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Background: During the COVID-19 pandemic children and young people (CYP) mortality in England reduced to the lowest on record, but it is unclear if the mechanisms which facilitated a reduction in mortality had a longer lasting impact, and what impact the pandemic, and its social restrictions, have had on deaths with longer latencies (e.g., malignancies). The aim of this analysis was to quantify the relative rate, and causes, of childhood deaths in England, before, during, and after national lockdowns for COVID-19 and its social changes. Methods and findings: Deaths of all children (occurring before their 18th birthday) occurring from April 2019 until March 2023 in England were identified. Data were collated by the National Child Mortality Database. Study population size and the underlying population profile was derived from 2021 Office of National Statistics census data Mortality for each analysis year was calculated per 1,000,000 person years. Poisson regression was used to test for an overall trend across the time period and tested if trends differed between April 2019 to March 2021 (Period 1)) and April 2021 to March 2023 (Period 2: after lockdown restrictions). This was then repeated for each category of death and demographic group. Twelve thousand eight hundred twenty-eight deaths were included in the analysis. Around 59.4% of deaths occurred under 1 year of age, 57.0% were male, and 63.9% were of white ethnicity. Mortality rate (per 1,000,000 CYP per year) dropped from 274.2 (95% CI 264.8–283.8) in 2019−2020, to 242.2 (95% CI 233.4–251.2) in 2020−2021, increasing to 296.1 (95% CI 286.3–306.1) in 2022−2023. Overall, death rate reduced across Period 1 (Incidence rate ratio (IRR) 0.96 (95% CI 0.92–0.99)) and then increased across Period 2 (IRR 1.12 (95% CI 1.08–1.16)), and this pattern was also seen for death by Infection and Underlying Disease. In contrast, rate of death after Intrapartum events increased across the first period, followed by a decrease in rate in the second (Period 1 IRR 1.15 (95% CI 1.00–1.34)) versus Period 2 (IRR 0.78 (95% CI 0.68–0.91), pdifference = 0.004). Rates of death from preterm birth, trauma and sudden unexpected deaths in infancy and childhood (SUDIC), increased across the entire 4-year-study period (preterm birth, IRR 1.03 (95% CI 1.00–1.07); trauma IRR 1.12 (95% CI 1.06–1.20); SUDIC IRR 1.09 (95% CI 1.04–1.13)), and there was no change in the rate of death from Malignancy (IRR 1.01 (95% CI 0.95–1.06)). Repeating the analysis, split by child characteristics, suggested that mortality initially dropped and subsequently rose for children between 1 and 4 years old (Period 1 RR 0.85 (95% CI 0.76–0.94) versus Period 2 IRR 1.31 (95% CI 1.19–1.43), pdifference < 0.001. For Asian, black and Other ethnic groups, we observed increased rates of deaths in the period 2021−2023, and a significant change in trajectory of death rates between Periods 1 and 2 (Asian (Period 1 IRR 0.93 (95% CI 0.86–1.01) versus Period 2 IRR 1.28 (95% CI 1.18–1.38), pdifference < 0.001); black (Period 1 IRR 0.97 (95% CI 0.85–1.10) versus Period 2 IRR 1.27 (95% CI 1.14–1.42), pdifference = 0.012); Other (Period 1 IRR 0.84 (95% CI 0.68–1.04) versus Period 2 IRR 1.45 (95% CI 1.20–1.75), pdifference = 0.003). Similar results were observed in CYP in the most deprived areas (Period 1 IRR 0.95 (95% CI 0.89–1.01) versus Period 2 IRR 1.18 (95% CI 1.12–1.25), pdifference < 0.001). There was no change in the trajectory of death rates for children from white (p = 0.601) or mixed (p = 0.823) ethnic backgrounds, or those in the least deprived areas (p = 0.832), between Periods 1 and 2; with evidence of a rise across the whole study period for children from white backgrounds (IRR 1.05 (95% CI 1.03–1.07), p < 0.001) and those in the least deprived areas (IRR 1.06 (95% CI 1.01–1.10), p < 0.001). Limitations include that the population at risk was estimated at a mid-point of the study, and changes may have biased our estimates. In particular, absolute rates should be interpreted with caution. In addition, child death in England is rare, which may further limit interpretation; particularly in the stratified analyses. Conclusions: In this study, overall child mortality in England after the national lockdowns was higher than before them. We observed different temporal profiles across the different causes of death, with reassuring trends in deaths from Intrapartum deaths after lockdowns were lifted. However, for all other causes of death, rates are either static, or increasing. In addition, the relative rate of dying for children from non-white backgrounds, compared to white children, is now higher than before or during the lockdowns. Author summary: Why was this study done?: We know that, during the national lockdowns initiated due to the COVID-19 pandemic, the number of children dying in England was lower than seen prior to the pandemic. The reduction in deaths appeared to be across most age groups, regions and areas of England, and in both boys and girls. The number of deaths increased once England returned to pre-pandemic rules, but we don't know what happened to the rate of death after this, and if rate of death varied according to child characteristics such as age, sex and