David Odd, Consultant Neonatologist
Preterm birth causes long term problems: even for infants born only 1 or 2 weeks early. However, little is known about those infants born after their due date (post-term) and over a quarter of infants are born a week later than their due date. The longer the infant stays in the womb the higher the risk of problems, without any obvious benefit. These post-term babies have higher risks of death and brain damage around their birth, but we don’t fully understand why, nor which is the best time to deliver them. We also know that many effects that impair babies and children’s development are not seen early on, and so effects of being born too late may ‘amplify’ as the child grows. The medical, financial, and personal impact of an adverse event during birth is enormous. However, while mothers report that the well-being of their infant is the biggest priority for them, the lack of research evidence in this area makes counselling for women difficult. Our current work has identified strong links between later birth and brain injury and we know that closer observation of pregnant women and early birth of infants at high risk is better for the mother and the infant. We anticipate that better information, more easily available, would help women, their babies and maternity services.
The aims of this work are to place our ongoing work into a wider context, and develop the project for a larger (separately) funded project.
The work is divided into two parts:
- I will perform a systematic review of the published evidence to summarize the current knowledge base and ensure that the second component (below) addresses all the current concerns and gaps in knowledge.
- We will develop the knowledge derived from the above, and using the time supported by this fellowship develop a larger grant application anticipated to test a number of ideas:
- We will look to see if the effects are seen in other, more recent UK data.
- We will test to see the cost of possible brain injury on the UK health service, and society as a whole.
- We will talk to mothers about the possible options available to reduce any problems, and which may, or may not, be acceptable to them.
- We will develop a tool and guidelines to help guide mothers, doctors and midwives to minimise risk to those infants at highest chance of a problem after their due date.
Progress Report (David Odd 17/04/2018)
The initial proposal listed two aims/objectives;
1. Systematic review: The aim of this review is to identify all published research looking at the neurological outcomes of infants born post-term and place our current work within this context.
- Currently I am well underway to completing this first component. The protocol for the systematic review has been published (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=88215) and the review completed. It is currently going through the final stages of formatting for possible peer-review publication.
2. Development of NIHR application (NBT-led) to identify potential intervention points and tools to reduce the neurological burden.
- Given I now have the results of the review (above) I am currently at the stage of developing NIHR application (anticipated to be a Research for Patient Benefit (RfPB) application).