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Objectives: To determine growth outcomes at 11 years of age in children born <27 weeks of gestation in England in 2006 (EPICure2) and to compare growth from birth to 11 years of age for births<26 weeks with those in England in 1995 (EPICure).Methods: 200 EPICure2 children assessed at 11 years alongside 143 term-born controls. Growth measures from birth to 11 years were compared for births<26 weeks between EPICure2 (n=112) and EPICure (n=176). Growth parameter z-scores were derived from 1990 UK standards.Results: Among EPICure2 children, mean z-scores for height and weight were close to the population standards (0.08 and 0.18 SD, respectively) but significantly below those of controls: difference in mean (Δ) z-scores for weight -0.42 SD (95% CI -0.68 to -0.17), for height -0.45 SD (-0.70 to -0.20) and for head circumference (HC) -1.05 SD (-1.35 to -0.75); mean body mass index (BMI) z-score in EPICure2 children was 0.18 SD, not significantly different from controls (0.43 SD, p=0.065). Compared with EPICure, EPICure2 children born <26 weeks at 11 years had higher z-scores for weight (Δ 0.72 (0.47, 0.96)), height (Δ 0.55 (0.29, 0.81)) and BMI (Δ 0.56 (0.24, 0.87)), which were not fully explained by perinatal/demographic differences between eras. Weight catch-up was greater from term-age to 2.5/3 years in EPICure2 than in EPICure (1.25 SD vs 0.53 SD; p<0.001). Poor HC growth was observed in EPICure2, unchanged from EPICure.Conclusions: Since 1995, childhood growth in weight, height and BMI have improved for births <26 weeks of gestation, but there was no improvement in head growth. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between gestational age at birth across the entire gestational age spectrum and special educational needs (SENs) in UK children at 11 years of age.Methods: The Millennium Cohort Study is a nationally representative longitudinal sample of children born in the UK during 2000-2002. Information about the child's birth, health and sociodemographic factors was collected when children were 9 months old. Information about presence and reasons for SEN was collected from parents at age 11. Adjusted relative risks (aRRs) were estimated using modified Poisson regression, accounting for confounders.Results: The sample included 12 081 children with data at both time points. The overall prevalence of SEN was 11.2%, and it was inversely associated with gestational age. Among children born <32 weeks of gestation, the prevalence of SEN was 27.4%, three times higher than among those born at 40 weeks (aRR=2.89; 95% CI 2.02 to 4.13). Children born early term (37-38 weeks) were also at increased risk for SEN (aRR=1.33; 95% CI 1.11 to 1.59); this was the same when the analysis was restricted to births after labour with spontaneous onset. Birth before full term was more strongly associated with having a formal statement of SEN or SEN for multiple reasons.Conclusion: Children born at earlier gestational ages are more likely to experience SEN, have more complex SEN and require support in multiple facets of learning. This association was observed even among children born early-term and when labour began spontaneously. [ABSTRACT FROM AUTHOR]