ethnicity. What did the researchers do and find?: We identified all those children in England who died between April 2019 and March 2023 and calculated what the rate of death was for each year, for each group of children (e.g., infants or older children) and what they appeared to die of. Using a mathematical model we then tested if the rate of death was going up or down across the 4 years, and if the trend seen was different for the first two years (before and during the national lockdowns) compared to the second two (after the national lockdowns). Overall, children were less likely to die during the pandemic (April 2020–March 2021) than at any other time, with 377 fewer deaths than expected from the previous year. The number of deaths in the following year was similar to before the pandemic, but in 2022−2023, there were 258 more deaths than expected from the pre-pandemic period. While mortality in the most deprived areas, and in children of non-white ethnicities, did not drop during the pandemic, they demonstrated significant increases in the post-lockdown period, making the relative rate of dying for children from non-white backgrounds, compared to white children, higher than before or during the pandemic. What do these findings mean?: Overall, child mortality after the national lockdowns was higher than during, or preceding them. While deaths in most categories appear to have increased or remained the same, intrapartum Deaths appeared to increase during the national lockdowns, but then reduced afterwards. As the number of children in the population is based on census data, this work may not perfectly reflect the actual number of children in England and so the absolute rates of death have some uncertainty around them. Equally, the category of death (e.g., infection) is often based on early information and might change as more information is known through the Child Death Review process. David Odd and colleagues analyse rates and causes of childhood deaths in England before, during, and after the COVID pandemic, and assess temporal trends for categories of death and demographic groups. [ABSTRACT FROM AUTHOR]

BackgroundMethodsResultsConclusionParents cuddling their babies during intensive care to promote parent-infant bonding is usual practice in the neonatal intensive care unit (NICU). However, babies undergoing cooling therapy and intensive care are not routinely offered parent-infant cuddles due to concerns of impacting the cooling process or intensive care. We developed the CoolCuddle intervention to enable parents to cuddle babies safely during cooling therapy. We investigated whether CoolCuddle impacted parent-infant bonding and parent’s mental health.We conducted parental interviews and compared mental health and bonding measures in two cohorts of parents; one with access to CoolCuddle and the other where CoolCuddle was not available.Ten tertiary NICUs in England and Wales from 2019 to 2023 were involved and 107 families. There were high levels of post-delivery depression amongst all parents. However, at discharge mothers in the CoolCuddle group had significantly less depression, lower EPDS scores, and higher MIBS scores (consistent with better mother-infant bonding) than those where CoolCuddle was not available. All measures appeared similar when re-measured at 8 weeks. Parents reported they were not ready to access psychological support or information whilst on NICU and stressed the need of mental health support following discharge, which was not offered or available.The CoolCuddle intervention was associated with a lower prevalence of depression and enhanced bonding scores for mothers at discharge compared to those who did not cuddle their babies. Parents highlighted increased levels of postnatal depression following the sudden and traumatic admission of their infant to NICU after birth asphyxia. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether infants born late preterm have poorer cognitive outcomes than term-born infants. Method: A cohort study based on the Avon Longitudinal Study of Parents and Children. Cognitive measures were assessed between the ages of 8 and 11 years. Exposure groups were defined as moderate/late preterm (32-36 weeks' gestation) or term (37-42 wk). Regression models were used to investigate the association between gestational age and IQ. Results: Seven hundred and forty-one infants (5.4% of total eligible population; 422 males, 319 females; mean (SD) birthweight 2495g [489]) were born between 32 and 36 weeks' gestation. The analysis was based on 6957 infants with IQ data at age 11 (50% of eligible infants). In the adjusted model, children born moderately and late preterm had similar IQ scores to peers born at term (mean difference [95% confidence interval] -0.18 [-1.88 to 1.52]). However, the preterm infants had a higher risk of having special educational needs at school (odds ratio 1.56 [1.18-2.07]). Interpretation: Despite an increased risk of special educational needs, there is little evidence of a reduction in IQ, memory, or attention measures at school age in children born between 32 and 36 weeks' gestation. Although interpretation is limited by the amount of missing data, further work is needed to identify why these infants have increased educational needs.

