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BACKGROUND: It is unclear if expiratory airflow in survivors born extremely low birth weight (ELBW; 500-999 g) has improved after the introduction of exogenous surfactant into clinical practice in 1991. The primary aim of this study was to describe the changes in airflow at 7-8 years of age of survivors born ELBW in five discrete cohorts from 14 years before to 14 years after the introduction of exogenous surfactant into clinical practice. METHODS: The cohorts comprised consecutive survivors born ELBW in 1977-82 and 1985-87 at the Royal Women's Hospital, Melbourne, and in 1991-92, 1997 and 2005 in the state of Victoria, Australia. Survival rates to 2-years of age for infants born ELBW in the state of Victoria rose from approximately 1-in-4 to 3-in-4 over the time of this study. Expiratory airflow measurements at 7-8 years included the forced expired volume in 1 s (FEV1), converted to z-scores for age, height, sex, and race. FINDINGS: There were 596 ELBW participants with expiratory flow data, 280 (47%) of whom had bronchopulmonary dysplasia (BPD). Overall, there was little change in zFEV1 over the 28-year period (mean change per year; 0.003, 95% CI -0.010, 0.015, P = 0.67). There was, however, evidence of an interaction between BPD and year; zFEV1 in those who had BPD fell over time (mean change per year -0.019, 95% CI -0.037, -0.009, P = 0.035), whereas zFEV1 improved in those who did not have BPD (mean change per year 0.021, 95% CI 0.006, 0.037, P = 0.007). INTERPRETATION: Contrary to recent evidence, expiratory airflow of children born ELBW has not improved with the introduction of surfactant, and may be deteriorating in those who had BPD. FUNDING: National Health and Medical Research Council (Australia); Victorian Government's Operational Infrastructure Support Program.

Introduction During the last trimester of pregnancy, the fetal brain undergoes a rapid growth spurt and accumulates essential nutrients including docosahexaenoic acid (DHA). This takes place ex-utero for infants born 29 weeks' gestation, without the in-utero provisions of DHA. Infants born 29 weeks' are more likely to experience behavioural and emotional difficulties than their term-born counterparts. It has been hypothesised that supplementing preterm infants with dietary DHA may alleviate insufficiency and subsequently prevent or minimise behavioural problems. This protocol describes a follow-up of infants born 29 weeks gestation who were enrolled in a randomised controlled trial (RCT) of DHA supplementation. We aim to determine whether DHA supplementation improves the behaviour, and general health of these infants. Methods and analysis Infants born 29 weeks' gestation were enrolled in a multicentre blinded RCT of enteral DHA supplementation. Infants were randomised to receive an enteral emulsion that provided 60 mg/kg/day of DHA or a control emulsion commenced within the first 3 days of enteral feeding, until 36 weeks' postmenstrual age or discharge home, whichever occurred first. Families of surviving children (excluding those who withdrew from the study) from the Australian sites (up to 955) will be invited to complete a survey. The survey will include questions regarding child behavioural and emotional functioning, executive functioning, respiratory health and general health. We hypothesise that the DHA intervention will have a benefit on the primary outcome, parent-rated behaviour and emotional status as measured using the Total Difficulties score of the Strengths and Difficulties Questionnaire. Detecting a 2-point difference between groups (small effect size of 0.25 SD) with 90% power will require follow-up of 676 participants. Ethics and dissemination The Women's and Children Health Network Human Research Ethics Committee reviewed and approved the study (HR

OBJECTIVES: It is unclear how newer methods of respiratory support for infants born extremely preterm (EP; 22-27 weeks gestation) have affected in-hospital sequelae. We aimed to determine changes in respiratory support, survival and morbidity in EP infants since the early 1990s. DESIGN: Prospective longitudinal cohort study. SETTING: The State of Victoria, Australia. PARTICIPANTS: All EP births offered intensive care in four discrete eras (1991-1992 (24 months): n=332, 1997 (12 months): n=190, 2005 (12 months): n=229, and April 2016-March 2017 (12 months): n=250). OUTCOME MEASURES: Consumption of respiratory support, survival and morbidity to discharge home. Cost-effectiveness ratios describing the average additional days of respiratory support associated per additional survivor were calculated. RESULT(S): Median duration of any respiratory support increased from 22 days (1991-1992) to 66 days (2016-2017). The increase occurred in non-invasive respiratory support (2 days (1991-1992) to 51 days (2016-2017)), with high-flow nasal cannulae, unavailable in earlier cohorts, comprising almost one-half of the duration in 2016-2017. Survival to discharge home increased (68% (1991-1992) to 87% (2016-2017)). Cystic periventricular leukomalacia decreased (6.3% (1991-1992) to 1.2% (2016-2017)), whereas retinopathy of prematurity requiring treatment increased (4.0% (1991-1992) to 10.0% (2016-2017)). The average additional costs associated with one additional infant surviving in 2016-2017 were 200 (95% CI 150 to 297) days, 326 (183 to 1127) days and 130 (70 to 267) days compared with 1991-1992, 1997 and 2005, respectively. CONCLUSION(S): Consumption of resources for respiratory support has escalated with improved survival over time. Cystic periventricular leukomalacia reduced in incidence but retinopathy of prematurity requiring treatment increased. How these changes translate into long-term respiratory or neurological function remains to be determined.Copyright © Author(s) (or t

INTRODUCTION: Docosahexaenoic acid (DHA) is an omega-3 (n-3) fatty acid that accumulates into neural tissue during the last trimester of pregnancy, as the fetal brain is undergoing a growth spurt. Infants born <29 weeks' gestation are deprived the normal in utero supply of DHA during this period of rapid brain development. Insufficient dietary DHA postnatally may contribute to the cognitive impairments common among this population. This follow-up of the N-3 fatty acids for improvement in respiratory outcomes (N3RO) randomised controlled trial aims to determine if enteral DHA supplementation in infants born <29 weeks' gestation during the first months of life improves cognitive development at 5 years of age corrected for prematurity. METHODS AND ANALYSIS: N3RO was a randomised controlled trial of enteral DHA supplementation (60 mg/kg/day) or a control emulsion (without DHA) in 1273 infants born <29 weeks' gestation to determine the effect on bronchopulmonary dysplasia (BPD). We showed that DHA supplementation did not reduce the risk of BPD and may have increased the risk.In this follow-up at 5 years' corrected age, a predefined subset (n=655) of children from five Australian sites will be invited to attend a cognitive assessment with a psychologist. Children will be administered the Wechsler Preschool and Primary Scale of Intelligence (fourth edition) and a measure of inhibitory control (fruit stroop), while height, weight and head circumference will be measured.The primary outcome is full-scale IQ. To ensure 90% power, a minimum of 592 children are needed to detect a four-point difference in IQ between the groups.Research personnel and families remain blinded to group assignment. ETHICS AND DISSEMINATION: The Women's and Children Health Network Human Research Ethics Committee reviewed and approved the study (HREC/17/WCHN/187). Caregivers will give informed consent prior to taking part in this follow-up study. Findings of this study will be disseminated through peer