Objective: To determine whether improvements in school age outcomes had occurred between two cohorts of births at 22-25 weeks of gestation to women residents in England in 1995 and 2006.Design: Longitudinal national cohort studies.Setting: School-based or home-based assessments at 11 years of age.Participants: EPICure2 cohort of births at 22-26 weeks of gestation in England during 2006: a sample of 200 of 1031 survivors were evaluated; outcomes for 112 children born at 22-25 weeks of gestation were compared with those of 176 born in England during 1995 from the EPICure cohort. Classroom controls for each group acted as a reference population.Main Outcome Measures: Standardised measures of cognition and academic attainment were combined with parent report of other impairments to estimate overall neurodevelopmental status.Results: At 11 years in EPICure2, 18% had severe and 20% moderate impairments. Comparing births at 22-25 weeks in EPICure2 (n=112), 26% had severe and 21% moderate impairment compared with 18% and 32%, respectively, in EPICure. After adjustment, the OR of moderate or severe neurodevelopmental impairment in 2006 compared with 1995 was 0.76 (95% CI 0.45 to 1.31, p=0.32). IQ scores were similar in 1995 (mean 82.7, SD 18.4) and 2006 (81.4, SD 19.2), adjusted difference in mean z-scores 0.2 SD (95% CI -0.2 to 0.6), as were attainment test scores. The use of multiple imputation did not alter these findings.Conclusion: Improvements in care and survival between 1995 and 2006 are not paralleled by improved cognitive or educational outcomes or a reduced rate of neurodevelopmental impairment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the cost-effectiveness of two rates of enteral feed advancement (18 vs 30 mL/kg/day) in very preterm and very low birth weight infants.Design: Within-trial economic evaluation alongside a multicentre, two-arm parallel group, randomised controlled trial (Speed of Increasing milk Feeds Trial).Setting: 55 UK neonatal units from May 2013 to June 2015.Patients: Infants born <32 weeks' gestation or <1500 g, receiving less than 30 mL/kg/day of milk at trial enrolment. Infants with a known severe congenital anomaly, no realistic chance of survival, or unlikely to be traceable for follow-up, were ineligible.Interventions: When clinicians were ready to start advancing feed volumes, infants were randomised to receive daily increments in feed volume of 30 mL/kg (intervention) or 18 mL/kg (control).Main Outcome Measure: Cost per additional survivor without moderate to severe neurodevelopmental disability at 24 months of age corrected for prematurity.Results: Average costs per infant were slightly higher for faster feeds compared with slower feeds (mean difference £267, 95% CI -6928 to 8117). Fewer infants achieved the principal outcome of survival without moderate to severe neurodevelopmental disability at 24 months in the faster feeds arm (802/1224 vs 848/1246). The stochastic cost-effectiveness analysis showed a likelihood of worse outcomes for faster feeds compared with slower feeds.Conclusions: The stochastic cost-effectiveness analysis shows faster feeds are broadly equivalent on cost grounds. However, in terms of outcomes at 24 months age (corrected for prematurity), faster feeds are harmful. Faster feeds should not be recommended on either cost or effectiveness grounds to achieve the primary outcome. [ABSTRACT FROM AUTHOR]

Objectives: To develop research priorities on the consequences of very preterm (VPT) birth for the RECAP Preterm platform which brings together data from 23 European VPT birth cohorts.Design and Setting: This study used a two-round modified Delphi consensus process. Round 1 was based on 28 research themes related to childhood outcomes (<12 years) derived from consultations with cohort researchers. An external panel of multidisciplinary stakeholders then ranked their top 10 themes and provided comments. In round 2, panel members provided feedback on rankings and on new themes suggested in round 1.Results: Of 71 individuals contacted, 64 (90%) participated as panel members comprising obstetricians, neonatologists, nurses, general and specialist paediatricians, psychologists, physiotherapists, parents, adults born preterm, policy makers and epidemiologists from 17 countries. All 28 initial themes were ranked in the top 10 by at least six panel members. Highest ranking themes were: education (73% of panel members' top 10 choices); care and outcomes of extremely preterm births, including ethical decisions (63%); growth and nutrition (60%); emotional well-being and social inclusion (55%); parental stress (55%) and impact of social circumstances on outcomes (52%). Highest ranking themes were robust across panel members classified by background. 15 new themes had at least 6 top 10 endorsements in round 2.Conclusions: This study elicited a broad range of research priorities on the consequences of VPT birth, with good consensus on highest ranks between stakeholder groups. Several highly ranked themes focused on the socioemotional needs of children and parents, which have been less studied. [ABSTRACT FROM AUTHOR]

