Brain injury in the perinatal period and the risk of cerebral palsy, motor and cognitive impairment in children born extremely preterm.
Professor Neil Marlow, University College London
The incidence of preterm delivery is increasing and the survival rate of preterm children has risen steadily due to advances in obstetric and neonatal intensive care. Surviving children born extremely preterm are at high risk of long term developmental problems, including cerebral palsy, impairment in motor and cognitive function, visual and auditory deficits and behavioural problems. This can have serious implications for their quality of life and that of their family and carers. These children take up a disproportionate amount of neonatal intensive care unit resources and overall costs, and as they grow are more likely to require additional health care services beyond routine care to compensate for their functional limitations. The early identification and management of factors that mediate long term outcome is necessary to assist healthcare professionals in selecting appropriate treatment pathways, and to develop, target and evaluate interventions.
EPICure was one of the first and largest prospective, national, population-based cohort studies to identify and follow up a birth cohort of extremely preterm infants born <26 weeks of gestation. The purpose of the study was to describe the survival, health and development of these infants and monitor their course through childhood into adolescence. Born in 1995, 306 survivors were contacted for follow up at 1, 2.5, 6, 11, 16 and 19 years of age. Outcome data on growth and development, motor and cognitive function, and behaviour was collected at each visit. A second birth cohort of extremely preterm infants was recruited in 2006 (EPICure 2) and 1041 survivors born <27 weeks of gestation were followed-up at age 3 and age 11.
In a recent systematic review, there was strong evidence that brain injury during the perinatal period was predictive of developing cerebral palsy, but mixed evidence that it was prognostic for motor and cognitive impairment. The aims of this DPhil project include:
- Conducting a meta-analysis to quantify the strength of the association between different types and grade of perinatal brain injury and cerebral palsy.
Using data from the two EPICure cohorts, to investigate whether there are different developmental phenotypes associated with specific clusters of perinatal morbidities, and how these relate to observed perinatal brain injury. This section of the project will be further formulated and informed by the findings of the systematic review.
RESEARCH EXPERIENCE, RESEARCH METHODS AND TRAINING
The student will work within a large multidisciplinary team and will gain research experience in systematic review, study design, epidemiological and statistical methodology, programming, data analysis, scientific writing and dissemination of findings at scientific meetings. The project will be based in the Nuffield Department of Public Health in collaboration with University College London, both thriving and stimulating research environments with excellent facilities and world-class scientists.
field work, secondments, industry placements and training
The project will provide an extensive range of training opportunities through attending specific courses, meetings, seminars, workshops and conferences.
A higher degree in medicine, epidemiology, statistics or public health, or be willing to do the MSc in Global Health Science at Oxford. The project requires a high level of numeracy and requires previous experience in statistics and programming.