INTRODUCTION: During the last trimester of pregnancy, the fetal brain undergoes a rapid growth spurt and accumulates essential nutrients including docosahexaenoic acid (DHA). This takes place ex-utero for infants born <29 weeks' gestation, without the in-utero provisions of DHA. Infants born <29 weeks' are more likely to experience behavioural and emotional difficulties than their term-born counterparts. It has been hypothesised that supplementing preterm infants with dietary DHA may alleviate insufficiency and subsequently prevent or minimise behavioural problems. This protocol describes a follow-up of infants born <29 weeks gestation who were enrolled in a randomised controlled trial (RCT) of DHA supplementation. We aim to determine whether DHA supplementation improves the behaviour, and general health of these infants. METHODS AND ANALYSIS: Infants born <29 weeks' gestation were enrolled in a multicentre blinded RCT of enteral DHA supplementation. Infants were randomised to receive an enteral emulsion that provided 60 mg/kg/day of DHA or a control emulsion commenced within the first 3 days of enteral feeding, until 36 weeks' postmenstrual age or discharge home, whichever occurred first. Families of surviving children (excluding those who withdrew from the study) from the Australian sites (up to 955) will be invited to complete a survey. The survey will include questions regarding child behavioural and emotional functioning, executive functioning, respiratory health and general health. We hypothesise that the DHA intervention will have a benefit on the primary outcome, parent-rated behaviour and emotional status as measured using the Total Difficulties score of the Strengths and Difficulties Questionnaire. Detecting a 2-point difference between groups (small effect size of 0.25 SD) with 90% power will require follow-up of 676 participants. ETHICS AND DISSEMINATION: The Women's and Children Health Network Human Research Ethics Committee reviewed and approved the st

Background: The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines. Methods: A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed. Results: Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid (Fresenius Kabi, Australia) and ClinOleic (Baxter Healthcare, Australia) preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed. Conclusions: The 2017 PN formulations and guidelines developed by the 2017 Neonatal Parenteral Nutrition Consensus Group offer concise and practical instructions to clinicians on how to implement current and up-to-date evidence based PN to the NICU population.

Background: The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines. Method(s): A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed. Result(s): Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid (Fresenius Kabi, Australia) and ClinOleic (Baxter Healthcare, Australia) preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed. Conclusion(s): The 2017 PN formulations and guidelines developed by the 2017 Neonatal Parenteral Nutrition Consensus Group offer concise and practical instructions to clinicians on how to implement current and up-to-date evidence based PN to the NICU population.Copyright © 2020 The Author(s).

OBJECTIVES: It is unclear how newer methods of respiratory support for infants born extremely preterm (EP; 22-27 weeks gestation) have affected in-hospital sequelae. We aimed to determine changes in respiratory support, survival and morbidity in EP infants since the early 1990s. DESIGN: Prospective longitudinal cohort study. SETTING: The State of Victoria, Australia. PARTICIPANTS: All EP births offered intensive care in four discrete eras (1991-1992 (24 months): n=332, 1997 (12 months): n=190, 2005 (12 months): n=229, and April 2016-March 2017 (12 months): n=250). OUTCOME MEASURES: Consumption of respiratory support, survival and morbidity to discharge home. Cost-effectiveness ratios describing the average additional days of respiratory support associated per additional survivor were calculated. RESULTS: Median duration of any respiratory support increased from 22 days (1991-1992) to 66 days (2016-2017). The increase occurred in non-invasive respiratory support (2 days (1991-1992) to 51 days (2016-2017)), with high-flow nasal cannulae, unavailable in earlier cohorts, comprising almost one-half of the duration in 2016-2017. Survival to discharge home increased (68% (1991-1992) to 87% (2016-2017)). Cystic periventricular leukomalacia decreased (6.3% (1991-1992) to 1.2% (2016-2017)), whereas retinopathy of prematurity requiring treatment increased (4.0% (1991-1992) to 10.0% (2016-2017)). The average additional costs associated with one additional infant surviving in 2016-2017 were 200 (95% CI 150 to 297) days, 326 (183 to 1127) days and 130 (70 to 267) days compared with 1991-1992, 1997 and 2005, respectively. CONCLUSIONS: Consumption of resources for respiratory support has escalated with improved survival over time. Cystic periventricular leukomalacia reduced in incidence but retinopathy of prematurity requiring treatment increased. How these changes translate into long-term respiratory or neurological function remains to be determined.

Background: Preterm birth may increase the risk of anxiety and depression, but the stability of anxiety and depression from adolescence to adulthood is not well understood. This study aimed to determine (1) the prevalence of "at least mild" anxiety and depression symptoms in young adults born extremely preterm/extremely low birthweight (<28 weeks/ <1000 g; EP/ELBW) and with normal birthweight (>=2500 g; NBW); (2) the persistence of such increases in mental health symptoms identified in late adolescence and whether this varied by birth group. Method(s): 170 EP/ELBW and 139 NBW 25 year-olds rated their current symptoms of depression and anxiety using the Center for Epidemiologic Studies Depression Scale-Revised and the Beck Anxiety Inventory. The prevalence of "at least mild" symptoms was analysed using logistic regression. Result(s): Rates of "at least mild" current depression symptoms were similar between groups (29% EP/ELBW, 24% NBW, P = 0.39). Having at least mild depression scores on the same measure in adolescence was strongly associated with at least mild scores at 25 years (OR = 8.5, 95%CI = 4.3, 16.5; P < 0.001) and this did not vary according to birth group (interaction P = 0.39). Rates of current anxiety symptoms were also similar between groups (45% EP/ELBW, 42% NBW, P = 0.57). Having at least mild anxiety symptoms in adolescence was strongly associated with anxiety symptoms at 25 years (OR = 3.9, 95%CI = 2.3, 6.8; P < 0.001) irrespective of group (interaction P = 0.23). Conclusion(s): Depression and anxiety symptoms occurred frequently in both EP/ELBW and NBW young adults. EP/ELBW young people were not more vulnerable than their NBW peers.

Background: Preterm birth is a risk factor for high blood pressure (BP) in adolescence. Little is known about the BP in adults born extremely preterm (EP) or extremely low birthweight (ELBW). Method(s): VICS is an established longitudinal geographic cohort of all EP/ELBW (<28 weeks' gestation /<1000 g birthweight) survivors and contemporaneously recruited term controls born in 1991-92 in Victoria, Australia. At age 25-26 years, 24-h ambulatory BP was measured; half hourly when awake and hourly when asleep. Systolic, diastolic and mean arterial BP (MAP) were recorded. Result(s): Overall, EP/ELBW participants had higher systolic, diastolic and MAP (Table). (Table presented) Similar trends were observed for both awake and asleep periods. Data are mean (SD). Conclusion(s): Young adult EP/ELBW survivors have higher BP compared with term controls. The magnitude of the difference in BP is clinically relevant, given that a small reduction in BP in an individual can lead to substantial reductions in future risk of hypertensive disorders and cardiovascular complications. This may have important implications in the overall management of high BP in EP/ELBW young adults.