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.Patients: VPT births: 22+0-31+6 weeks of gestation.Data Collection: Standardised data collection tools relating to pregnancy, birth and neonatal care and developmental outcomes at 2 years corrected age using a validated parent completed questionnaire.Main Outcome Measures: Crude and standardised prevalence ratios calculated to compare rates of moderate to severe neurodevelopmental impairment between regions grouped by country using fixed effects models.Results: Parent reported rates of moderate or severe neurodevelopmental impairment for the cohort were: 17.3% (ranging 10.2%-26.1% between regions grouped by country) with crude standardised prevalence ratios ranging from 0.60 to 1.53. Adjustment for population, maternal and infant factors resulted in a small reduction in the overall variation (ranging from 0.65 to 1.30).Conclusion: There is wide variation in the rates of moderate to severe neurodevelopmental impairment for VPT cohorts across Europe, much of which persists following adjustment for known population, maternal and infant factors. Further work is needed to investigate whether other factors including quality of care and evidence-based practice have an effect on neurodevelopmental outcomes for these children. [ABSTRACT FROM AUTHOR]

Objective: To report outcomes at 2 years corrected age for children of women recruited to a trial comparing alternative policies for timing of cord clamping and immediate neonatal care at very preterm birth.Design: Parallel group randomised (1:1) trial.Setting: Eight UK tertiary maternity units.Participants: Two hundred and seventy-six babies born to 261 women expected to have a live birth before 32+0 weeks' gestation.Interventions: Deferred cord clamping (≥2 min) and immediate neonatal care with cord intact or immediate (≤20 s) clamping and immediate neonatal care after clamping.Main Outcome Measure: Composite of death or adverse neurodevelopmental outcome at 2 years corrected age.Results: Six babies born after 35+6 weeks were excluded. At 2 years corrected age, outcome data were not available for a further 52 children, leaving 218 for analysis (115 deferred clamping, 103 immediate clamping). Overall, 24/115 (21%) children allocated deferred clamping died or had an adverse neurodevelopmental outcome compared with 35/103 (34%) allocated immediate clamping; risk ratio (RR) 0.61 (95% CI 0.39 to 0.96); risk difference (RD) -13% (95% CI -25% to -1%). Multiple imputation for missing data gave an RR 0.69 (95% CI 0.44 to 1.09) and RD -9% (95% CI -21% to 2%).Conclusions: Deferred clamping and immediate neonatal care with cord intact may reduce the risk of death or adverse neurodevelopmental outcome at 2 years of age for children born very premature. Confirmation in larger studies is needed to determine the real benefits and harms.Trial Registration Number: ISRCTN21456601. [ABSTRACT FROM AUTHOR]

Introduction The aim of the protocol is to present the methodology of a scoping review that aims to synthesise up-to- date evidence on adolescent undernutrition in South Asia. Methods and analysis The proposed scoping review will be guided by Arksey and O’Malley’s framework and the Joanna Briggs Institute Reviewers’ Manual. The scoping review question, eligibility criteria and search strategy will be based on the Population, Concept and Context strategy. We will conduct the search in electronic bibliographic databases (Medline (OVID), Embase, Cochrane Library, Web of Science, CINAHL, PsycInfo, Scopus) as well as various grey literature sources in order to synthesise and present the findings with descriptive statistics and a narrative description of both quantitative and qualitative evidence. Ethics and dissemination This study protocol does not require ethical approval. This protocol will accurately describe the proposed scoping review that will map the evidence on adolescent undernutrition in South Asia. The proposed review aims to gather published and unpublished literature to inform policy and healthcare organisations as well as identify future research priorities in South Asia. [ABSTRACT FROM AUTHOR]

Objectives Children born preterm are at higher risk for special educational needs and poor academic attainment compared with term-born peers, yet education professionals receive limited training and have poor knowledge of preterm birth. We have developed an interactive e-learning resource and evaluated its efficacy in improving teachers' knowledge of preterm birth and their confidence in supporting the learning of children born preterm. Setting Eight primary, infant or junior schools in England. Participants 61 teachers of children aged 4-11 years, of which 55 (90%) were female. Intervention Interactive e-learning resource designed to improve education professionals' knowledge of longterm outcomes following preterm birth and strategies that can be used to support children's learning ( www. pretermbirth. info). In a repeated measures design, participants were given up to 30 days access to the e-learning resource, before and after which they completed the Preterm Birth Knowledge Scale (PB-KS; scores 0-33; higher scores indicate greater knowledge) to assess knowledge of outcomes of prematurity. Four Likert scale items were used to assess confidence in supporting children's learning and 10 items were used to evaluate the utility of the resource. PB-KS scores and responses on confidence item were compared preresource and post-resource use. Results PB-KS scores significantly increased after accessing the e-learning resource (median (95% CI): pre-resource 13 (11 to 14); post-resource 29 (28 to 30)), equating to a 2.6 SD increase in PB-KS scores. Teachers' confidence in supporting children born preterm was also significantly improved after using the resource. The utility of the resource was evaluated positively by participants with 97% reporting that they would recommend its use to others. Conclusions The e-learning resource substantially improved teachers' knowledge of preterm birth and their confidence in supporting preterm children in the classroom. Use of this resource may represent a key advance in improving educational outcomes for children born preterm. [ABSTRACT FROM AUTHOR]

