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No change in neurodevelopment at 11 years after extremely preterm birth
  1. Neil Marlow1,
  2. Yanyan Ni1,2,
  3. Rebecca Lancaster3,
  4. Emmi Suonpera1,
  5. Marialivia Bernardi1,
  6. Amanda Fahy1,
  7. Jennifer Larsen3,
  8. Jayne Trickett3,
  9. John R Hurst4,
  10. Joan Morris5,
  11. Dieter Wolke6,
  12. Samantha Johnson3
  1. 1 Institute for Women's Health, University College London, London, UK
  2. 2 Psychology, University of Warwick, Coventry, UK
  3. 3 Health Sciences, University of Leicester, Leicester, UK
  4. 4 UCL Respiratory, University College London, London, UK
  5. 5 Statistics, St George's University of London, London, UK
  6. 6 Department of Psychology and Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK
  1. Correspondence to Professor Neil Marlow, Institute for Women's Health, University College London, London WC1E 6BT, UK; n.marlow{at}


Objective To determine whether improvements in school age outcomes had occurred between two cohorts of births at 22–25 weeks of gestation to women residents in England in 1995 and 2006.

Design Longitudinal national cohort studies.

Setting School-based or home-based assessments at 11 years of age.

Participants EPICure2 cohort of births at 22–26 weeks of gestation in England during 2006: a sample of 200 of 1031 survivors were evaluated; outcomes for 112 children born at 22–25 weeks of gestation were compared with those of 176 born in England during 1995 from the EPICure cohort. Classroom controls for each group acted as a reference population.

Main outcome measures Standardised measures of cognition and academic attainment were combined with parent report of other impairments to estimate overall neurodevelopmental status.

Results At 11 years in EPICure2, 18% had severe and 20% moderate impairments. Comparing births at 22–25 weeks in EPICure2 (n=112), 26% had severe and 21% moderate impairment compared with 18% and 32%, respectively, in EPICure. After adjustment, the OR of moderate or severe neurodevelopmental impairment in 2006 compared with 1995 was 0.76 (95% CI 0.45 to 1.31, p=0.32). IQ scores were similar in 1995 (mean 82.7, SD 18.4) and 2006 (81.4, SD 19.2), adjusted difference in mean z-scores 0.2 SD (95% CI −0.2 to 0.6), as were attainment test scores. The use of multiple imputation did not alter these findings.

Conclusion Improvements in care and survival between 1995 and 2006 are not paralleled by improved cognitive or educational outcomes or a reduced rate of neurodevelopmental impairment.

  • neonatology
  • epidemiology
  • neurology
  • psychology

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  • Contributors NM conceptualised and designed the study, obtained funding, drafted the first version of the manuscript and revised it for important intellectual content. YN conducted the statistical analyses and critically reviewed and revised the manuscript for intellectual content. RL, ES, JT, MB, JL and AF assisted in the design of study, collected the data, and reviewed and revised the manuscript for intellectual content. JRH, DW, SJ and JM, contributed to the conceptualisation and design of the study, and critically reviewed and revised the manuscript for intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding This study was supported by Medical Research Council (MR/N024869/1).

  • Competing interests All authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years and no other relationships or activities that could appear to have influenced the submitted work. NM declares consultancy fees from Novartis in the past 3 years outside this study; the other authors have no other relationships or activities that could appear to have influenced the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval Approval was granted by both the UCL Research Ethics Committee (reference: 10175/001) and University of Leicester Research Ethics Committee (ref: 10225); UCL sponsored the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data are available subject to the EPICure Data Sharing Policy ( and will be available as part of the RECAP preterm Cohort Platform (

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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