Background: Extremely preterm (EP, <28 weeks) infants are at high risk of morbidity and mortality. This study aimed to determine how outcomes have changed over 25 years in the post surfactant era. Method(s): All EP infants offered intensive care in Victoria from 4 eras (1991-92, 1997, 2005 and 2016-17). Perinatal data across eras were compared using tests for trend or ANOVA. Result(s): Over time, survival increased, but so did bronchopulmonary dysplasia (BPD) and durations of assisted ventilation (mostly increased CPAP or HiFlow) and supplemental oxygen (Table). (Table presented) Conclusion(s): Survival has improved in the most recent era, but durations of assisted ventilation and supplemental oxygen, and rates of BPD have also increased. Whether these latter changes translate to poorer long term neurological or lung function needs to be explored.

INTRODUCTION: Infants born extremely preterm (EP, <28 weeks' gestation) or with extremely low birth weight (ELBW,<1000 g) in the era when surfactant has been available clinically are at high risk of health and developmental problems in childhood and adolescence. However, how their health and well-being may be affected in adulthood is not well known. This study aims to compare between EP/ELBW and normal birthweight (NBW) controls: (1) physical health, mental health and socioemotional functioning at 25 years of age and (2) trajectories of these outcomes from childhood to adulthood. In addition, this study aims to identify risk factors in pregnancy, infancy, childhood and adolescence for poor physical health and well-being in EP/ELBW young adults. METHODS AND ANALYSIS: The Victorian Infant Collaborative Study (VICS) is a prospective geographical cohort of all EP/ELBW survivors to 18 years of age born in the State of Victoria, Australia, from 1 January 1991 to 31 December 1992 (n=297) and contemporaneous term-born/NBW controls (n=262). Participants were recruited at birth and followed up at 2, 5, 8 and 18 years. This 25-year follow-up includes assessments of physical health (cardiovascular, respiratory and musculoskeletal), mental health and socioemotional functioning. Outcomes will be compared between the birth groups using linear and logistic regression, fitted using generalised estimating equations (GEEs). Trajectories of health outcomes from early childhood will be compared between the birth groups using linear mixed-effects models. Risk factors for adult outcomes will be assessed using linear and logistic regression (fitted using GEEs). ETHICS AND DISSEMINATION: This study was approved by the Human Research Ethics Committees of the Royal Women's Hospital, Mercy Hospital for Women, Monash Medical Centre and the Royal Children's Hospital, Melbourne. Study outcomes will be disseminated through conference presentations, peer-reviewed publications, the internet and soci

BACKGROUND: The relationship of developmental disability rates with difficulty obtaining follow-up data is unclear. With this study, we aimed to determine if children who attended research follow-up assessments with more difficulty had more disability at school age, compared with those who attended with less difficulty, and to establish the relationship between follow-up and disability rates. METHOD(S): Two groups, comprising 219 consecutive survivors born at <28 weeks' gestation or at <1000 g birth weight in the state of Victoria, Australia, in 2005, and 218 term-born, normal birth weight controls were assessed at 8 years of age for neurodevelopmental disability (any of IQ <-1 SD, cerebral palsy, blindness, or deafness). Children were classified as either more or less difficult to get to attend by research nurses involved in the study. RESULT(S): The follow-up rate was 87% for both groups. Overall, children who attended with more difficulty had higher rates of neurodevelopmental disability (42%; 19 of 45) than those who attended with less difficulty (20%; 66 of 328) (odds ratio: 3.09, 95% confidence interval: 1.58 to 6.01; P = .001). As the follow-up rate rose among the 3 individual hospitals involved in the assessments, so did the rate of neurodevelopmental disability (P = .025). CONCLUSION(S): Children who attend with more difficulty have higher rates of neurodevelopmental disability at school age than those who attend with less difficulty, and disability rates rise with higher follow-up rates. Rates of neurodevelopmental disability will be underestimated if researchers are not persistent enough to obtain high follow-up rates.Copyright © 2018 by the American Academy of Pediatrics. All rights reserved.

Background and Objectives: To determine if executive functioning outcomes at school age are different for extremely preterm (EP; <28 weeks' gestation) or extremely low birth weight (ELBW; <1000 g birth weight) children born in 1991 to 1992, 1997, and 2005 relative to their term-born peers. Method(s): Population-based cohorts of all EP/ELBW survivors born in the state of Victoria, Australia, in 1991 to 1992, 1997, and 2005, and contemporaneous controls (matched for expected date of birth, sex, mother's country of birth [English speaking or not], and health insurance status) were recruited at birth. At 7 to 8 years of age, parents of 613 children who were EP/ELBW and 564 children who were controls rated their children's executive functioning on the Behavior Rating Inventory of Executive Function (BRIEF). The proportion of children with elevated BRIEF scores (in the clinically significant range) in each birth group and era was compared by using logistic regression. Sensitivity analyses explored these associations after excluding children with intellectual impairment. Result(s): Across the eras, EP/ELBW children had higher rates of elevated scores than controls in almost all BRIEF domains. The 2005 EP/ELBW cohort had increased executive dysfunction compared with earlier cohorts, particularly in working memory and planning and organization. This effect persisted after accounting for demographic factors and weakened slightly when those with intellectual impairment were excluded. Conclusion(s): These results indicate a concerning trend of increasing executive dysfunction for EP/ELBW children who were born more recently. This may have adverse implications for other functional domains, such as academic achievement and social-emotional well-being.Copyright © 2018 by the American Academy of Pediatrics. All rights reserved.