Objectives We were commissioned by the behavioural insights team at Public Health England to synthesise the evidence on choice architecture interventions to increase healthy purchasing and/or consumption of food and drink by National Health Service (NHS) staff. Data sources MEDLINE, EMBASE, CINAHL, Cochrane Central register of Controlled Trials, PsycINFO, Applied Social Sciences Index and Abstracts and Web of Science were searched from inception until May 2017 and references were screened independently by two reviewers. Design A systematic review that included randomised experimental or intervention studies, interrupted time series and controlled before and after studies. Participants Healthcare staff of high-income countries. Intervention Choice architecture interventions that aimed to improve dietary purchasing and/or consumption (outcomes) of staff. Appraisal and synthesis Eligibility assessment, quality appraisal, data abstraction and analysis were completed by two reviewers. Quality appraisal of randomised trials was informed by the Cochrane Handbook, and the Risk of Bias Assessment Tool for Nonrandomized Studies was used for the remainder. Findings were narratively synthesised. Results Eighteen studies met the inclusion criteria. Five studies included multiple workplaces (including healthcare settings), 13 were conducted in healthcare settings only. Interventions in 10 studies were choice architecture only and 8 studies involved a complex intervention with a choice architecture element. Interventions involving a proximity element (making behavioural options easier or harder to engage with) appear to be frequently effective at changing behaviour. One study presented an effective sizing intervention. Labelling alone was generally not effective at changing purchasing behaviour. Interventions including an availability element were generally reported to be successful at changing behaviour but no included study examined this element alone. There was no strong evidence for the effect of pricing on purchasing or dietary intake. Conclusion Proximity, availability and sizing are choice architecture elements that are likely to be effective for NHS organisations. [ABSTRACT FROM AUTHOR]

Objective: To determine the trajectory of cognitive test scores from infancy to adulthood in individuals born extremely preterm compared with term-born individuals.Design: A prospective, population-based cohort study.Setting: 276 maternity units in the UK and Ireland.Patients: 315 surviving infants born less than 26 completed weeks of gestation recruited at birth in 1995 and 160 term-born classroom controls recruited at age 6.Main Outcome Measures: Bayley Scales of Infant Development-Second Edition (age 2.5); Kaufman Assessment Battery for Children (ages 6/11); Wechsler Abbreviated Scale of Intelligence-Second Edition (age 19).Results: The mean cognitive scores of extremely preterm individuals over the period were on average 25.2 points below their term-born peers (95% CI -27.8 to -22.6) and remained significantly lower at every assessment. Cognitive trajectories in term-born boys and girls did not differ significantly, but the scores of extremely preterm boys were on average 8.8 points below those of extremely preterm girls (95% CI -13.6 to -4.0). Higher maternal education elevated scores in both groups by 3.2 points (95% CI 0.8 to 5.7). Within the extremely preterm group, moderate/severe neonatal brain injury (mean difference: -10.9, 95% CI -15.5 to -6.3) and gestational age less than 25 weeks (mean difference: -4.4, 95% CI -8.4 to -0.4) also had an adverse impact on cognitive function.Conclusions: There is no evidence that impaired cognitive function in extremely preterm individuals materially recovers or deteriorates from infancy through to 19 years. Cognitive test scores in infancy and early childhood reflect early adult outcomes. [ABSTRACT FROM AUTHOR]

