Surrey and Sussex Healthcare NHS Trust

AIM:This national survey aimed to evaluate the adoption and implementation of delivery room cuddles (DRC) for preterm infants (<32 weeks' gestation) in neonatal units across the UK. We sought to determine the extent of the practice, and understand the consistency and challenges associated with DRC, with the goal of enhancing care for preterm infants. METHODS:Between January and March 2024, all UK level 2 and 3 neonatal units were invited to complete a structured survey on DRC practices. We collected data on the existence, frequency and facilitation of DRC, as well as any institutional guidelines and barriers for its practice. RESULTS:We received complete responses from all 131 centres invited (100% response rate). Among these, 60 centres (45.8%) reported routinely practising DRC, 66 (50.4%) did so occasionally and 5 (3.8%) reported not practising DRC at all. Notably, 81 centres (61.8%) practised DRC without formal institutional guidelines. Main barriers to practice included equipment limitations, varying staff attitudes, and concerns about the clinical condition of preterm infants. CONCLUSION:This survey demonstrates an encouraging high uptake of DRC in recent years, typically offered after initial stabilisation (within 30-60 min post-birth). Despite the recognised benefits of DRC to parents and in enhancing neonatal outcomes, considerable variability remains in its implementation underscoring the need for comprehensive guidelines and professional training. These could standardise DRC practices across the UK, promoting more consistent and effective care for preterm infants.

Abstract Atopic eczema is increasingly common in older adults, and real-world experience with systemic therapies is limited. We examined therapeutic choices and clinical patterns in adult patients with atopic eczema ≥ 60 years of age. Patients in A-STAR were stratified by age at enrolment (≥ 60 years, n = 69; 18 to < 60 years, n = 742; < 18 years, n = 336: this sequence used throughout) and age of drug initiation between October 2018 and November 2025. The χ2-test was used to assess the statistical significance of differences in characteristics among groups, with P-values < 0.05 considered statistically significant. Older adult patients with atopic eczema starting systemic therapy were predominantly male (65%, 54.0%, 57.1% in the three age groups) with a higher proportion with Fitzpatrick I/II skin type (62%, 59.4%, 44.9%) vs. V/VI (4%, 10.7%, 18.5%; P < 0.001). At drug initiation, the mean Eczema Area and Severity Index (17.0, 18.0, 21.8; P < 0.001), Dermatology Life Quality Index (14.0, 15.5, 14.0; P = 0.006) and Patient-Oriented Eczema Measure (18.8, 20.1, 18.7; P = 0.007) were significantly different among the age groups. Differences in clinical phenotype were confined to follicular eczema (1%, 8.5%, 16.5%) and ichthyosis (20%, 25.2%, 15.0%; P < 0.001). Allergic cophenomena also differed between groups: food allergy was less frequent (24%, 42.0%, 60.7%) and contact allergy more common in the older adults (44%, 38.6%, 12.8%; P < 0.001). The older adult cohort was more commonly exposed to at least two previous systemic treatments (58%, 54.0%, 35.6%; P < 0.001). Dupilumab (39%, 41.8%, 49.6%; P < 0.001) and methotrexate (13%, 17.0%, 26.5%) were utilized less in the older patients, while tralokinumab was more frequently prescribed (11%, 4.4%, 0.5%; P < 0.001). Overall, 13% of drug episodes in the older adult group were with Janus kinase inhibitors. When prescribing systemic treatment, comorbidities were considered more commonly (26%, 17.8%, 6.6%; P < 0.001), while the therapeutic profile determined treatment choice less often (19%, 29.5%, 43.0%). The clinical expression of atopic eczema in older adults is subtly different from that in younger groups. Significant differences in selected treatment regimens suggest consideration of cofactors by prescribers.

