1. Bayley Assessment Results Analysis for Prematurely Born Babies Dr Chrisantha Halahakoon Lead – Long term follow up group By

2. Dr Chrisantha Halahakoon Objectives Purpose of the project Reasons for the follow up Inclusion Criteria Assessors and Assessments Results Conclusions /way forwards

3. Dr Chrisantha Halahakoon Why – Follow up Pre-terms are at a greater risk for developmental impairment Outcome is poorly predicted from the neonatal course Monitoring long term morbidity is an important function of neonatal care. Inform ethical debate regarding treatment of babies – Borderline viability

4. Dr Chrisantha Halahakoon Purpose/Reasons Health status at two years as a Perinatal outcome Quality control purposes Effect of the care on long term development ? Analysis to seek social differences such as deprivation Referrals to be done @ two years if subtle developmental problems are identified

5. Dr Chrisantha Halahakoon What do we know already Epicure-Trial @ 6 years  41% moderately to severe impaired group compared to classmates (-2SD)  31% have mild cognitive impairment (-1SD to -2SD) IQ is directly proportionate to gestational age Boys have a grater risk for impairment than girls At a greater risk for more subtle longer term deficits The above is mirrored often with developmental impairment@ 2 years.

6. Dr Chrisantha Halahakoon Inclusion Criteria Babies born in SSBCNN < 31 weeks or birth weight < 1250 gms. Assessors were trained for Bayley III

7. Dr Chrisantha Halahakoon About Bayley III Widely used standardised developmental test- Gold Std. Test mental (MDI) & psychomotor (PDI) development – aged 1- 42 months Consists of three administered scales  Cognitive scale  Language scale: Receptive & expressive  Motor scale: Fine & Gross Caregiver questionnaires

8. Dr Chrisantha Halahakoon About Bayley III ctd.. It has derived scores – Raw score – Scaled scores –Composite Scores –Confidence interval –Percentile rank –Developmental age equivalent –Growth scores Scaled Scores represent a child’s performance on a subset relative to his or her same- age peers

9. Dr Chrisantha Halahakoon Analysis Criteria Relation of Scaled Scores to standard deviations StdRange of ScoreState of Performance  -3SD: 1Severe Impairment  -2SD:2-4Moderate Impairment  -1SD:5-7 Mild Impairment  Mean & above8-19Good Good Validity and Reliability -3SD – Best @ predicting later Severe Disability & impaired IQ -3SD to -2SD should also be identified as an at risk group

10. Data corresponding to: New Borns Birth YearNos. 2005- 1 Babies 2006- 78 Babies 2007-100 Babies 2008-98 Babies 2009-122 Babies 2010-102 Babies 2011-2 Babies No Year5 Babies

11. Dr Chrisantha Halahakoon

14. Summary of Morbidity Data 11 Babies Gestation 21-25 Weeks of total 85 Babies with Morbidity IDGestationGenderBirth Year Birth Weight Hear Imp Hear Imp Unaid Hear Imp Aid TPNSpDiatGastro Sp Diet TextMalfor mation (Birth) Malf Impairs (Two Yrs) AntiCon vu FitsVp Shunt Resp Continu al Support Resp Ltd Exer Toler Treat BlindBlind No Corr Visual Prob 33921Wks 0 Days ??02009156000 000 000000 1 24723Wks 4 Days 200854000 000 0000010001 50023Wks 4 Days0200762000 000 1000000001 36023Wks 5 Days1201057200 000 0000000001 21924Wks 3 Days0200876000 000 0000000111 48824Wks 5 Days1200676000 001 Severe Gastro-oesophageal 0001000000 48525Wks Days0200664000 000 0000000 1 28125Wks 0 Days1200980000 000 0001000001 2525Wks 2 Days1200779000 0 1 Gastro oesophageal reflux - feeding difficulties 0000001001 40425Wks 4 Days1201055000 000 000 0001 20925Wks 4 Days0200894010 000 0 0 1 Total Number with Morbidity (% calculated for the Gestation Group) 1 (9.09%) 0002 (18.18) 1 (9.09%) 002 (18.18% 01 (9.09%) 10 (90.90%)