BACKGROUND Assisted ventilation for extremely preterm infants (<28 weeks of gestation) has become less invasive, but it is unclear whether such developments in care are associated with improvements in short-term or long-term lung function. We compared changes over time in the use of assisted ventilation and oxygen therapy during the newborn period and in lung function at 8 years of age in children whose birth was extremely premature. METHODS We conducted longitudinal follow-up of all survivors of extremely preterm birth who were born in Victoria, Australia, in three periods - the years 1991 and 1992 (225 infants), 1997 (151 infants), and 2005 (170 infants). Perinatal data were collected prospectively, including data on the duration and type of assisted ventilation provided, the duration of oxygen therapy, and oxygen requirements at 36 weeks of age. Expiratory airflow was measured at 8 years of age, and values were converted to z scores for age, height, ethnic group, and sex. RESULTS The duration of assisted ventilation rose substantially over time, with a large increase in the duration of nasal continuous positive airway pressure. Despite the increase in the use of less invasive ventilation over time, the duration of oxygen therapy and the rate of oxygen dependence at 36 weeks rose, and airflows at 8 years of age were worse in 2005 than in earlier periods. For instance, for 2005 versus 1991-1992, the mean difference in the z scores for the ratio of forced expiratory volume in 1 second to forced vital capacity was -0.75 (95% confidence interval [CI], -1.07 to -0.44; P<0.001), and for 2005 versus 1997 the mean difference was -0.53 (95% CI, -0.86 to -0.19; P=0.002). CONCLUSIONS Despite substantial increases in the use of less invasive ventilation after birth, there was no significant decline in oxygen dependence at 36 weeks and no significant improvement in lung function in childhood over time. (Funded by the National Health and Medical Research Council of Australia an

Background: The aim of this study was to determine if children who are more difficult to get to attend for research followup assessments differ systematically from those who attend with more ease with respect to major neurosensory disability at school-age. Method(s): Participants were enrolled in the 2005 VICS cohort, comprising 219 consecutive surviving children born <28 weeks or <1000 g in Victoria in the calendar year 2005, and 218 term and normal birthweight survivors; 87% of both cohorts were assessed at 7-8 years of age. Research nurses arranging the follow-up appointments assessed the difficulty they had to get the child to attend the appointment, dichotomised into no difficulty and some difficulty. Children had neurosensory assessments and their outcomes were divided into major disability (any of IQ <-2 SD, moderate or severe CP, blindness or deafness) or no major disability. Result(s): Of those who attended 12% were assessed with difficulty. Children assessed with difficulty had more major disability (26%) than those assessed with ease (10%) (odds ratio 3.1, 95% confidence interval 1.5, 6.6; P = 0.002). No significant interaction was found between gestational age group and difficulty of assessment on the outcome of major disability. Conclusion(s): Children eventually assessed after considerable difficulty have more disability than those assessed with ease. Importantly this affects not only high-risk preterm groups, but also healthy controls. Studies reporting low follow-up rates will underestimate rates of major disability if they do not persist in tracking children who are difficult to assess and obtaining outcome data from them.

OBJECTIVES: Cognitive and behavioral impairments of children born extremely preterm (EP) (<28 weeks' gestation) and extremely low birth weight (ELBW) (<1000 g) may change with age. We assessed the individual stability of behavioral executive function (EF) from 8 to 18 years of age in children born EP or ELBW and their academic outcomes. METHOD(S): Participants comprised 180 children born EP or ELBW from a large geographic cohort. We investigated the frequency of 4 developmental groups (persistent, remitting, late-onset, and typical development) on the basis of dichotomized scores (typical versus elevated) at ages 8 and 18 years in 2 indices (the Behavioral Regulation Index [BRI] and the Metacognition Index [MCI]) of the parental form of the Behavior Rating Inventory of Executive Function. Adolescent academic outcomes were measured by using the word reading, spelling, and math computation subtests of the Wide Range Achievement Test, Fourth Edition. RESULT(S): Most participants had a typical EF (BRI 61%, MCI 53%), followed by persistent (BRI 15%, MCI 16%), late-onset (BRI 12%, MCI 19%), or remitting (BRI 12%, MCI 13%) executive difficulties. Groups with executive impairments at age 18 years (persistent and late onset) had poorer academic outcomes than the typical and remitting groups. Shifting impairment categories between 8 and 18 years old was relevant to later academic outcomes. CONCLUSION(S): Most children showed stable and age-appropriate EF, although persistent and transient difficulties were observed and related to uneven academic outcomes. Studying the origins and consequences of the developmental stability of EF may contribute to the development of interventions to decrease the adverse neurodevelopmental outcomes of preterm birth.Copyright © 2017 by the American Academy of Pediatrics.

Background: The evolution of airway obstruction into late adolescence of extremely preterm (gestational age <28 weeks) or extremely low-birthweight (birth weight <1000 g) survivors in the era after surfactant was introduced is unclear. Objective(s): To compare changes in spirometry from 8 to 18 years of age of a geographical cohort of preterm survivors with normal birth weight controls, and to determine higher risk groups within the preterm cohort. Method(s): Of 297 extremely preterm/low-birthweight survivors born in 1991-1992 in the state of Victoria, Australia, 81% and 70% had spirometry at 8 and 18 years of age, respectively. Corresponding rates among 260 normal birth weight controls were 80% and 58%, respectively. Data were analysed using linear mixed models. Result(s): The preterm group had substantial impairments in airflow at both ages compared with controls (eg, mean differences in z-score for FEV 1; 8 years -1.02, 95% CI -1.21 to -0.82; 18 years -0.92, 95% CI -1.14 to -0.71). The preterm group had a greater increase in small airway obstruction between 8 and 18 years compared with controls. Within the preterm group, those who had bronchopulmonary dysplasia in the newborn period and those who were smokers at 18 years had airway obstruction that increased over time compared with those who did not. Conclusion(s): Preterm survivors born in the surfactant era had significant impairments in airflow through childhood into late adolescence that increased over time compared with controls. At-risk preterm participants include those who had bronchopulmonary dysplasia, and smokers at 18 years.Copyright © 2017 Published by the BMJ Publishing Group Limited.

Background: Bronchopulmonary dysplasia (BPD) is a major cause of mortality and long-term respiratory and neurological morbidity in very preterm infants. While survival rates of very preterm infants have increased over the past two decades there has been no decrease in the rate of BPD in surviving infants. Evidence from animal and human studies has suggested potential benefits of docosahexaenoic acid (DHA), an n-3 long chain polyunsaturated fatty acid, in the prevention of chronic lung disease. This randomised controlled trial aims to determine the effectiveness of supplementary DHA in reducing the rate of BPD in infants less than 29 weeks' gestation. Methods/design: This is a multicentre, parallel group, randomised, blinded and controlled trial. Infants born less than 29 weeks' gestation, within 3 days of first enteral feed and with parent informed consent are eligible to participate. Infants will be randomised to receive an enteral emulsion containing DHA or a control emulsion without DHA. The DHA emulsion will provide 60 mg/kg/day of DHA. The study emulsions will continue to 36 weeks' postmenstrual age (PMA). The primary outcome is BPD as assessed by the requirement for supplemental oxygen and/or assisted ventilation at 36 weeks' PMA. Secondary outcomes include the composite of death or BPD; duration of respiratory support and hospitalisation, major neonatal morbidities. The target sample size is 1244 infants (622 per group), which will provide 90 % power to detect a clinically meaningful absolute reduction of 10 % in the incidence of BPD between the DHA and control emulsion (two tailed alpha =0.05). Discussion(s): DHA supplementation has the potential to reduce respiratory morbidity in very preterm infants. This multicentre trial will provide evidence on whether an enteral DHA supplement reduces BPD in very preterm infants. Trial registration: Australia and New Zealand Clinical Trial Registry: ACTRN12612000503820. Registered 09 May 2012.Copyright © 2016 The Autho

