function deficits and sensory processing atypicalities and anxiety in ASD, though neither relationship has been explored in detail. Aims: To examine the putative relationships between anxiety, executive function difficulties and sensory processing atypicalities in children with ASD, taking into account potential heterogeneity within the sample. Method: Thirty six families with a child with ASD were recruited. The children completed an anxiety questionnaire and standardised assessments of executive function. Parents completed questionnaire about their child’s anxiety, sensory processing difficulties and autism severity. 22 parents completed a follow-up study of their child’s anxiety, everyday executive function and repetitive behaviours. Correlational analysis and cluster analysis were used to examine the data. Results: Anxiety scores were high and remained stable over a twenty month period. No significant associations were found between objective measures of executive function difficulties and anxiety, though parent reported child executive difficulties were associated with heightened parent reported child anxiety.High anxiety was associated with sensory processing atypicalities, and higher levels of ASD severity. Importantly, cluster analysis revealed distinct subgroups of children in relation to anxiety, sensory and executive profiles, illustrating heterogeneity within the sample. Conclusions: The findings supports previous research that anxiety is high in children with ASD and remains high over time and is associated with sensory processing atypicalities. The relationship between executive function and anxiety varied as a function of the source of the data. Cluster analysis illustrates the importance of considering heterogeneity in ASD. Implications for clinical practice and future research are discussed. Description: Ph. D. Thesis. Fri, 01 Jan 2021 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/5235 2021-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/5226 Title: The role of residual beta-cell function on glycaemic and vascular outcomes at rest and post exercise in people with type 1 diabetes Authors: Taylor, Guy Stuart Abstract: Within patients with type 1 diabetes (T1D), residual ꞵ-cell function and endogenous insulin secretion occurs in a substantial number of individuals. The role this ꞵ-cell function plays in glycaemic control in individuals with T1D is currently not fully understood. This is especially true around exercise, where maintaining glycaemic control is challenging and a large inter-individual variation exists. Micro amounts of endogenous insulin secretion appears to offer some protection against vascular damage and diabetes complications. Endothelial progenitor cells (EPCs) are important for the repair and growth of blood vessels, with circulating numbers increased by exercise. However, the count of EPCs appear to be reduced in individuals with T1D. It is unknown whether residual ꞵ-cell function in individuals with T1D influences these circulating cells. Therefore, this thesis aimed to investigate the effects of residual ꞵ-cell function in individuals with T1D and its influence on glycaemic control under free-living conditions and after an acute bout of aerobic exercise, as well as on the count of circulating EPCs at rest and after exercise mobilisation. Chapter 3 demonstrated that under free-living conditions, increased endogenous insulin secretion was associated with improved continuous glucose monitoring measures, including increased time spent in euglycaemia. The results of Chapter 4 revealed that within a cohort who had comparable glycaemic control under free-living conditions, individuals with higher residual ꞵ-cell function displayed a substantially greater amount of time spent in euglycaemia in the hours following a bout of moderate intensity exercise compared to those with undetectable or lower endogenous insulin secretion. Lastly, Chapter 5 assessed the number of circulating EPCs at rest and after mobilisation with a bout of moderate intensity exercise. In comparison to matched non-diabetes controls, all markers of EPCs were lower in the T1D group, with some markers having attenuated mobilisation with exercise. Despite comparable resting counts, only the high residual ꞵ-cell function group had mobilisation of these cells with exercise within the T1D participants. In conclusion, the findings of this thesis demonstrate that residual ꞵ-cell function impacts upon individuals with longer duration T1D. Increased C-peptide secretion is associated with improved glycaemic control under free-living conditions and after an acute bout of exercise, as well as increasing the count of circulating EPCs that are mobilised with exercise. Description: PhD Thesis Wed, 01 Jan 2020 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/5226 2020-01-01T00:00:00Z