David Odd

Resuscitation at birth and cognition at 8 years of age: a cohort study

Summary Background Mild cerebral injury might cause subtle defects in cognitive function that are only detectable as the child grows older. Our aim was to determine whether infants receiving resuscitation after birth, but with no symptoms of encephalopathy, have reduced intelligence quotient (IQ) scores in childhood. Methods Three groups of infants were selected from the Avon Longitudinal Study of Parents and Children: infants who were resuscitated at birth but were asymptomatic for encephalopathy and had no further neonatal care (n=815), those who were resuscitated and had neonatal care for symptoms of encephalopathy (n=58), and the reference group who were not resuscitated, were asymptomatic for encephalopathy, and had no further neonatal care (n=10 609). Cognitive function was assessed at a mean age of 8·6 years (SD 0·33); a low IQ score was defined as less than 80. IQ scores were obtained for 5953 children with a shortened version of the Weschler intelligence scale for children (WISC-III), the remaining 5529 were non-responders. All children did not complete all parts of the test, and therefore multiplied IQ values comparable to the full-scale test were only available for 5887 children. Results were adjusted for clinical and social covariates. Chained equations were used to impute missing values of covariates. Findings In the main analysis at 8 years of age (n=5887), increased risk of a low IQ score was recorded in both resuscitated infants asymptomatic for encephalopathy (odds ratio 1·65 [95% CI 1·13–2·43]) and those with symptoms of encephalopathy (6·22 [1·57–24·65]). However, the population of asymptomatic infants was larger than that of infants with encephalopathy, and therefore the population attributable risk fraction for an IQ score that might be attributable to the need for resuscitation at birth was 3·4% (95% CI 0·5–6·3) for asymptomatic infants and 1·2% (0·2–2·2) for those who developed encephalopathy. Interpretation Infants who were resuscitated had increased risk of a low IQ score, even if they remained healthy during the neonatal period. Resuscitated infants asymptomatic for encephalopathy might result in a larger proportion of adults with low IQs than do those who develop neurological symptoms consistent with encephalopathy. Funding Wellcome Trust.

Investigating whether adverse prenatal and perinatal events are associated with non-clinical psychotic symptoms at age 12 years in the ALSPAC birth cohort

BACKGROUND Non-clinical psychosis-like symptoms (PLIKS) occur in about 15% of the population. It is not clear whether adverse events during early development alter the risk of developing PLIKS. We aimed to examine whether maternal infection, diabetes or pre-eclampsia during pregnancy, gestational age, perinatal cardiopulmonary resuscitation or 5-min Apgar score were associated with development of psychotic symptoms during early adolescence. METHOD A longitudinal study of 6356 12-year-old adolescents who completed a semi-structured interview for psychotic symptoms in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. Prenatal and perinatal data were obtained from obstetric records and maternal questionnaires completed during pregnancy. RESULTS The presence of definite psychotic symptoms was associated with maternal infection during pregnancy [adjusted odds ratio (OR) 1.44, 95% confidence interval (CI) 1.11-1.86, p=0.006], maternal diabetes (adjusted OR 3.43, 95% CI 1.14-10.36, p=0.029), need for resuscitation (adjusted OR 1.50, 95% CI 0.97-2.31, p=0.065) and 5-min Apgar score (adjusted OR per unit decrease 1.30, 95% CI 1.12-1.50, p<0.001). None of these associations were mediated by childhood IQ score. Most associations persisted, but were less strong, when including suspected symptoms as part of the outcome. There was no association between PLIKS and gestational age or pre-eclampsia. CONCLUSIONS Adverse events during early development may lead to an increased risk of developing PLIKS. Although the status of PLIKS in relation to clinical disorders such as schizophrenia is not clear, the similarity between these results and findings reported for schizophrenia indicates that future studies of PLIKS may help us to understand how psychotic experiences and clinical disorders develop throughout the life-course.

Long-term cognitive outcomes of infants born moderately and late preterm

Aim  To investigate whether infants born late preterm have poorer cognitive outcomes than term‐born infants.

Long Term Cognitive Outcomesof Infants Born at Moderate and Late Preterm.

Aim  To investigate whether infants born late preterm have poorer cognitive outcomes than term‐born infants.

Early school attainment in late-preterm infants

Aim To investigate whether infants born late-preterm have poorer school attainment compared to those born at term. Methods This study used data from the Avon Longitudinal Study of Parents and Children. Key stage one (KS1) school assessment results were obtained from local education authorities. Logistic regression models were used to investigate the effect of gestation, that is, late-preterm (32–36 weeks) versus term (37–41 weeks), on success in KS1 teacher assessments. Regression models were adjusted for potential confounders, including maternal education and markers of socioeconomic status. Results There were 12 089 term infants and 734 late-preterm infants. 71% of late-preterm children were successful in KS1 assessments compared to 79% of those born at term (OR 0.64 (95% CI 0.53 to 0.78); p<0.001). This difference persisted on adjusting for potential confounders (OR 0.74 (95% CI 0.59 to 0.92); p=0.007). Conclusions Children born late-preterm are less likely to be successful in early school assessments than those born at term. This group of vulnerable children warrants closer surveillance for early identification of potential educational failure.

