Improving outcomes for very preterm babies in England: does place of birth matter? Findings from OPTI-PREM, a national cohort study.

Objective: Babies born between 27 and 31 weeks of gestation contribute substantially towards infant mortality and morbidity. In England, their care is delivered in maternity services colocated with highly specialised neonatal intensive care units (NICU) or less specialised local neonatal units (LNU). We investigated whether birth setting offered survival and/or morbidity advantages to inform National Health Service delivery.

Estimated neonatal survival of very preterm births across the care pathway: a UK cohort 2016-2020.

Objective: Currently used estimates of survival are nearly 10 years old and relate to only those babies admitted for neonatal care. Due to ongoing improvements in neonatal care, here we update estimates of survival for singleton and multiple births at 22 to 31 weeks gestational age across the perinatal care pathway by gestational age and birth weight.

Design: Retrospective analysis of routinely collected data.

Methods for Constructing Normalised Reference Scores: An Application for Assessing Child Development at 24 Months of Age.

The use of the lambda-mu-sigma (LMS) method for estimating centiles and producing reference ranges has received much interest in clinical practice, especially for assessing growth in childhood. However, this method may not be directly applicable where measures are based on a score calculated from question response categories that is bounded within finite intervals, for example, in psychometrics. In such cases, the main assumption of normality of the conditional distribution of the transformed response measurement is violated due to the presence of ceiling (and floor) effects, leading to biased fitted centiles when derived using the common LMS method.

Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study.

Objectives: To investigate inequalities in stillbirth rates by ethnicity to facilitate development of initiatives to target those at highest risk.

Design: Population-based perinatal mortality surveillance linked to national birth and death registration (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK).

Setting: UK.

EPICE cohort: two-year neurodevelopmental outcomes after very preterm birth.

Objective: To determine whether the variation in neurodevelopmental disability rates between populations persists after adjustment for demographic, maternal and infant characteristics for an international very preterm (VPT) birth cohort using a standardised approach to neurodevelopmental assessment at 2 years of age.

Design: Prospective standardised cohort study.

Setting: 15 regions in 10 European countries.

Standardisation of the Parent Report of Children's Abilities-Revised (PARCA-R): a norm-referenced assessment of cognitive and language development at age 2 years.

Background: The Parent Report of Children's Abilities-Revised (PARCA-R) can be used to identify preterm born children at risk for developmental delay at age 24 months. However, standardised scores for assessing all children in the general population and quantifying development relative to the norm are unavailable, thus limiting the use of the questionnaire. We aimed to develop scores that are standardised by age and sex for the PARCA-R to assess children's cognitive and language development at age 24-27 months.

Assessing the deprivation gap in stillbirths and neonatal deaths by cause of death: a national population-based study.

Objective: To investigate socioeconomic inequalities in cause-specific stillbirth and neonatal mortality to identify key areas of focus for future intervention strategies to achieve government ambitions to reduce mortality rates.

Design: Retrospective cohort study.

Setting: England, Wales, Scotland and the UK Crown Dependencies.

Estimating neonatal length of stay for babies born very preterm.

Objective: To predict length of stay in neonatal care for all admissions of very preterm singleton babies.

Setting: All neonatal units in England.

Patients: Singleton babies born at 24-31 weeks gestational age from 2011 to 2014.

Wide variation in severe neonatal morbidity among very preterm infants in European regions.

Objective: To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates.

Design: Area-based cohort study of all births before 32 weeks of gestational age.

Setting: 16 regions in 11 European countries in 2011/2012.

Differentiating the Preterm Phenotype: Distinct Profiles of Cognitive and Behavioral Development Following Late and Moderately Preterm Birth.

Objectives: To explore patterns of comorbidity in cognitive and behavioral outcomes at 2 years' corrected age among children born late or moderately preterm (LMPT) and to identify predictors of different patterns of comorbidity.

Study Design: Geographical, prospective population-based cohort study of 1139 infants born LMPT (32 to 36 weeks' gestation) and 1255 infants born at term (37 to 42 weeks' gestation). Parent questionnaires were obtained to identify impaired cognitive and language development, behavioral problems, delayed social-emotional competence, autistic features, and clinically significant eating difficulties at 24 months corrected age for 638 (57%) children born LMPT and 765 (62%) children born at term.

Variability in Very Preterm Stillbirth and In-Hospital Mortality Across Europe.

Background And Objective: Stillbirth and in-hospital mortality rates associated with very preterm births (VPT) vary widely across Europe. International comparisons are complicated by a lack of standardized data collection and differences in definitions, registration, and reporting. This study aims to determine what proportion of the variation in stillbirth and in-hospital VPT mortality rates persists after adjusting for population demographics, case-mix, and timing of death.

Variability in the management and outcomes of extremely preterm births across five European countries: a population-based cohort study.

Objective: To explore international variations in the management and survival of extremely low gestational age and birthweight births.

Design: Area-based prospective cohort of births SETTING: 12 regions across Belgium, France, Italy, Portugal and the UK PARTICIPANTS: 1449 live births and fetal deaths between 22 and 25 weeks gestation born in 2011-2012.