BACKGROUND: Preterm birth and social deprivation are known risk factors for learning difficulties. However there has been little work looking into the interaction between these two risks. We aimed to identify if children born preterm to families with higher levels of social deprivation are disproportionately more likely to have learning difficulties than those with lower levels of social deprivation. METHODS: Data from the RANOPS (Respiratory And Neurological Outcomes in children born Preterm Study) was used to assess prevalence of learning difficulties. The effects of preterm birth and deprivation were reviewed. Multi-level logistic regression models were used to examine if gestational age and deprivation impacts interacted after adjustment for possible confounders. Primary outcome measure was parent-reported learning difficulties. Secondary outcome measures were parent-reported behavioural problems and a statement of special educational need. RESULTS: We investigated the developmental outcomes of 6,691 infants with a median age of 5 years at time of survey (IQR 5). Deprivation decile (OR 1.08 (1.03,1.12)) and preterm birth (OR 2.67 (2.02,3.53)) were both associated with increased risk of learning difficulties. There was little evidence for any interaction between preterm birth and deprivation (p = 0.298) and the risk of learning difficulties. CONCLUSIONS: Deprivation and preterm birth have significant associations with learning difficulties. While deprivation does not appear to have potentiated the impact of preterm birth, preterm infants in the most deprived areas have the highest risk of learning difficulties with almost 1 in 3 extremely premature infants with a learning difficulty in the most deprived areas. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Intraventricular haemorrhage (IVH) is a common problem in preterm infants, being a major cause of morbidity and mortality. Despite many randomised controlled trials comparing interventions to prevent IVH, the best prevention remains unclear. This study aims to review all the interventions which intended to reduce the incidence of IVH and compare them in a network meta-analysis. METHODS: A search on MEDLINE, EMBASE, Emcare, and CENTRAL was performed. Randomised controlled trials which evaluated neonatal interventions with a primary aim to reduce incidence of IVH in preterm infants were eligible. A surface under a cumulative ranking curve (SUCRA) was produced to indicate the intervention's likelihood of being the most effective for preventing IVH. RESULTS: 40 studies were eligible, enrolling over 6760 infants. Twelve intervention groups were found, including delayed cord clamping, erythropoietin, ethamsylate, fresh frozen plasma, heparin, ibuprofen, indomethacin, magnesium, nursing interventions, sedation, tranexamic acid, and vitamin E. Vitamin E and indomethacin had the highest probability of being the best interventions to prevent IVH in premature infants, but interpretation of these results is difficult due to study limitations. CONCLUSION: Despite the impact of IVH, we were unable to identify a clearly beneficial treatment to reduce its incidence. Interpretation of the network meta-analysis was limited due to differences within studied populations, wide range of therapies trialled, and underlying advances in neonatal care between units, and over time. Although vitamin E and indomethacin appear to be promising candidates, contemporaneous trials of these, or novel agents, enrolling the most at-risk infants is needed urgently. [ABSTRACT FROM AUTHOR]