Rationale: Advances in neonatal care have resulted in increased survival rates of children born extremely preterm (EPT; gestational age <28 weeks at birth) and extremely low birth weight (ELBW; birth weight <1000 g). Despite these advances the incidences of bronchopulmonary dysplasia (BPD) and long-term respiratory morbidity remain high. We investigated the respiratory function of EPT/ELBW survivors at 18 years of age to ascertain whether respiratory morbidity in EPT/ELBW young adults primarily reflects alterations in the lung periphery or more centralised airway function in this population. Method(s): 18-year follow-up of participants born either EPT or ELBW in 1991-92 in the state of Victoria, Australia and randomly selected term, normal birth weight (NBW; birth weight >= 2500 g) controls. Spirometry, plethysmography, diffusing capacity (DLCO), and multiple-breath-washout (MBW) were measured according to standard guidelines. Spirometry was also measured at an 8 year follow-up, this will be analysed longitudinally (mixed models) to see if abnormal lung function at 8 years of age tracks through the period of normal lung development to predict impaired maximal lung function. Result(s): Lung function data were obtained from 134/298 (45%) EPT/ELBW subjects and 140/262 (53%) controls. EPT/ELBW (All) subjects had lower flow rates than expected for age, height and gender, and when compared with controls (C). Airways resistance (sRaw, sReff) and residual volume (gas trapping) were increased in the EPT/ELBW group. No significant difference was found between the groups for diffusing capacity and lung clearance index. Longitudinal analysis reveals no significant improvement in lung function z-score slope over the study period, except for those EPT/ELBW BPD survivors who showed improvement in FVC and reductions in mean FEV1/FVC and mean FEF25-75. nature and persists throughout childhood. (Table Presented).

Rationale: Advances in neonatal care have resulted in increased survival of children born extremely preterm (EPT; gestational age <28 weeks at birth) and extremely low birth weight (ELBW; birth weight <1000 g). Despite these advances the incidences of bronchopulmonary dysplasia (BPD) and long-term respiratory morbidity remains high. Several publications focus on exercise capacity in preterm, very low birth weight survivors, but most date from the previous era of neonatal care, they lack the power required to establish up-to-date evidence for today's surviving EPT/ELBW children. None have published data relating to exercise capacity in late adolescence for EPT/ELBW survivors. The primary aim was to determine the maximal exercise capacity of EPT/ELBW survivors at 18 years of age compared with term controls. A secondary aim was to determine the effect having had BPD on exercise capacity in the EPT/EBLW survivors. Method(s): 18-year follow-up of participants born either EPT/ELBW in 1991-92 in the state of Victoria, Australia and randomly selected term, NBW controls (C). Cardiopulmonary exercise was performed on a treadmill according to standard guidelines. Result(s): EPT/ELBW (All) survivors have reduced peak oxygen consumption (VO2max), tidal volumes (Vt/kg) and anaerobic threshold (VO2 AT) at peak exercise compared to controls, despite achieving the similar maximum heart rates (HRmax) and maximum work rates (Work/kg). Those who had BPD show further reductions in VO2max, Vt/kg and VO2 AT at peak exercise compared to controls. Conclusion(s): EPT/ELBW survivors, especially those who had BPD, have lower cardiopulmonary exercise capacity than their term-born NBW peers in late adolescence. (Table Presented).

Rationale: Apnea of prematurity is a common condition that is usually treated with caffeine, an adenosine receptor blocker that has powerful influences on the central nervous system. However, little is known about the long-term effects of caffeine on sleep in the developing brain. Objective(s): We hypothesized that neonatal caffeine use resulted in long-term abnormalities in sleep architecture and breathing during sleep. Method(s): A total of 201 ex-preterm children aged 5-12 years who participated as neonates in a double-blind, randomized, controlled clinical trial of caffeine versus placebo underwent actigraphy, polysomnography, and parental sleep questionnaires. Coprimary outcomes were total sleep time on actigraphy and apnea-hypopnea index on polysomnography. Measurements and Main Results: There were no significant differences in primary outcomes between the caffeine group and the placebo (adjusted mean difference of -6.7 [95% confidence interval (CI) = -15.3 to 2.0min]; P = 0.13 for actigraphic total sleep time; and adjusted rate ratio [caffeine/placebo] for apnea-hypopnea index of 0.89 [95% CI = 0.55 -1.43]; P = 0.63). Polysomnographic total recording time and total sleep time were longer in the caffeine group, but there was no difference in sleep efficiency between groups. The percentage of children with obstructive sleep apnea (8.2% of caffeine group versus 11.0% of placebo; P = 0.22) or elevated periodic limb movements of sleep (17.5% in caffeine group versus 11% in placebo group) was high, but did not differ significantly between groups. Conclusion(s): Therapeutic neonatal caffeine administration has no long-term effects on sleep duration or sleep apnea during childhood. Ex-preterm infants, regardless of caffeine status, are at risk for obstructive sleep apnea and periodic limb movements in later childhood.Copyright © 2014 by the American Thoracic Society.

Objective: All previous studies using TMS to assess short-interval intracortical inhibition (SICI) in older adults have used a conventional coil orientation, which produces posterior-to-anterior (PA) current flow in the motor cortex. However, no studies have examined SICI in older adults by reversing the coil to induce anterior-to-posterior (AP) current flow, which is considered more sensitive at detecting SICI. Therefore, we investigated age-related changes in SICI using both PA and AP TMS across different conditioning stimulus intensities and muscle activation states. Methods: In 22 young and 20 older adults, SICI was assessed using PA and AP coil orientations, across a range of conditioning stimulus intensities (70-90% active motor threshold), and whilst participants kept their first dorsal interosseous (FDI) muscle either relaxed or active (2. N force). Results: There were no age-related differences in SICI using conventional PA TMS in resting or active FDI muscle. However, SICI was increased in elderly participants when assessed with reverse coil AP TMS in resting FDI. Conclusions: Coil orientation is a key factor to consider when assessing age-related differences in SICI. Significance: Reverse coil AP TMS can reveal age-related changes in SICI, which were previously not evident with conventional PA TMS. This may have implications for the assessment of SICI in some clinical populations that may show subtle differences in SICI circuitry.

