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Background Children born very preterm (<32 weeks of gestation) face high risks of neurodevelopmental and health difficulties compared with children born at term. Follow-up after discharge from the neonatal intensive care unit is essential to ensure early detection and intervention, but data on policy approaches are sparse. Methods We investigated the characteristics of follow-up policy and programmes in 11 European countries from 2011 to 2022 using healthcare informant questionnaires and the published/grey literature. We further explored how one aspect of follow-up, its recommended duration, may be reflected in the percent of parents reporting that their children are receiving follow-up services at 5 years of age in these countries using data from an area-based cohort of very preterm births in 2011/12 (N  = 3635). Results Between 2011/12 and 22, the number of countries with follow-up policies or programmes increased from 6 to 11. The policies and programmes were heterogeneous in eligibility criteria, duration and content. In countries that recommended longer follow-up, parent-reported follow-up rates at 5 years of age were higher, especially among the highest risk children, born <28 weeks' gestation or with birthweight <1000 g: between 42.1% and 70.1%, vs. <20% in most countries without recommendations. Conclusions Large variations exist in follow-up policies and programmes for children born very preterm in Europe; differences in recommended duration translate into cross-country disparities in reported follow-up at 5 years of age. [ABSTRACT FROM AUTHOR]

Aim: We investigated the timing of survival differences and effects on morbidity for foetuses alive at maternal admission to hospital delivered at 22 to 26 weeks' gestational age (GA). Methods: Data from the EXPRESS (Sweden, 2004–07), EPICure‐2 (England, 2006) and EPIPAGE‐2 (France, 2011) cohorts were harmonised. Survival, stratified by GA, was analysed to 112 days using Kaplan‐Meier analyses and Cox regression adjusted for population and pregnancy characteristics; neonatal morbidities, survival to discharge and follow‐up and outcomes at 2–3 years of age were compared. Results: Among 769 EXPRESS, 2310 EPICure‐2 and 1359 EPIPAGE‐2 foetuses, 112‐day survival was, respectively, 28.2%, 10.8% and 0.5% at 22–23 weeks' GA; 68.5%, 40.0% and 23.6% at 24 weeks; 80.5%, 64.8% and 56.9% at 25 weeks; and 86.6%, 77.1% and 74.4% at 26 weeks. Deaths were most marked in EPIPAGE‐2 before 1 day at 22–23 and 24 weeks GA. At 25 weeks, survival varied before 28 days; differences at 26 weeks were minimal. Cox analyses were consistent with the Kaplan‐Meier analyses. Variations in morbidities were not clearly associated with survival. Conclusion: Differences in survival and morbidity outcomes for extremely preterm births are evident despite adjustment for background characteristics. No clear relationship was identified between early mortality and later patterns of morbidity. [ABSTRACT FROM AUTHOR]

Objective: To explore international variations in the management and survival of extremely low gestational age and birthweight births.Design: Area-based prospective cohort of births SETTING: 12 regions across Belgium, France, Italy, Portugal and the UK PARTICIPANTS: 1449 live births and fetal deaths between 22+0 and 25+6 weeks gestation born in 2011-2012.Main Outcome Measures: Percentage of births; recorded live born; provided antenatal steroids or respiratory support; surviving to discharge (with/without severe morbidities).Results: The percentage of births recorded as live born was consistently low at 22 weeks and consistently high at 25 weeks but varied internationally at 23 weeks for those weighing 500 g and over (range 33%-70%) and at 24 weeks for those under 500 g (range 5%-71%). Antenatal steroids and provision of respiratory support at 22-24 weeks gestation varied between countries, but were consistently high for babies born at 25 weeks. Survival to discharge was universally poor at 22 weeks gestation (0%) and at any gestation with birth weight <500 g, irrespective of treatment provision. In contrast, births at 23 and 24 weeks weighing 500 g and over showed significant international variation in survival (23 weeks: range: 0%-25%; 24 weeks range: 21%-50%), reflecting levels of treatment provision.Conclusions: Wide international variation exists in the management and survival of extremely preterm births at 22-24 weeks gestation. Universally poor outcomes for babies at 22 weeks and for those weighing under 500 g suggest little impact of intervention and support the inclusion of birth weight along with gestational age in ethical decision-making guidelines. [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]