15. Dr Chrisantha Halahakoon Summary of Morbidity Data 20 Babies Gestation: 26-27 Weeks of total 85 Babies with Morbidity IDGestationGenderBirth Year Birth Weight Hear Imp Hear Imp Unaid Hear Imp Aid TPNSpDiatGastro Sp Diet TextMalfor mation (Birth) Malf Impairs (2Yrs) AntiCo nvu FitsVp Shunt Resp Continual Support Resp Ltd Exer Toler Treat BlindBlind No Corr Visual Prob 1226Wks Days1200678000 000 0000000001 29026Wks Days 2009110000 001 Lactose free 0000000000 35726Wks 0 Days1200997000 0 1 00000000 32826Wks 1 Days 200992011 000 0000000000 36126Wks 4 Days0201087000 000 0000000001 26426Wks 5 Days12009116000 000 0000100000 26026Wks 6 Days1200981010 100 0000000 7826Wks 6 Days1200794010 111 Paedisure overnight feeds 1100011000 5827Wks Days12007110000 000 0000000001 8827Wks Days0200753010 110 00000000 25827Wks 0 Days 200998000 000 1000000000 28327Wks 1 Days1200980000 000 00000001 32427Wks 2 Days 200970000 010 0000000000 11627Wks 4 Days12008121000 000 0000000001 42827Wks 4 Days0201090000 010 00000000 10927Wks 4 Days0200884000 001 Wheat free 0000000000 48627Wks 4 Days12006112000 001 Has Nissan Fundoplication for sliding hiatus hernia, has severe oesophagitis requiring oesophageal dilation 3-4 weekly 0000000000 32327Wks 5 Days 2009126000 000 0001001000 12427Wks 5 Days1200713201 100 0000000000 39527Wks 5 Days12010131000 011 paediasure plus fibre 0000010000 Total Number with Morbididy Total Number with Morbidity (% calculated for the Gestation Group) 5 (25%)1 (5%)4 (20%)5 (25%) 3 (15%)1 (5%)0 2 (10%) 005 (25%)

16. Dr Chrisantha Halahakoon Babies With Morbidity and CP IDGestationGenderBirthYearBirthWeightNeurological DiagNeuro Status Hear Imp Sp Diet Mal formation FitsVp Shu nt Resp Ltd Exer Tol Supp BlindBlind Not Corr Visual Prob Add. Of Morb % of Mob of 17 CP Babies 32929Wks 5 Days020101450Hemiplegia: Right sidedHe0000000011 26426Wks 5 Days120091160Hemiplegia: Left sidedHe (2)0000100001 48330Wks Days120061340Spastic bilateral: 2 limb involvementDi0000000112 13430Wks 3 Days120081470Spastic bilateral: 2 limb involvementDi0010000001 38728Wks 3 Days120101290Spastic bilateral: 2 limb involvementDi0000000011 35830Wks 6 Days120091540Spastic bilateral: 2 limb involvementDi0000010001 35228Wks 0 Days12009970Spastic bilateral: 2 limb involvementDi (5)1000000001 29530Wks 5 Days120091680Spastic bilateral: 3 limb involvementTr (1)0000000011 21924Wks 3 Days02008760Spastic bilateral: 4 limb involvementQu00000011131(5.88%) 46130Wks Days120061850Spastic bilateral: 4 limb involvementQu0100000012 29930Wks Days 20091650Spastic bilateral: 4 limb involvementQu0010000012 200Wks Days02008 Spastic bilateral: 4 limb involvementQu00 00 0 11 46629Wks Days020061460Spastic bilateral: 4 limb involvementQu0000000011 29129Wks 6 Days 20091380Spastic bilateral: 4 limb involvementQu0000100001 38928Wks 4 Days020101320Spastic bilateral: 4 limb involvementQu (8)001000000111(64.70%) 48824Wks 5 Days12006760Not classifiable?(1)01010000025(29.41%)

17. Dr Chrisantha Halahakoon Babies With CP but no Morbidity IDGestationGenderBirthYearBirthWeightNeurological DiagNeuro Status % of Babies in Each category out of13 Cases 50929Wks 4 Days120061510Hemiplegia: Right sided1_He 30526Wks 3 Days120101060Hemiplegia: Right sided1_He 33727Wks 4 Days020091090Hemiplegia: Right sided1_He 40327Wks 2 Days12010752Hemiplegia: Right sided1_He 39032Wks 1 Days120102460Hemiplegia: Left sided1_He 16727Wks Days120081060Hemiplegia: Left sided1_He 41324Wks Days02010500Hemiplegia: Left sided1_He7(53%) 6028Wks Days020071120Spastic bilateral: 2 limb involvement2_Di 49331Wks Days020061500Spastic bilateral: 2 limb involvement2_Di 41929Wks 6 Days120101488Spastic bilateral: 2 limb involvement2_Di 16530Wks 1 Days 20081500Spastic bilateral: 2 limb involvement2_Di4(31%) 3730Wks 2 Days020071440Spastic bilateral: 4 limb involvement4_Qu 43027Wks Days120101190Spastic bilateral: 4 limb involvement4_Qu2(15%)

18. Dr Chrisantha Halahakoon Progress in 2014 Parents and carers Questionnaire DNA Parents and carers Questionnaire Forming Links with Health Visitors

19. Good outcome in Majority Difficult to draw conclusion (Sample size) Data Quality issues (missing data/ Participation of all Hospitals)/Deaths Feedback for neonatologists Dr Chrisantha Halahakoon

20. Way Forwards 2014-2015 Implementation of Parent carer Questionnaires To obtain information from health Visitors

21. Dr Chrisantha Halahakoon