Nicola Austin

Very preterm children show impairments across multiple neurodevelopmental domains by age 4 years.

Objectives: Neurodevelopmental outcomes associated with preterm birth are of major health and educational concern. This study examined the neuromotor, cognitive, language and emotional/behavioural outcomes of a regional cohort of 4-year-old children born extremely preterm (EPT: 23–27 weeks’ gestation), very preterm (VPT: 28–33 weeks) and full term (FT: 38–41 weeks). Of particular interest were children’s risks of impairment across multiple neurodevelopmental domains. Methods: Data were gathered as part of a prospective longitudinal study of 105 very preterm (⩽33 weeks gestation) and 107 FT children born during 1998–2000. At 4 years corrected age, children underwent a comprehensive multidisciplinary assessment that included a paediatric neurological examination, cognitive and language testing, and an assessment of child emotional and behavioural adjustment. Results: At age 4 years, compared to FT children, EPT and VPT children had increased risks of cerebral palsy (EPT 18%, VPT 15%, FT 1%), cognitive delay (EPT 33%, VPT 36%, FT 13%), language delay (EPT 29%, VPT 29%, FT 10%) and emotional/behavioural adjustment problems (EPT 37%, VPT 13%, FT 11%). EPT and VPT children were three times more likely to have multiple domain impairments than FT children (EPT 30%, VPT 29%, FT 10%). Conclusions: A substantial proportion of preschool children born very preterm show clinically significant problems in at least one neurodevelopmental domain, with impairment in multiple domains being common. There is a need to monitor preschool development across a range of functional domains and to consider the likely cascading effects of multiple impairments on later development.

High iron status in very low birth weight infants is associated with an increased risk of retinopathy of prematurity

OBJECTIVE To explore the hypothesis that excessive iron loads may increase the formation of free radicals and the development of retinopathy of prematurity in preterm infants, we carried out a prospective observational study of the association between transfusion volume, iron status, and retinopathy.

Very preterm birth: maternal experiences of the neonatal intensive care environment

Objective:Examine sources, predictors and child outcomes associated with neonatal intensive care unit (NICU)-related stress for mothers of infants born very preterm (VPT).Study Design:Participants were 133 mothers of VPT infants admitted to a regional level-III NICU. At term equivalent, mothers completed the Parental Stressor Scale: NICU and were interviewed about their psychological well-being and family circumstances. Infant clinical data were also collected. At corrected age 4 years, 49 children were assessed for cognition, language and socio-emotional development.Result:Mothers reported moderate to low stress, with parental role alteration considered most stressful and parent–staff communications least stressful. Predictors of overall stress included maternal educational underachievement, stressful life events, postnatal depression and infant unsettled-irregular behavior. NICU-related stress was associated with child anxiety and poorer language development.Conclusion:Parental well-being is an important focus of care in the neonatal setting. Strategies are needed to optimize early engagement and reduce stress levels to assist improved child outcomes.

Infant outcomes after exposure to Tdap vaccine in pregnancy: an observational study.

Objective Pertussis vaccination during pregnancy has recently been recommended in both the USA and UK to prevent pertussis infection in infants. While there are no apparent safety concerns about the administration of Tdap vaccine during pregnancy, there is only limited safety data available. We aimed to closely monitor infants exposed to Tdap during pregnancy to look for any adverse outcomes that may be attributable to the vaccine. Design This was a prospective observational study, collecting information to evaluate the safety of Tdap vaccine for infants exposed during pregnancy. Infants were followed for between 6 and 12 months after birth, with 84% completing 12 months of follow-up. Information was obtained from objective sources including routine health visits and vaccination records wherever possible, as well as frequent parental reports. Setting The Canterbury region of New Zealand. Patients A cohort of 403 infants whose mothers had received Tdap vaccine. Main outcome measures Gestational age at birth, growth parameters, congenital anomalies, immunisation status and timeliness of immunisation, development of pertussis infection. Results There were no significant differences in birth weight, gestational age at birth, congenital anomalies or infant growth as compared with baseline population data. Infants of mothers who had received the vaccine were more likely to receive their vaccinations on time during infancy. No cases of pertussis occurred in this cohort despite high rates of disease in the community. We have not found any adverse events attributable to vaccine exposure. Conclusions These data add to the growing pool of evidence that the administration of Tdap vaccine during pregnancy is an appropriate strategy for reducing the burden of pertussis in infants. Clinical trial registration Australia New Zealand Clinical Trials Registry ACTRN12613001045707.