The objective of the study is to investigate whether episodic binge pattern of alcohol consumption during pregnancy is independently associated with child mental health and academic outcomes. Using data from the prospective, population-based Avon Longitudinal Study of Parents and Children (ALSPAC), we investigated the associations between binge patterns of alcohol consumption during pregnancy (≥4 drinks per day) and child mental health [as rated by both parent ( n = 4,610) and teacher ( n = 4,274)] and academic outcomes [based on examination results ( n = 6,939)] at age 11 years. After adjusting for prenatal and postnatal risk factors, binge pattern of alcohol consumption (≥4 drinks in a day on at least one occasion) during pregnancy was associated with higher levels of mental health problems (especially hyperactivity/inattention) in girls at age 11 years, according to parental report. After disentangling binge-pattern and daily drinking, binge-pattern drinking was independently associated with teacher-rated hyperactivity/inattention and lower academic scores in both genders. Episodic drinking involving ≥4 drinks per day during pregnancy may increase risk for child mental health problems and lower academic attainment even if daily average levels of alcohol consumption are low. Episodic binge pattern of drinking appears to be a risk factor for these outcomes, especially hyperactivity and inattention problems, in the absence of daily drinking. [ABSTRACT FROM AUTHOR]

Background: There is substantial debate as to whether moderate alcohol use during pregnancy could have subtle but important effects on offspring, by impairing later cognitive function and thus school performance. The authors aimed to investigate the unconfounded effect of moderately increased prenatal alcohol exposure on cognitive/educational performance.Methods: We used mother-offspring pairs participating in the Avon Longitudinal Study of Parents and Children (ALSPAC) and performed both conventional observational analyses and Mendelian randomization using an ADH1B variant (rs1229984) associated with reduced alcohol consumption. Women of White European origin with genotype and self-reported prenatal alcohol consumption, whose offspring's IQ score had been assessed in clinic (N=4061 pairs) or Key Stage 2 (KS2) academic achievement score was available through linkage to the National Pupil Database (N=6268), contributed to the analyses.Results: Women reporting moderate drinking before and during early pregnancy were relatively affluent compared with women reporting lighter drinking, and their children had higher KS2 and IQ scores. In contrast, children whose mothers' genotype predisposes to lower consumption or abstinence during early pregnancy had higher KS2 scores (mean difference +1.7, 95% confidence interval +0.4, +3.0) than children of mothers whose genotype predisposed to heavier drinking, after adjustment for population stratification.Conclusions: Better offspring cognitive/educational outcomes observed in association with prenatal alcohol exposure presumably reflected residual confounding by factors associated with social position and maternal education. The unconfounded Mendelian randomization estimates suggest a small but potentially important detrimental effect of small increases in prenatal alcohol exposure, at least on educational outcomes. [ABSTRACT FROM AUTHOR]

Background The epidemiology of congenital small intestinal atresia (SIA) has not been well studied. This study describes the presence of additional anomalies, pregnancy outcomes, total prevalence and association with maternal age in SIA cases in Europe. Methods Cases of SIA delivered during January 1990 to December 2006 notifi ed to 20 EUROCAT registers formed the population-based case series. Prevalence over time was estimated using multilevel Poisson regression, and heterogeneity between registers was evaluated from the random component of the intercept. Results In total 1133 SIA cases were reported among 5126, 164 registered births. Of 1044 singleton cases, 215 (20.6%) cases were associated with a chromosomal anomaly. Of 829 singleton SIA cases with normal karyotype, 221 (26.7%) were associated with other structural anomalies. Considering cases with normal karyotype, the total prevalence per 10 000 births was 1.6 (95% CI 1.5 to 1.7) for SIA, 0.9 (95% CI 0.8 to 1.0) for duodenal atresia and 0.7 (95% CI 0.7 to 0.8) for jejunoileal atresia (JIA). There was no signifi cant trend in SIA, duodenal atresia or JIA prevalence over time (RR=1.0, 95% credible interval (CrI): 1.0 to 1.0 for each), but SIA and duodenal atresia prevalence varied by geographical location (p=0.03 and p=0.04, respectively). There was weak evidence of an increased risk of SIA in mothers aged less than 20 years compared with mothers aged 20 to 29 years (RR=1.3, 95% CrI: 1.0 to 1.8). Conclusion This study found no evidence of a temporal trend in the prevalence of SIA, duodenal atresia or JIA, although SIA and duodenal atresia prevalence varied signifi cantly between registers. INSETS: What is known about the topic;What this study adds. [ABSTRACT FROM AUTHOR]