There is no question that birth at extremely low gestational ages presents a significant threat to an infant's survival, health and development. Growing evidence suggests that gestational age may be conceptualised as a continuum in which births before 28 weeks of gestation (extremely preterm: EP) represent the severe end of a spectrum of health and developmental adversity. Although comprising just 1%-2% of all births, EP deliveries pose the greatest challenge to neonatal medicine and to health, education and social services for the provision of ongoing support for survivors with additional needs. Studying the outcomes of these infants remains critical for evaluating and enhancing clinical care, planning long-term support and for advancing our understanding of the life-course consequences of immaturity at birth. Here we review literature relating to early and long-term neurodevelopmental, cognitive, behavioural and educational outcomes following EP birth focusing on key themes and considering implications for intervention. [ABSTRACT FROM AUTHOR]

Background: Routine comparable outcome data collection relating to the later health status of babies born very preterm has long been considered important, but has not been achieved in the UK. Aim: To test the potential for a parental questionnaire to provide these data for all eligible babies from a geographical population. Methods: Consent for follow-up by questionnaire (using the Parent Report of Children's Abilities-Revised combined with questions derived from the Oxford minimum dataset) was sought for all babies ≤30 weeks of gestation, discharged from a hospital in the East Midlands and Yorkshire regions of the UK, having been born between 1 January 2007 and 31 December 2011. Results: The rate of consent to participate in follow-up showed a steady increase over time to 83.1% in 2011. However, the response rate in terms of completion and return of the questionnaire at 2 years, as a proportion of those eligible, showed little change over time, varying between 42% and 46%. Among those children where a questionnaire was returned, the rate of disability was broadly consistent over time: lowest in 2009, 21.0% (95% CI 16.8% to 25.6%) and highest in 2011, 25.5% (95% CI 21.5% to 31.2%). The instruments used appeared effective with the capability of discriminating between children with physical and/or cognitive disability. Conclusions: The overall response rate in terms of returned questionnaires was disappointing and inadequate to recommend for implementation. It is possible that response rates would have been higher had clinical follow-up been linked to the data obtained from the questionnaires rather than running as a parallel process. [ABSTRACT FROM AUTHOR]

Objective: To describe neonatal outcomes and explore variation in delivery of care for infants born late (34-36  weeks) and moderately (32-33 weeks) preterm (LMPT).Design/setting: Prospective population-based study comprising births in four major maternity centres, one midwifery-led unit and at home between September 2009 and December 2010. Data were obtained from maternal and neonatal records.Participants: All LMPT infants were eligible. A random sample of term-born infants (≥37 weeks) acted as controls.Outcome Measures: Neonatal unit (NNU) admission, respiratory and nutritional support, neonatal morbidities, investigations, length of stay and postnatal ward care were measured. Differences between centres were explored.Results: 1146 (83%) LMPT and 1258 (79% of eligible) term-born infants were recruited. LMPT infants were significantly more likely to receive resuscitation at birth (17.5% vs 7.4%), respiratory (11.8% vs 0.9%) and nutritional support (3.5% vs 0.3%) and were less likely to be fed breast milk (64.2% vs 72.2%) than term infants. For all interventions and morbidities, a gradient of increasing risk with decreasing gestation was evident. Although 60% of late preterm infants were never admitted to a NNU, 83% required medical input on postnatal wards. Clinical management differed significantly between services.Conclusions: LMPT infants place high demands on specialist neonatal services. A substantial amount of previously unreported specialist input is provided in postnatal wards, beyond normal newborn care. Appropriate expertise and planning of early care are essential if such infants are managed away from specialised neonatal settings. Further research is required to clarify optimal and cost-effective postnatal management for LMPT babies. [ABSTRACT FROM AUTHOR]