IMPORTANCE: Antenatal magnesium sulfate given to pregnant women at imminent risk of very preterm delivery reduces the risk of cerebral palsy in early childhood, although its effects into school age have not been reported from randomized trials. OBJECTIVE(S): To determine the association between exposure to antenatal magnesium sulfate and neurological, cognitive, academic, and behavioral outcomes at school age. DESIGN, SETTING, AND PARTICIPANTS: The ACTOMgSO4 was a randomized clinical trial conducted in 16 centers in Australia and New Zealand, comparing magnesium sulfate with placebo given to pregnant women (n = 535 magnesium; n = 527 placebo) for whom imminent birth was planned or expected before 30 weeks' gestation. Children who survived from the 14 centers who participated in the school-age follow-up (n = 443 magnesium; n = 424 placebo) were invited for an assessment at 6 to 11 years of age between 2005 and 2011. MAIN OUTCOMES AND MEASURES: Mortality, cerebral palsy, motor function, IQ, basic academic skills, attention and executive function, behavior, growth, and functional outcomes. Main analyses were imputed for missing data. RESULT(S): There were 1255 fetuses known to be alive at randomization. Of 867 survivors available for follow-up, outcomes at school age (corrected age 6-11 years) were determined for 669 (77%). There was little difference between groups on any of the cognitive, behavioral, growth, or functional outcomes. (Table Presented) CONCLUSIONS AND RELEVANCE: Magnesium sulfate given to pregnant women at imminent risk of birth before 30 weeks' gestation was not associated with neurological, cognitive, behavioral, growth, or functional outcomes in their children at school age, although a mortality advantage cannot be excluded. The lack of long-term benefit requires confirmation in additional studies. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12606000252516.Copyright 2014 American Medical Association. All rights reserved.

Introduction: Apnea of prematurity is a common condition that is usually treated with caffeine. Caffeine is an adenosine receptor blocker that has powerful inluences on the central nervous system. However, little is known about the long-term effects of caffeine on sleep in the developing brain. In particular, it is not known whether neonatal caffeine administration has permanent adverse effects on sleep architecture and ventilatory control, resulting in an increased prevalence of sleep disorders such as insomnia and obstructive sleep apnea. We hypothesized that neonatal caffeine use resulted in long-term abnormalities in sleep architecture and breathing during sleep. Method(s): 201 ex-premature (500-1,250 gm) children aged 5-12 years who participated as neonates in a double-blind, randomized clinical trial (Caffeine for Apnea of Prematurity [CAP]) of caffeine versus placebo underwent sleep questionnaires, actigraphy and full ambulatory polysomnography. Result(s): There were no signiicant differences in sleep quality or quantity based on actigraphy and questionnaires between the caffeine group vs placebo. Total recording time and total sleep time on polysomnography were longer in the caffeine group, but there was no difference in sleep eficiency between groups. Obstructive sleep apnea (apnea hypopnea index > 2/hr) was common (8.2% of caffeine group vs 11.0% of placebo) compared to normative literature. Further, 24% of the caffeine and 29% of the placebo group had either obstructive sleep apnea on polysomnography and/or a history of adenoidectomy/tonsillectomy. However, neither the apnea hypopnea index nor the proportion of children with obstructive sleep apnea differed between groups. The proportion of subjects with elevated periodic limb movements was high (17.5% in caffeine vs 11% in placebo) but did not differ signiicantly between groups. Conclusion(s): Therapeutic neonatal caffeine administration has no longterm effects on sleep pathology during childhood. Howeve

Many maternity providers recommend that women with diabetes in pregnancy express and store breast milk in late pregnancy so breast milk is available after birth, given (1) infants of these women are at increased risk of hypoglycaemia in the first 24 h of life; and (2) the delay in lactogenesis II compared with women without diabetes that increases their infant's risk of receiving infant formula. The Diabetes and Antenatal Milk Expressing (DAME) trial will establish whether advising women with diabetes in pregnancy (pre-existing or gestational) to express breast milk from 36 weeks gestation increases the proportion of infants who require admission to special or neonatal intensive care units (SCN/NICU) compared with infants of women receiving standard care. Secondary outcomes include birth gestation, breastfeeding outcomes and economic impact.

Lactation and breast milk can hold great value and meaning for grieving mothers who have experienced a recent death of an infant. Donation to a human milk bank (HMB) as an alternative to discarding breast milk is one means of respecting the value of breast milk. There is little research, national policy discussion, or organizational representation in Australia on the subject of breast milk donation after infant death. On 29 November 2013 the Mercy Hospital for Women in Melbourne, Australia hosted Australia's first National Stakeholder Meeting (NSM) on the topic of milk donation after neonatal death. The NSM drew together representatives from Australian HMBs, neonatal intensive care units (NICUs) currently using donor human milk, and Australia's chief NICU parent support organization. The NSM was video-recorded and transcribed, and analyzed thematically by researchers. This article reports the seven dominant themes discussed by stakeholders during the NSM: the spectrum of women's lactation and donation experiences after infant death; the roles of the HMB and NICU in meeting the needs of the bereaved donor; how bereaved mothers' lactation autonomy may interface with a HMB's donation guidelines; how milk donation may be discussed with bereaved mothers; the variation between four categories of milk donation after neonatal death; the impact of limited resources and few HMBs on providing donation programs for bereaved mothers in Australia. This article provides evidence from researchers and practitioners that can assist HMB staff in refining their bank's policy on milk donation after infant death, and provides national policy makers with key considerations to support lactation, human milk banking, and bereavement services nation-wide.

OBJECTIVES: To determine changes in height, weight, and BMI of extremely preterm (EPT; gestational age ,28 completed weeks) survivors from birth to 18 years of age, compared with term controls. METHOD(S): Birth, discharge, and follow-up at ages 2, 5, 8, and 18 years of consecutive EPT survivors and contemporaneous term controls born in 1991-1992 in Victoria, Australia. Weight, height, and BMI were converted to z scores and compared between groups. Height z scores at age 2 and midparental height z scores were examined as predictors of height z score at age 18 years. RESULT(S): Follow-up rates were .90% until 18 years, when 166 (74%) of 225 EPT subjects and 153 (60%) of 253 controls were assessed. EPT subjects had lower weight z scores than controls at birth, with a much greater difference at discharge, which reduced progressively until age 18 years. EPT children were shorter than controls at all ages, and this difference did not alter greatly over time. BMI z scores were lower in EPT children at younger ages, but by age 18 were similar between groups. Height at age 2 was a better predictor of height at age 18 in EPT participants, compared with midparental height. CONCLUSION(S): EPT survivors were substantially lighter than term controls from birth to late adolescence, although the gap in weight steadily decreased over time from a peak at the time of discharge. The height disadvantage in EPT children compared with controls remained constant over time and BMI scores were similar at age 18 years. Copyright © 2013 by the American Academy of Pediatrics.