Background: About 10% of twins are born before 32 weeks of gestation and very preterm birth rates are increasing. Preterm twins tend to have more favourable outcomes than singletons of the same gestational age, but fewer data are available for very preterm infants. This study aims to determine whether outcomes differ between very preterm twins and singletons.Method: This study was of a population-based cohort of very preterm babies in 10 European regions in 2003. Mortality and morbidity to discharge from hospital were compared for twins and singletons between 24 and 31 weeks of gestation, who were alive at the onset of labour and without lethal congenital anomalies. Clinical characteristics, pregnancy complications and healthcare factors were taken into consideration.Results: Between 28 and 31 weeks of gestation, mortality and oxygen dependency at 36 corrected weeks of gestation were lower for twins than singletons (3.9 versus 6.5% and 7.1 versus 10.4%, respectively), but this advantage disappeared after controlling for medical and healthcare factors. Hypertension, growth restriction and haemorrhaging were less frequent complications of twin birth and more twins received antenatal corticosteroids and were born in level III units. In contrast, between 24 and 27 weeks of gestation, twins had higher adjusted risks of mortality and Grade III/IV intraventricular haemorrhaging [adjusted ORs 1.5 (95% CI 1.1-2.2) and 1.5 (1.0-2.1)]. These adverse outcomes were concentrated among twins from same sex pairs with discordant birthweights.Conclusions: Between 24 and 27 weeks of gestation, risks of mortality and severe cranial haemorrhaging were higher for twins than singletons if they were from same sex pairs with discordant birthweights. [ABSTRACT FROM AUTHOR]

The authors tested the hypothesis that the birth prevalence of gastroschisis is positively associated with use of recreational drugs in early pregnancy. A matched case-control study was carried out in three regions of the United Kingdom over the period January 2001 through August 2003. For each case, three liveborn controls were matched by initial intended place of delivery, region, and maternal age. Maternal hair analysis provided independent verification of recreational drug use. Conditional logistic regression was used to estimate mutually adjusted odds ratios. Estimates were revised using data from hair analysis. Statistically significant adjusted odds ratios for gastroschisis were associated with first-trimester use of 1) any recreational drug (odds ratio (OR) = 2.2, 95% confidence interval (CI): 1.2, 4.3) and 2) vasoconstrictive recreational drugs (defined as cocaine, amphetamines, and ecstasy) (OR = 3.3, 95% CI: 1.0, 10.5). Other significant exposures included aspirin use (OR = 20.4, 95% CI: 2.2, 191.5), cigarette smoking (OR = 1.7, 95% CI: 1.1, 2.6), and prior history of gynecologic infection/disease (OR = 2.6, 95% CI: 1.2, 5.6). Recreational drug use is a significant risk factor for gastroschisis and is one of a constellation of potentially preventable exposures which include cigarette smoking, aspirin use, and history of gynecologic infection/disease. Maternal hair analysis proved an acceptable and valuable method of independently verifying recreational drug use. [ABSTRACT FROM PUBLISHER]