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.Results: Women who smoked during pregnancy were at 38% increased risk of LMPT birth compared with non-smokers (RR 1.38, 95% CI (1.04 to 1.84)). Low consumption of fruit and vegetables was associated with a 31% increased risk compared with those who reported eating higher consumption levels (RR 1.31 (1.03 to 1.66)). Women who did not have any aspects of a Mediterranean diet were nearly twice as likely to deliver LMPT compared with those whose diet included more Mediterranean characteristics (RR 1.81 (1.04 to 3.14)). Women who smoked and consumed low levels of fruit and vegetables (5% of women) were at particularly high risk (RR=1.81 (1.29 to 2.55)). There was no significant effect of alcohol or recreational drug use on LMPT birth.Conclusions: Smoking and poor diet during pregnancy, factors that strongly impact on very preterm birth, are also important at later gestations and experienced together are associated with an elevated rate of risk. Our findings suggest early cessation of smoking during pregnancy may be an effective strategy to reduce LMPT births. [ABSTRACT FROM AUTHOR]

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. At 2 years corrected age, parents completed a questionnaire to assess neurosensory (vision, hearing, motor) impairments and the Parent Report of Children's Abilities-Revised to identify cognitive impairment. Relative risks for adverse outcomes were adjusted for sex, socio-economic status and small for gestational age, and weighted to account for over-sampling of term-born multiples. Risk factors for cognitive impairment were explored using multivariable analyses. Results Parents of 638 (57%) LMPT infants and 765 (62%) controls completed questionnaires. Among LMPT infants, 1.6% had neurosensory impairment compared with 0.3% of controls (RR 4.89, 95% CI 1.07 to 22.25). Cognitive impairments were the most common adverse outcome: LMPT 6.3%; controls 2.4% (RR 2.09, 95% CI 1.19 to 3.64). LMPT infants were at twice the risk for neurodevelopmental disability (RR 2.19, 95% CI 1.27 to 3.75). Independent risk factors for cognitive impairment in LMPT infants were male sex, socio-economic disadvantage, non-white ethnicity, preeclampsia and not receiving breast milk at discharge. Conclusions Compared with term-born peers, LMPT infants are at double the risk for neurodevelopmental disability at 2 years of age, with the majority of impairments observed in the cognitive domain. Male sex, socio-economic disadvantage and preeclampsia are independent predictors of low cognitive scores following LMPT birth. [ABSTRACT FROM AUTHOR]

The article examines the accountability of clinical trials in terms of neurodevelopmental impairment and long-term morbidity. Topics discussed include use of validated psychometric instruments to quantify a child's developmental process, association of whole-body hypothermia with primary outcome of death or neurodisability and a chart that depicts the types of disability such as motor, hearing and vision.

Objective: Children born very preterm (VP; <32 weeks) are at risk for attention deficit/hyperactivity disorders (ADHD). ADHD in VP children have a different clinical presentation to ADHD in the general population, and therefore VP children with difficulties may not come to the teacher's attention in school. We have assessed ADHD symptoms to determine whether VP children's difficulties may go undetected in the classroom. Design: Parents and teachers of 117 VP and 77 term-born children completed the Strengths and Difficulties Questionnaire to assess hyperactivity/ inattention, emotional, conduct and peer problems, and the Du Paul ADHD Rating Scale-IV to assess inattention and hyperactivity/impulsivity symptoms. Special Educational Needs (SEN) were assessed using teacher report. Group differences in outcomes were adjusted for socio-economic deprivation. Results: Parents and teachers rated VP children with significantly higher mean Strengths and Difficulties Questionnaire hyperactivity/inattention scores, and parents rated them with more clinically significant hyperactivity/inattention difficulties than term-born controls (Relative Risk (RR) 4.0; 95% CI 1.4 to 11.4). Examining ADHD dimensions, parents and teachers rated VP children with significantly more inattention symptoms than controls, and parents rated them with more clinically significant inattention (RR 4.8; 95% CI 1.4 to 16.0); in contrast, there was no excess of hyperactivity/ impulsivity. After excluding children with SEN, VP children still had significantly higher inattention scores than controls but there was no excess of hyperactivity/ impulsivity. Conclusions: VP children are at greater risk for symptoms of inattention than hyperactivity/impulsivity. Inattention was significantly increased among VP children without identified SEN suggesting that these problems may be difficult to detect in school. Raising teachers' awareness of inattention problems may be advantageous in enabling them to identify VP children who may benefit from intervention. [ABSTRACT FROM AUTHOR]

