Helping babies bloom
One in three babies admitted to a neonatal intensive care unit will fail their school readiness assessment at age five, with consequences lasting into adulthood. A new project aims to identify those babies at greatest risk and give them a helping hand to fulfil their potential.
Every year in the UK, around 600,000 babies are born. For most parents, this is a time of joy and celebration, a welcoming into the family of a beautiful new member. For some families, however, it can also be a very stressful time.
Around one in 10 babies is transferred to a neonatal intensive care unit (NICU) when they are born as they require specialist care. It might be because they have been born prematurely before their organs have fully developed, or because of low birth weight or breathing difficulties, or they need surgery, for example.
Fortunately, because of the high standard of care in NHS hospitals, in most cases the babies will survive, and their parents can look forward to introducing their baby to his or her new home. However, for many of these children, something about their unsteady start to life will have a long-term impact.
A difficult start
At age five, children in reception at UK state schools will have undergone a school readiness assessment to see if they are ready for the transition to formal education. This looks at such things as how well the child can communicate, at their behaviour and social interactions, physical skills (for example, tying shoes), cognitive skills and ability to follow instructions. While one in six children will fail this assessment across the UK, Cambridge research indicates that children who had been admitted to NICU are twice as likely to do so.
“Not every child with a tricky start has a problem later on,” says Professor Catherine Aiken from the Department of Obstetrics and Gynaecology at the University of Cambridge. “Some of them thrive and go on to do brilliantly well at school. But we know that they've got a higher chance than most children of needing extra support.”
Aiken is Chief Investigator of the new Babies’ Longitudinal Outcomes, Omics and Milestones Study (BLOOMS). Funded by a £4 million award from the Wellcome Trust, it aims to recruit 1,000 babies admitted to NICUs across three NHS hospitals in the East of England – the Rosie Hospital in Cambridge, Luton and Dunstable University Hospital, and Norfolk and Norwich University Hospital – to try and understand which babies will need most support in their early life and what that support might look like. In addition, the team aims to include not only children in the East of England, but also across the UK using national records for neonates and their educational outcomes.
“If we could better identify which children are going to need help to meet their potential earlier on,” explains Aiken, “then there are support interventions that can be put in place when they are very young to get them to a place where they're ready to learn by the time they go to school.”
David Rowitch, Professor of Paediatrics at Cambridge and Deputy Director of Research at Cedars-Sinai Guerin Children’s in Los Angeles is Principal Investigator of BLOOMS. He says that there is an optimal window in which to intervene, with learning interventions less effective in older children.
“Waiting until age five to find out about a problem is not ideal because it’s possible you've missed this window,” he says. “The premise of our study is that we can identify babies in NICU during an actionable time frame.
“We want to be able to say ‘There’s a red flag. Here's a child who should be admitted into an interventional support programme.’ If we use techniques such as genomics, we can go beyond the clinical record alone to be even more specific about this assessment, targeting help to those most likely to benefit.”
This is important, he says, because children who fail their school readiness assessments are more likely to experience problems in their adult life: to have poorer physical and mental health; to be incarcerated; to be deprived; even to die early.
“[School readiness] is one of the most important outcomes that we can focus on because it packs so much in about a child’s later trajectory across the life course,” Rowitch says.