Objective: To explore the differences in outcome of very preterm pregnancies between two geographically defined populations in Europe with similar socioeconomic characteristics and healthcare provision but different organisational arrangements for perinatal care. Design: Prospective cohort study. Setting: Nord Pas-de-Calais (NPC), France, and Trent, UK. Participants: All pregnancy outcomes 22+0 to 32+6 weeks' gestational age for resident mothers. Outcome measures: Mortality patterns (antepartum death, intrapartum death, labour ward death and neonatal unit death) among very preterm babies were analysed by region. Multinomial logistic regression was used to model regional differences for a variety of pregnancy outcomes and to adjust for regional differences in the organisation of perinatal care. Results: Delivery of very preterm infants was significantly higher in Trent compared with NPC (1.9% v 1.5% of all births, respectively (p<0.001 )). Stillbirth rate was significantly higher in NPC than in Trent (23.0%, 95% CI 20.0% to 26.5% v 14.4%, 95% CI 12.3% to 16.6%, respectively (p<0.001)) and survival to discharge was higher in Trent than in NPC (74.6%, 95% CI 71 .9% to 77.1% v 66.7%, 95% Cl 63.3% to 69.9%, respectively (p<0.001 )). Probability of intrapartum and labour ward death in NPC was more than five times higher than Trent (relative risk 5.3, 95% CI 2.2 to 13.1 (p<0.001)). Conclusion: The high rate of very preterm deliveries and the larger proportion of these infants recorded as live born in Trent appear to be the cause of the excess neonatal mortality seen in the routine statistics. Information about very preterm babies (not usually included in routine statistics) is vital to avoid inappropriate interpretation of international perinatal and infant data. This study highlights the importance of including deaths before transfer to neonatal care and emphasises the need to include the outcome of all pregnancies in a population in any comparative analysis. [ABSTRACT FROM AUTHOR]

Objective:The incidence of gastroschisis, a congenital anomaly where the infant abdominal wall is defective and intestines protrude from the abdominal cavity, is increasing in many countries. The role of maternal stress in some adverse birth outcomes is now well established. We tested the hypothesis that major stressful life events in the first trimester are risk factors for gastroschisis, and social support protective, in a case-control study in the United Kingdom. Methods:Gastroschisis cases and three controls per case (matched for maternal age) were identified at routine 18-20 week fetal anomaly ultrasound scan, in 2007-2010. Face to face questionnaire interviews were carried out during the antenatal period (median 24 weeks gestation) asking about serious stressful events and social support in the first trimester. Data were analysed using conditional logistic regression. Results:Two or more stressful life events in the first trimester (adjusted OR 4.9; 95% CI 1.2-19.4), and moving address in the first trimester (aOR 4.9; 95% CI 1.7-13.9) were strongly associated with risk of gastroschisis, independent of behavioural risk factors including smoking, alcohol, and poor diet. Perceived availability of social support was not associated with reduced risk of gastroschisis (aOR 0.8; 95% CI 0.2-3.1). Conclusions:Stressful maternal life events in the first trimester of pregnancy including change of address were strongly associated with a substantial increase in the risk of gastroschisis, independent of stress related high risk behaviours such as smoking, alcohol consumption and poor diet. This suggests that stress pathways are involved in the aetiology of gastroschisis. [ABSTRACT FROM AUTHOR]

BACKGROUND. It is known that extremely premature infants do less well than more mature infants, and this fact has led some countries to adopt a "cutoff for viability" using birth weight or gestation. Infants affected by intrauterine growth retardation are at additional risk of poor outcome. There are few data to inform decisions about viability and (dis)continuation of intensive care when both extreme pre-maturity and severe growth retardation are present. OBJECTIVE. We focused on (1) premature infants affected by marked intrauterine growth retardation to determine if there was a cutoff weight centile below which the mortality sharply increased and (2) the short-term outcome of extremely premature and growth-retarded infants to determine a cutoff for viability. METHODS. We evaluated preterm infants of 22-32 weeks' gestation if they were alive at the onset of labor and born to European mothers resident in the Trent (United Kingdom) health region between 1994 and 2003. Infants were categorized into 6 weight centiles, and infants in each category were assessed for survival to discharge from the neonatal unit, duration of respiratory support, length of stay in the neonatal unit, and the age at death in nonsurvivors. RESULTS. We identified a total of 8228 infants who met the study criteria. Of these, 4448 infants were male, 6194 were front singleton pregnancies, and 2887 were born at ≤28 completed weeks of gestation. Survival to discharge was markedly reduced in the infants born at ≤28 weeks of gestation with a birth weight less than the 2nd centile. Stillbirth was inversely related to birth weight centile in infants born before 29 weeks of gestation. CONCLUSIONS. The survival for infants born at ≤28 weeks' gestation and having a birth weight in less than the 2nd centile is poor, and consideration should be given to modifying their management. [ABSTRACT FROM AUTHOR]