Main Outcome Measures: Percentage of births; recorded live born; provided antenatal steroids or respiratory support; surviving to discharge (with/without severe morbidities).

Causes and temporal changes in nationally collected stillbirth audit data in high-resource settings.

Few high-income countries have an active national programme of stillbirth audit. From the three national programmes identified (UK, New Zealand, and the Netherlands) steady declines in annual stillbirth rates have been observed over the audit period between 1993 and 2014. Unexplained stillbirth remains the largest group in the classification of stillbirths, with a decline in intrapartum-related stillbirths, which could represent improvements in intrapartum care.

What factors predict length of stay in a neonatal unit: a systematic review.

Objective: In the UK, 1 in 10 babies require specialist neonatal care. This care can last from hours to months depending on the need of the baby. The increasing survival of very preterm babies has increased neonatal care resource use.

Modelling Neonatal Care Pathways for Babies Born Preterm: An Application of Multistate Modelling.

Modelling length of stay in neonatal care is vital to inform service planning and the counselling of parents. Preterm babies, at the highest risk of mortality, can have long stays in neonatal care and require high resource use. Previous work has incorporated babies that die into length of stay estimates, but this still overlooks the levels of care required during their stay.

Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort.

Objectives:  To evaluate the implementation of four high evidence practices for the care of very preterm infants to assess their use and impact in routine clinical practice and whether they constitute a driver for reducing mortality and neonatal morbidity.

Design:  Prospective multinational population based observational study.

Setting:  19 regions from 11 European countries covering 850 000 annual births participating in the EPICE (Effective Perinatal Intensive Care in Europe for very preterm births) project.

Correcting for prematurity affects developmental test scores in infants born late and moderately preterm.

Background: Corrected age is typically applied when assessing the development of children born <32 weeks of gestation. There is no consensus as to whether corrected age should be applied when assessing children born late/moderately preterm (LMPT; 32-36 weeks of gestation).

Aims: This study explored the impact of corrected age on developmental test scores in infants born LMPT.

Eating difficulties in children born late and moderately preterm at 2 y of age: a prospective population-based cohort study.

Background: Very preterm (<32 wk of gestation) infants are at increased risk of eating difficulties compared with their term-born peers. Little is known about the impact of late and moderately preterm (LMPT; 32-36 wk of gestation) birth on eating difficulties in early childhood.

Objectives: The aims were to assess the prevalence of eating difficulties in infants born LMPT at 2 y corrected age and to explore the impact of neonatal and neurodevelopmental factors.

Early Emergence of Delayed Social Competence in Infants Born Late and Moderately Preterm.

Objective: To assess behavioral outcomes and social competence at 2 years of age in infants born late and moderately preterm (LMPT; 32-36 wk gestation).

Method: One thousand one hundred and thirty LMPT infants and 1255 term-born (≥37 wk) controls were recruited at birth to a prospective geographical population-based study. Parents completed the Brief Infant and Toddler Social Emotional Assessment (BITSEA) at 2 years corrected age to assess infants' behavior problems and social competence.

Associations between late and moderately preterm birth and smoking, alcohol, drug use and diet: a population-based case-cohort study.

Objective: This study explores the associations between lifestyle factors and late and moderate preterm birth (LMPT: 32(+0)-36(+6) weeks' gestation), a relatively under-researched group.

Study Design: A population-based case-cohort study was undertaken involving 922 LMPT and 965 term (37+ weeks' gestation) singleton live and stillbirths born between 1 September 2009 and 31 December 2010 to women residing in Leicestershire and Nottinghamshire, UK. Poisson multivariable regression models were fitted to estimate relative risks (RR) of LMPT birth associated with maternal smoking, alcohol and recreational drug use, and diet.

Neurodevelopmental outcomes following late and moderate prematurity: a population-based cohort study.

Objective: There is a paucity of data relating to neurodevelopmental outcomes in infants born late and moderately preterm (LMPT; 32(+0)-36(+6) weeks). This paper present the results of a prospective, population-based study of 2-year outcomes following LMPT birth.

Design: 1130 LMPT and 1255 term-born children were recruited at birth.

Infants born late/moderately preterm are at increased risk for a positive autism screen at 2 years of age.

Objectives: To assess the prevalence of positive screens using the Modified Checklist for Autism in Toddlers (M-CHAT) questionnaire and follow-up interview in late and moderately preterm (LMPT; 32-36 weeks) infants and term-born controls.

Study Design: Population-based prospective cohort study of 1130 LMPT and 1255 term-born infants. Parents completed the M-CHAT questionnaire at 2-years corrected age.

A parent questionnaire for developmental screening in infants born late and moderately preterm.

Background: The Parent Report of Children's Abilities-Revised (PARCA-R) is a questionnaire for assessing cognitive and language development in very preterm infants. Given the increased risk of developmental delay in infants born late and moderately preterm (LMPT; 32-36 weeks), this study aimed to validate this questionnaire as a screening tool in this population.

Methods: Parents of 219 children born LMPT completed the PARCA-R questionnaire and the Brief Infant Toddler Social and Emotional Assessment when children were 24 months corrected age (range, 24 months-27 months).