Objective: To investigate temporal trends in multiple birth rates and associated stillbirth and neonatal mortality by socioeconomic deprivation and maternal age in England. Design: Population cohort study. Setting: England. Participants: All live births and stillbirths (1 January 1997 to 31 December 2008). Main outcome measures: Multiple maternity rate, stillbirth and neonatal death rate by year of birth, decile of socioeconomic deprivation and maternal age. Results: The overall rate of multiple maternities increased over time (+0.64% per annum 95% CI (0.47% to 0.81%)) with an increase in twin maternities (+0.85% per annum 95% CI (0.67% to 1.0%)) but a large decrease in triplet and higher order maternities (-8.32% per annum 95% CI (-9.39% to -7.25%)). Multiple maternities were significantly lower in the most deprived areas, and this was most evident in the older age groups. Women over 40 years of age from the most deprived areas had a 34% lower rate of multiple births compared with similar aged women from the most deprived areas (rate ratio (RR) 0.66 95% CI (0.61 to 0.73)). Multiple births remain at substantially higher risk of neonatal mortality (RR 6.30 95% CI (6.07 to 6.53)). However, for stillbirths, while twins remain at higher risk, this has decreased over time (1997-2000: RR 2.89 (2.69 to 3.10); 2005-2008: RR 2.22 95% CI (2.06 to 2.40)). Socioeconomic inequalities existed in mortality for singletons and multiple births. Conclusions: This period has seen increasing rates of twin pregnancies and decreasing rates of higher order births which have coincided with changes in recommendations regarding assisted reproductive techniques. Socioeconomic differences in multiple births may reflect differential access to these treatments. Improved monitoring of multiple pregnancies is likely to have led to the reductions in stillbirths over this time. [ABSTRACT FROM AUTHOR]

Children born very preterm have poorer attainment in all school subjects, and a markedly greater reliance on special educational support than their term-born peers. In particular, difficulties with mathematics are especially common and account for the vast majority of learning difficulties in this population. In this paper, we review research relating to the causes of mathematics learning difficulties in typically developing children, and the impact of very preterm birth on attainment in mathematics. Research is needed to understand the specific nature and origins of mathematics difficulties in very preterm children to target the development of effective intervention strategies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of parenting intervention on maternal responsiveness and infant neurobehavioural development following a very premature birth. Design: Cluster-randomised controlled trial, with a crossover design and three-month washout period. Setting: Six neonatal intensive care units. Patients: Infants born <32 weeks' gestation. Intervention: The Parent Baby Interaction Programme (PBIP) is a supportive, educational intervention delivered by research nurses in the neonatal intensive care unit, with optional home follow-up for up to six weeks after discharge. Main outcome measures: Parenting stress at 3 months adjusted age, as measured by the Parenting Stress Index (PSI). Other outcomes included the Neurobehavioural Assessment of the Preterm Infant (NAPI) and maternal interaction as assessed by the Nursing Child Assessment Teaching Scale (NCATS) and the responsivity subscale for Home Observation for Measurement of the Environment (HOME). Results: 112 infants were recruited in the intervention phases and 121 in the control phases. Mean standardised NAPI scores at 35 weeks did not differ between the PBIP and control groups. Both groups had low but similar NCATS caregiver scores before discharge (36.6 in the PBIP group and 37.4 in control, adjusted mean difference -0.7, 95% Cl-2.7 to 1.4). At three months, adjusted age mean PSI scores for the PBIP group were 71.9 compared with 67.1 for controls (adjusted mean difference 3.8, 95% Cl -4.7 to 12.4). NCATS scores and HOME responsivity scores were similarly distributed between the groups. Conclusion: This early, nurse-delivered, parent-focused interaction programme intervention had no measurable effects on short-term infant neurobehavioural function, mother-child interaction or parenting stresses. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor of the periodical "Journal of Medical Genetics," concerning clustering and frequency of mutations in the retinal guanylate cyclase gene in patients with dominant cone-red dystrophies.

