THE YOUNG INVESTIGATOR'S PRIZE LECTURE 2012
Presented at the Neonatal Society 2012 Summer Meeting (programme).
Tamanna Moore, University of Nottingham
Are neurodevelopmental outcomes improving after EP birth?
The EPICure study reported outcomes after extremely preterm birth in England on a national level (1). Much has changed in the intervening years since 1995 when the EPICure cohort was recruited, and the relevance of the survival and outcome statistics has come into question. To answer these queries, we carried out a second study of births in England in 2006. Results from the initial phases of EPICure-2 have demonstrated a significant increase in survival at 24 and 25 weeks of gestation. However, an improvement in early neonatal morbidities such as retinopathy of prematurity and chronic lung disease have not been shown, and the prevalence of severe cranial ultrasound abnormalities remains disappointingly static (2).
Cognitive and language assessments were conducted using the updated 3rd edition of the Bayley Scales of Infant development – this revised version has superseded the previous 2nd edition used to assess the first EPICure cohort. For validation purposes, both editions of the Bayley scales were used to evaluate a subcohort of the EPICure-2 group. A total of 185 children were tested using the 2nd and 3rd editions of the Bayley Scales, resulting in the largest validation study of both tests to date (3). Importantly, children gained significantly higher scores using the 3rd edition. This has powerful implications for outcome studies in early childhood and for our interpretation of trends in developmental morbidity over time using the Bayley Scales. As a result, we have strongly suggested that a higher cut-off score should be adopted nationally to define cognitive impairment using the Bayley-III.
Our research has focused on whether the prevalence of neurodevelopmental morbidity in early childhood has improved. At age 30-35 months corrected for prematurity, we have shown that there has been no change in the prevalence of cerebral palsy or in significant cognitive, motor or neurosensory impairment after extremely preterm birth in England between 1995 and 2006. However, more admissions for neonatal care now survive without disability - particularly at 24 and 25 weeks (4).
These results have underscored the importance of future efforts to prevent brain injury in the neonatal period – survival after extremely preterm birth has improved, but this has not translated to a decrease in neurodevelopmental morbidity.
This research was funded by the Medical Research Council, and would not have been possible without the efforts of a huge EPICure-2 study team, the study participants and their families.
1. Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. N Engl J Med. 2000;343(6):378-384.
2. Costeloe KL, Draper ES, Hennessy EM, Myles J. Epicure 2: early survival of extremely preterm babies in 2006; changes since 1995. Acta Paediatrica. 2007;96:171-171.
3. Moore T, Johnson S, Haider S, Hennessy E, Marlow N. Relationship between Test Scores Using the Second and Third Editions of the Bayley Scales in Extremely Preterm Children. The Journal of Pediatrics. 2012;160(4):553-558.
4. Moore T, Johnson S, Hennessy E, Chisholm P, Marlow N. The EPICure studies: better survival, better outcomes? Archives of Disease in Childhood - Fetal and Neonatal Edition. June 1, 2011 2011;96(Suppl 1):Fa16.