Aim: Cohorts of EPT/ELBW survivors are known to have higher blood pressure than term controls in late adolescence in the past. The aim of this study was to determine if this pattern persists. Method(s): The subjects of this study were 18-year-olds born either EPT/ ELBW in 1991-92 in the state of Victoria and randomly selected term, normal birthweight controls. Ambulatory blood pressure was measured for 24 h and results compared between groups. Result(s): Adequate blood pressure data were obtained from 180/298 (60%) EPT/ELBW subjects and 125/262 (48%) controls. EPT/ELBW subjects had higher blood pressures than controls, not only over the 24-h period, but also when they were awake (Table), but not when they were asleep. (Table presented) Conclusion(s): The most recent EPT/ELBW survivors have higher blood pressure in late adolescence than term controls, continuing a trend that has been observed in cohorts born in earlier eras. The long-term cardiovascular health of EPT/ELBW survivors must be monitored through adulthood.

Aim: To determine the height, weight and body mass index (BMI) achievement of EPT/ELBW survivors at 18 years of age compared with term controls. Method(s): Eighteen-year follow-up of participants born either EPT/ELBW in 1991-92 in the state of Victoria and randomly selected term, normal birthweight controls. Height and weight were measured according to standard guidelines, using a stadiometer for height, and results converted to z-scores for age and gender. Result(s): Growth data were obtained from 208/298 (70%) EPT/ELBW subjects and 155/262 (59%) controls. EPT/ELBW subjects had height z-scores significantly below zero, but not weight z-scores; they were, however, significantly shorter and lighter than controls, but their BMI z-scores were little different (Table). These differences persisted when adjusted for midparental height z-score (Table). (Table presented) Conclusion(s): EPT/ELBW survivors remain substantially shorter and lighter than their term peers in late adolescence, a pattern which has persisted throughout childhood.

Aim Advances in neonatal care have resulted in increased survival rates in extremely preterm (EPT; gestational age < 28 weeks at birth) and extremely low birth weight (ELBW; birth weight < 1000 g) children. Bronchopulmonary dysplasia (BPD) rates and long-term respiratory morbidity remain. We investigated lung function in EPT/ELBW survivors at 18 years of age to ascertain if respiratory morbidity in EPT/ELBW young adults reflects alterations in the lung periphery or centralized airway function. Methods Eighteen-year follow-up of participants born either EPT/ELBW in 1991-1992 in the state of Victoria and randomly selected term, NBW controls. Spirometry, plethysmography and specific airways resistance (sRaw) were measured according to standard guidelines. Results The EPT/ELBW (All) had impaired lung function especially variables reflecting flow, and airways resistance. Those with BPD had greater impairments in lung function. Conclusions EPT/ELBW survivors had lower lung function than their termborn NBW peers in late adolescence. Those who had BPD had the greatest impairment in their lung function. The impaired lung function is obstructive in nature.

Aim To determine the maximal exercise capacity of extremely preterm (EPT; gestational age <28 weeks), extremely low birth weight (ELBW; birth weight <1000 g) survivors at 18 years of age compared with term controls. Methods 18-year follow-up of participants born either EPT/ELBW in 1991- 1992 and randomly selected term, NBW controls (C). Cardiopulmonary exercise was performed on a treadmill according to standard guidelines. Results EPT/ELBW (All) survivors, especially BPD survivors, have reduced peak oxygen consumption (VO2max), tidal volumes (Vt/kg) and anaerobic threshold (VO2 AT) at peak exercise compared to controls, despite achieving the similar maximum heart rates (HRmax) and maximum work rates (Work/kg). (Table presented) Conclusions EPT/ELBW survivors, especially those who had BPD, have worse cardiopulmonary exercise capacity than their term-born NBW peers in late adolescence.

Aim: To understand better why EPT/ELBW survivors have higher blood pressure than term controls by contrasting differences in the heart and blood vessels between EPT/ELBW survivors and controls in late adolescence. Method(s): Eighteen-year follow-up of participants born either EPT/ELBW in 1991-1992 in the state of Victoria and randomly selected term, normal birthweight controls. Cardiovascular investigations included echocardiography, incorporating Doppler assessments of valvular and cardiac muscle function, pulse wave velocity (PWV), carotid intimal thickness, and endothelial function. Result(s): Adequate cardiovascular data were obtained from 139/298 (47%) EPT/ELBW subjects and 81/262 (31%) controls. EPT/ELBW subjects had smaller aortic diameters and smaller left ventricular (LV) volumes that persisted after adjustment for body size, and higher augmentation indices (Table), but no differences in ventricular function, PWV, carotid intimal thickness, or endothelial function. (Table presented) Conclusion(s): The smaller vessel size in the presence of normal ventricular and endothelial function may explain why blood pressure is higher in EPT/ELBW survivors than in term controls.

Aim Advances in neonatal care have resulted in increased survival of children born extremely preterm (EPT; gestational age < 28 weeks at birth) and extremely low birth weight (ELBW; birth weight < 1000 g). Despite these advances the incidences of Bronchopulmonary dysplasia (BPD) and long-term respiratory morbidity remains high. Methods Eighteen-year follow-up of participants born either EPT/ELBW in 1991-1992 in the state of Victoria. At the same time a normal birth weight (NBW; birth weight > 2499 g) control group randomly selected from those eligible born on the date EPT/ELBW due, matched for gender, mother's health insurance and country of birth. Cardiopulmonary exercise performed on a treadmill according to standard guidelines. Results EPT/ELBW (All) survivors have reduced peak oxygen consumption (VO2max), tidal volumes (Vt/kg) and anaerobic threshold (VO2 AT) at peak exercise compared to controls, despite achieving the similar maximum heart rates (HRmax) and maximum work rates (Work/kg). Those who had BPD show further reductions in VO2max, Vt/kg and VO2 AT. (Table presented) Conclusions EPT/ELBW survivors, especially those who had BPD, have worse exercise capacity than NBW peers.

Aim: To determine the respiratory function of EPT/ELBW survivors at 18 years of age compared with term controls. Method(s): Eighteen-year follow-up of participants born either EPT/ELBW in 1991-1992 in the state of Victoria and randomly selected term, normal birthweight controls. Lung volumes and flows, including the forced expired volume in 1 s (FEV1), forced vital capacity (FVC), the FEV1/FVC, and the forced expiratory flow (FEF25-75%) were measured according to standard guidelines and results converted to z-scores for age, height and gender. Result(s): Lung function data were obtained from 206/298 (69%) EPT/ ELBW subjects and 153/262 (58%) controls. EPT/ELBW subjects had lower flow rates than expected for age height and gender, and also compared with controls (Table). (Table presented) Conclusion(s): EPT/ELBW survivors have substantially worse lung function than their term-born peers in late adolescence, a pattern which has persisted throughout childhood.