The article presents a reprint of the article "Neurological and developmental outcome in extremely preterm children born in England in 2006 and 1995: the EPICure studies," which was published on bmj.com on December 4, 2012.

The authors reflect on the effectiveness of teachers in dealing with students who are suffering meningitis in Great Britain. They stressed that the effect of perinatal illness on long-term cognitive development is evident in children born very preterm. They noticed that the effects of serious illness during the perinatal period and in infancy may only become evident during formal schooling when the increasingly complex demands of academic environment aggravate the subsisting conditions.

Since the 1980s, there has been an increasing acknowledgement of the importance of recognising the ethical dimension of clinical decision-making. Medical professional regulatory authorities in some countries now include ethical knowledge and practice in their required competencies for undergraduate and post graduate medical training. Educational interventions and clinical ethics support services have been developed to support and improve ethical decision making in clinical practice, but research evaluating the effectiveness of these interventions has been limited. We undertook a systematic review of the published literature on measures or models of evaluation used to assess the impact of interventions to improve ethical decision making in clinical care. We identified a range of measures to evaluate educational interventions, and one tool used to evaluate a clinical ethics support intervention. Most measures did not evaluate the key impact of interest, that is the quality of ethical decision making in real-world clinical practice. We describe the results of our review and reflect on the challenges of assessing ethical decision making in clinical practice that face both developers of educational and support interventions and the regulatory organisations that set and assess competency standards., Competing Interests: Competing interests: AMS, FG, KR and AI received grants from the UK National Institute of Health Research during the conduct of the study pertaining to this manuscript., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Exposure to SARS-CoV-2 during pregnancy or in the neonatal period may impact fetal or neonatal brain development either through direct central nervous system infection or indirectly through the adverse effects of viral infection-related inflammation in the mother or newborn infant. This study aims to determine whether there are early neurodevelopmental effects of SARS-CoV-2 infection., Methods and Analysis: We will conduct a prospective national population-based cohort study of children aged 21-24 months who were born at term (≥37 weeks' gestation) between 1 March 2020 and 28 February 2021 and were either antenatally exposed, neonatally exposed or unexposed (comparison cohort) to SARS-CoV-2. Nationally, hospitals will identify and approach parents of children eligible for inclusion in the antenatally and neonatally exposed cohorts using information from the UK Obstetric Surveillance System (UKOSS) and British Paediatric Surveillance Unit (BPSU) national surveillance studies and will identify and approach eligible children for the comparison cohort through routine birth records. Parents will be asked to complete questionnaires to assess their child's development at 21-24 months of age. Outcome measures comprise the Ages and Stages Questionnaire, Third Edition (ASQ-3), Ages and Stages Questionnaire Social-Emotional, Second Edition (ASQ-SE-2), Liverpool respiratory symptoms questionnaire and questionnaire items to elicit information about healthcare usage. With parental consent, study data will be linked to routine health and education records for future follow-up. Regression models will compare ASQ-3 and ASQ-SE-2 scores and proportions, frequency of respiratory symptoms and healthcare usage between the exposed and comparison cohorts, adjusting for potential confounders., Ethics and Dissemination: Ethics approval was obtained from the London-Westminster Research Ethics Committee. Findings will be disseminated in scientific conference presentations and peer-reviewed publications., Isrctn Registration Number: ISRCTN99910769., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Inequity in routine childhood vaccination coverage is well researched. Pandemics disrupt infrastructure and divert health resources from preventive care, including vaccination programmes, leading to increased vaccine preventable morbidity and mortality. COVID-19 control measures have resulted in coverage reductions. We conducted a rapid review of the impact of pandemics on existing inequities in routine vaccination coverage. PICO search framework: Population: children 0-18 years; Intervention/exposure: pandemic/epidemic; Comparison: inequality; Outcome: routine vaccination coverage. The review demonstrates a gap in the literature as none of the 29 papers selected for full-paper review from 1973 abstracts identified from searches met the inclusion criteria., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)