Risk of low Apgar score and socioeconomic position: a study of Swedish male births

Aim: The aim of this study was to investigate the association between maternal socioeconomic position and a persistent low Apgar score (a score of < 7 at 1 and 5 min following birth).

Movement outcomes of infants born moderate and late preterm

To investigate whether children born between 32 and 36 weeks of gestation have an increased risk of motor coordination difficulties or cerebral palsy (CP) at age 7 years.

Long-term Impact of Poor Birth Condition on Social and Economic Outcomes in Early Adulthood

OBJECTIVE: The goal of this study was to investigate the association of poor birth condition with long-term social and economic outcomes at 25 to 31 years of age. METHODS: This was a population-based cohort study using data derived from linkage of routinely collected Swedish data. All term infants born in Sweden between 1973 and 1979 identified from the Swedish birth registry (n = 651 615) were included in the study. Infants were categorized into 3 groups: (1) infants with a normal (>7) Apgar score at 1 or 5 minutes of age without encephalopathy; (2) infants with a low (<7) Apgar score at 1 and 5 minutes of age without encephalopathy; and (3) infants with a low (<7) Apgar score at 1 and 5 minutes with evidence of encephalopathy. The main outcome measures were achievement of a university education and participants income in early adulthood. RESULTS: Infants with low Apgar scores who did not develop encephalopathy were less likely to have attended university (odds ratio [OR]: 1.14 [95% confidence interval (CI): 1.05–1.23]) and were more likely to have no income from work (OR: 1.19 [95% CI: 1.07–1.32]) than those born in good condition. Infants who developed encephalopathy also had greater risks of these adverse outcomes (not attended university, OR: 1.94 [95% CI: 1.13–3.33]); no income from work, OR: 3.08 [95% CI: 1.89–5.01]). CONCLUSIONS: Infants born in poor condition had worse measures of social performance than their peers, and this association was not restricted to those infants who developed obvious neurologic symptoms in the neonatal period. However, even in infants with likely encephalopathy, more than half obtained employment and one third attended university.

Preterm Birth, Age at School Entry and Educational Performance

Objective To investigate if the lack of gestational age correction may explain some of the school failure seen in ex-preterm infants. Design A cohort study based on the Avon Longitudinal Study of Parents and Children (ALSPAC). The primary outcome was a low Key Stage 1 score (KS1) score at age 7 or having special educational needs (SEN). Exposure groups were defined as preterm (<37 weeks gestation, n = 722) or term (37–42 weeks, n = 11,268). Conditional regression models were derived, matching preterm to term infants on date of birth (DOB), expected date of delivery (EDD) or expected date of delivery and year of school entry. Multiple imputation was used to account for missing covariate data. Results When matching for DOB, infants born preterm had an increased odds of a low KS1 score (OR 1.73 (1.45–2.06)) and this association persisted after adjusting for potential confounders (OR 1.57 (1.25–1.97)). The association persisted in the analysis matching for EDD (fully adjusted OR 1.53 (1.21–1.94)) but attenuated substantially after additionally restricting to those infants who entered school at the same time as the control infants (fully adjusted OR 1.25 (0.98–1.60)). A compatible reduction in the population attributable risk fraction was seen from 4.60% to 2.12%, and year of school entry appeared to modify the association between gestational age and the risk of a poor KS1 score (p = 0.029). Conclusions This study provides evidence that the school year placement and assessment of ex-preterm infants based on their actual birthday (rather than their EDD) may increase their risk of learning difficulties with corresponding school failure.

The impact of a sepsis quality improvement project on neurodisability rates in very low birthweight infants

Objective Very low birthweight (VLBW; <1500 g) infants with late-onset sepsis (LOS) have an increased risk of neurodisability. Care bundles to reduce bloodstream infections in neonatal intensive care unit (NICU) are effective in reducing LOS. Our aim was to determine if a sepsis reduction bundle introduced through a quality improvement project would impact neurodevelopmental outcomes in VLBW infants. Design Cohort study. Setting Level 3 regional NICU in the South West of England. Patients VLBW infants born between 2002 and 2011. Interventions A sepsis reduction care bundle implemented between July 2006 and December 2007. Main outcome measures The primary outcome was risk of coagulase-negative Staphylococcus (CONS) infection diagnosed >3 days of age. Secondary outcomes were death and moderate cognitive impairment. A logistic regression model was derived using the birth era as the independent variable with adjustment for typical confounders. Results In total, 379 infants were born in the preintervention cohort and 378 in the postintervention cohort. The CONS infection rate was reduced after the intervention (26.7% vs 14.1% p<0.001). Death prior to discharge reduced without reaching statistical significance (14.1% vs10.9%, p=0.195). The rate of cognitive disability reduced in the postintervention cohort (18.8% vs 6.1%, p=0.042). The adjusted ORs (95% CI) for CONS infection, death and cognitive impairment were 0.46 (0.29 to 0.72), 0.73 (0.43 to 1.24) and 0.3 (0.07 to 1.33), respectively. Conclusions There appears to be an association between reduced cognitive disability and the implementation of a sepsis reduction bundle. Further study in larger series is required to confirm these findings.