Aim To determine the respiratory function of extremely preterm (EPT; gestational age/GA < 28 weeks), extremely low birth weight (ELBW; birth weight/ BW < 1000 g) survivors at 18 years of age compared with term controls. Methods 18-year follow-up of participants born either EPT/ELBW in 1991- 1992 in the state of Victoria and randomly selected term, NBW controls (C). Spirometry, plethysmography, airways resistance (sRaw), diffusing capacity and multiple-breath-washout were measured according to standard guidelines. Result(s): The EPT/ELBW (All) had impaired lung function especially variables reflecting flow, and airways resistance. Those with BPD had greater impairments in lung function. Data are mean (SD), unless otherwise stated. (Table presented) Conclusions EPT/ELBW survivors had lower lung function than their NBW peers in late adolescence. Those who had BPD had the greatest impairment in their lung function. The impaired lung function is obstructive in nature.

Objective: To determine the survival and neurological outcome at 2 years of age of extremely low birthweight (ELBW, birth weight 500-999 g) infants born in the state of Victoria compared with term controls, and contrasted with ELBW cohorts from previous eras. Design and setting: A population-based cohort study of consecutive ELBW infants born during 2005 in the state of Victoria, and also in 1979-1980, 1985-1987, 1991-1992 and 1997. Participant(s): All 257 live births free of lethal malformations weighing 500-999 g in 2005, 220 randomly selected term, normal birthweight (birth weight >2499 g) controls, and equivalent cohorts born in earlier eras. Main Outcome Measure(s): Survival rates and qualityadjusted survival rates at 2 years of age, contrasted between cohorts. Result(s): Of 257 ELBW live births in 2005, 66.9% survived to 2 years of age, significantly lower than the survival rate of 75.2% for 1997 (odds ratio (OR) 0.67, 95% CI 0.45 to 0.99, p=0.046), but not after adjustment for confounders of birth weight, gestational age and gender (adjusted OR 0.73, 95% CI 0.46 to 1.16, p=0.18). This was a reversal of the steady increase in survival rates up to 1997. Rates of blindness, severe developmental delay and severe disability were significantly lower in 2005 than in ELBW survivors from previous eras. Consequently the difference in the quality-adjusted survival rates between 2005 and 1997 was only -3.8% (95% CI -11.4% to 3.7%, p=0.32). Conclusion(s): Regional survival rates for ELBW infants have plateaued since the late 1990s, but the neurosensory outcome in survivors has improved in 2005.

BACKGROUND: Late onset sepsis is a frequent complication of prematurity associated with increased mortality and morbidity. The commensal bacteria of the gastrointestinal tract play a key role in the development of healthy immune responses. Healthy term infants acquire these commensal organisms rapidly after birth. However, colonisation in preterm infants is adversely affected by delivery mode, antibiotic treatment and the intensive care environment. Altered microbiota composition may lead to increased colonisation with pathogenic bacteria, poor immune development and susceptibility to sepsis in the preterm infant.Probiotics are live microorganisms, which when administered in adequate amounts confer health benefits on the host. Amongst numerous bacteriocidal and nutritional roles, they may also favourably modulate host immune responses in local and remote tissues. Meta-analyses of probiotic supplementation in preterm infants report a reduction in mortality and necrotising enterocolitis. Studies with sepsis as an outcome have reported mixed results to date.Allergic diseases are increasing in incidence in "westernised" countries. There is evidence that probiotics may reduce the incidence of these diseases by altering the intestinal microbiota to influence immune function. METHODS/DESIGN: This is a multi-centre, randomised, double blinded, placebo controlled trial investigating supplementing preterm infants born at < 32 weeks' gestation weighing < 1500 g, with a probiotic combination (Bifidobacterium infantis, Streptococcus thermophilus and Bifidobacterium lactis). A total of 1,100 subjects are being recruited in Australia and New Zealand. Infants commence the allocated intervention from soon after the start of feeds until discharge home or term corrected age. The primary outcome is the incidence of at least one episode of definite (blood culture positive) late onset sepsis before 40 weeks corrected age or discharge home. Secondary outcomes include: Necrotising enteroco

Objective: There is evidence of increasing prescription of antidepressant medication in pregnant women. This has arisen from the recognition of the importance of treating maternal depression. This must be balanced, however, with information on outcomes for infants and children exposed to antidepressants in pregnancy. The aim of the present study was to examine whether neonatal outcomes including gestational age at birth, neonatal growth outcomes at birth and then at 1 month postpartum were altered by in utero exposure to antidepressant medication using a prospective and controlled design. Method: A prospective case–control study recruited 27 pregnant women taking antidepressant medication and 27 matched controls who were not taking antidepressant medication in pregnancy at an obstetric hospital in Melbourne, Australia. Of the 27 women taking medication, 25 remained on medication in the third trimester. A purpose-designed self-report questionnaire and the Beck Depression Inventory-II were completed in pregnancy, after birth and at one month postpartum. In addition information was collected on exposed and non-exposed infants including Apgar scores, birthweight/length/head circumference and gestational age at birth. Weight/length/head circumference was again collected at 1 month of age. Results: Infants exposed to antidepressants in utero were eightfold more likely to be born at a premature gestational age, had significantly lower birthweight and were smaller in length and head circumference than non-exposed infants. There was no association between birth outcomes and maternal depression. At 1 month, the difference in weight in the exposed group became significantly greater than the control group. Conclusion: Antidepressant exposure in utero may affect gestational age at birth and neonatal outcomes independently of antenatal maternal depression. Further studies are needed to examine whether these findings vary according to the type of antidepressant prescribed and foll

Background: Major grades of intraventricular haemorrhage (IVH) are associated with adverse neurodevelopmental sequelae in early childhood but the extent of problems in specific cognitive areas, such as executive function, and the contribution of lesser grades of IVH to neurodevelopmental problems at school age are not well described. Aim(s): To determine the neuromotor, cognitive and educational outcome of extremely low birthweight (ELBW, birthweight < 1000 g) or very preterm (< 28 weeks) infants at 8 years of age related to the severity of IVH diagnosed in the newborn period. Design(s): Regional cohort study. Patient(s): Consecutive surviving children of either birthweight < 1000 g or gestational age < 28 weeks born in the state of Victoria in 1991 or 1992. Main Outcome Measure(s): Neurological impairments and disabilities, cognitive function and academic progress. Result(s): Of 298 consecutive ELBW/very preterm survivors 270 (90.6%) with cranial ultrasound data were assessed at 8 years of age. Cerebral palsy, poor motor performance and major neurosensory disability were more prevalent with increasing severity of IVH. Cognitive functioning across domains was worse with increasing severity of IVH. Most of the differences were attributable to the few (n = 6) survivors who had grade 4 IVH; there were few substantial differences between survivors with lesser grades of IVH. Conclusion(s): Neurodevelopmental dysfunction at school age in ELBW/very preterm survivors varies little with increasing severity of IVH, with the exception of grade 4 IVH. © 2005 Elsevier Ireland Ltd. All rights reserved.