Abstract Atopic dermatitis (AD) is often accompanied by elevated blood eosinophils. While eosinophils are central in asthma pathophysiology, their role and clinical relevance in AD is poorly characterized. The aim of this study was to assess the relationship between baseline eosinophil levels and AD severity, clinical characteristics and treatment response. A-STAR is a prospective longitudinal study of patients with AD receiving systemic therapy in the UK. Patients enrolled between October 2018 and May 2025 with baseline eosinophil counts were included. Eosinophil levels were stratified as normal (< 0.5 × 109 cells L−1), moderately raised (0.5–1.5 × 109 cells L−1) or hypereosinophilia (> 1.5 × 109 cells L−1). The eosinophil-to-lymphocyte ratio (ELR) was split into four categories (0 to < 0.15, 0.15 to < 0.29, 0.29 to < 0.49, ≥ 0.49). Clinical scores were normalized to 0–100. Treatment response outcomes were evaluated through achieving EASI 75 and EASI 90 (≥ 75% and ≥ 90% improvement in Eczema Area and Severity Index score from baseline, respectively) for each patient censored at 1 year. Multivariable regression was performed using R 4.4.1. In total, 719 patients were included; the mean age was 27.6 years (SD 15.5), 56.1% were male, 9.3% had prior dupilumab exposure and 47.1% received dupilumab during A-STAR follow-up. Patients with hypereosinophilia (n = 64, 8.9%) were younger, with earlier AD onset and erythrodermic phenotype. Compared with those with normal eosinophil count, hypereosinophilia was associated with asthma [odds ratio (OR) 2.4, 95% confidence interval (CI) 1.1–2.1] and higher AD severity with, EASI +15% (95% CI 9.5–20.5), Dermatology Life Quality Index (DLQI) +14.4% (95% CI 5.2–23.6), Peak Pruritus Numerical Rating Scale (PP-NRS) +8.8% (95% CI 0.4–17.1) and Patient-Oriented Eczema Measure (POEM) +8.3 (95% CI −0.3 to 17). ELR ≥ 0.49 correlated with asthma (OR 3.2, 95% CI 1.7–6.0) and higher EASI (+11.2%, 95% CI 6.7–15.7), but not DLQI, PP-NRS or POEM. Baseline eosinophil counts were not associated with treatment response to any systemic therapy, including both conventional agents and biologics or small molecule. High eosinophil counts are associated with more severe AD, independently of asthma, yet baseline eosinophil counts or ELR do not impact treatment response.

Abstract Drug survival of systemic medications in atopic eczema is a commonly used measure of effectiveness and tolerability informing clinical decision making. This study evaluates the drug survival of methotrexate, ciclosporin and dupilumab in patients in the A-STAR register. Patients who initiated oral (oMTX) and subcutaneous methotrexate (s/c MTX), ciclosporin (CsA) and dupilumab were included. Patients were stratified by treatment received. One-year drug survival was calculated using Kaplan–Meier estimates. oMTX was used as the reference. Adjusted hazard ratios (aHRs) and corresponding 95% confidence intervals (CIs) were estimated using Cox proportional hazard models with covariate adjustment. In total, 1132 drug episodes were included (oMTX 289, s/c MTX 51, CsA 117, dupilumab 675). Baseline characteristics were largely similar among the patients across the treatment groups, except for higher Eczema Area and Severity Index and number of previous systemic therapies in the CsA and dupilumab groups. One-year survival rates of CsA, oMTX, s/c MTX and dupilumab were 34%, 56%, 64% and 83%, respectively. When stratifying the dupilumab cohort by the number of previous conventional systemic treatments (one vs. at least two), there was no statistically significant difference in dupilumab survival between the subgroups. Median time on treatment (interquartile range) was 6.0 months (2.2–11.4) for CsA, 7.4 months (3.0–18.7) for oMTX, 9.6 months (5.0–16.4) for s/c MTX and 16.6 months (6.9–30.6) for dupilumab. Using oMTX as the reference, dupilumab was associated with a lower chance of drug discontinuation (aHR 0.26, 95% CI 0.19–0.36), whereas drug discontinuation was significantly higher in those receiving CsA (aHR 1.53, 95% CI 1.08–2.17). There was no significant difference in drug survival between s/c and oMTX (aHR 0.73, 95% CI 0.41–1.31). Similar trends were observed in adult and paediatric patients. In conclusion, dupilumab demonstrated the highest drug survival, with CsA showing the highest rate of drug discontinuation among the four assessed treatment modalities, fitting in with clinical experience. Further analyses to stratify survival by reasons for discontinuation are underway.