Health service utilisation of a regional cohort of very preterm infants over the first 2 years of life.

Aim:  Very preterm infants represent major consumers of health services following neonatal discharge. We examined the health service utilisation of a regional cohort of very preterm infants over the first 2 years of life, including the association with neurodevelopmental outcome.

Identifying Very Preterm Children at Educational Risk Using a School Readiness Framework

OBJECTIVES: Children born very preterm (VPT) are at high risk of educational delay, yet few guidelines exist for the early identification of those at greatest risk. Using a school readiness framework, this study examined relations between preschool neurodevelopmental functioning and educational outcomes to age 9 years. METHODS: The sample consisted of a regional cohort of 110 VPT (≤32 weeks’ gestation) and 113 full-term children born during 1998–2000. At corrected age 4 years, children completed a multidisciplinary assessment of their health/motor development, socioemotional adjustment, core learning skills, language, and general cognition. At ages 6 and 9, children’s literacy and numeracy skills were assessed using the Woodcock-Johnson III Tests of Achievement. RESULTS: Across all readiness domains, VPT children were at high risk of delay/impairment (odds ratios 2.5–3.5). Multiple problems were also more common (47% vs 16%). At follow-up, almost two-thirds of VPT children were subject to significant educational delay in either literacy, numeracy or both compared with 29% to 31% of full-term children (odds ratios 3.4–4.4). The number of readiness domains affected at age 4 strongly predicted later educational risk, especially when multiple problems were present. Receiver operating characteristic analysis confirmed ≥2 readiness problems as the optimal threshold for identifying VPT children at educational risk. CONCLUSIONS: School readiness offers a promising framework for the early identification of VPT children at high educational risk. Findings support the utility of ≥2 affected readiness domains as an effective criterion for referral for educational surveillance and/or additional support during the transition to school.

Excessive exposure of sick neonates to sound during transport.

Objective: To determine the levels of sound to which infants are exposed during routine transport by ambulance, aircraft, and helicopter. Design: Sound levels during 38 consecutive journeys from a regional level III neonatal intensive care unit were recorded using a calibrated data logging sound meter (Quest 2900). The meter was set to record “A” weighted slow response integrated sound levels, which emulates the response of the human ear, and “C” weighted response sound levels as a measure of total sound level exposure for all frequencies. The information was downloaded to a computer using MS HyperTerminal. The resulting data were stored, and a graphical profile was generated for each journey using SigmaPlot software. Setting: Eight journeys involved ambulance transport on country roads, 24 involved fixed wing aircraft, and four were by helicopter. Main outcome measures: Relations between decibel levels and events or changes in transport mode were established by correlating the time logged on the sound meter with the standard transport documentation sheet. Results: The highest sound levels were recorded during air transport. However, mean sound levels for all modes of transport exceeded the recommended levels for neonatal intensive care. The maximum sound levels recorded were extremely high at greater than 80 dB in the “A” weighted hearing range and greater than 120 dB in the total frequency range. Conclusions: This study raises major concerns about the excessive exposure of the sick newborn to sound during transportation.

Systemic antifungal prophylaxis for very low birthweight infants: a systematic review

Systematic review and meta-analysis of four randomised controlled trials suggest that prophylactic fluconazole reduces the incidence of invasive fungal infection in very low birthweight infants. Further trials are needed to provide more precise estimates of effect size, and to assess the effect on mortality, neurodevelopment and the emergence of antifungal resistance.

Emotional and behavioural adjustment of children born very preterm at early school age.

Aims:  This paper describes the emotional and behavioural adjustment of children born very preterm (VPT) at early school age. Of particular interest was the degree of agreement between parents and teachers, and the extent of situational (parent or teacher) and pervasive (parent and teacher reported) adjustment problems.

Admissions of all gestations to a regional neonatal unit versus controls: 2‐year outcome

Aims:  To assess neurodevelopmental outcome at 2 years for neonatal intensive care unit (NICU) admissions compared with controls, and to trial a parent‐reporting scheme.