Third of NICU Graduates Fail School Readiness Tests

In the new year, researchers will begin their study of 1,000 babies admitted to such units across three hospitals in the east of England and follow their physical and mental health and educational outcomes until they are 16 years old. These hospitals include the Rosie Hospital in Cambridge, the Luton and Dunstable University Hospital, and Norfolk and Norwich University Hospital. Academics said there was not enough known about which children leaving intensive care units were most likely to miss milestones when they reached school, or the impact that everything from genetics to their postnatal environment played in this. One of the key parts of the study will analyse the results of the government’s school readiness assessment at the age of five. While one in six children fail this assessment, this rises to one in three for children previously admitted to an intensive care unit. School readiness is assessed by teachers at the end of reception based on observation and is called a “good level of development”. Readiness ranges from being able to dress and eat independently to being able to verbally count beyond 20 and write recognisable letters. Professor Catherine Aiken, who works in the department of obstetrics and gynaecology at the University of Cambridge and as an obstetrician for complex pregnancies, said: “This study has been led by the questions parents are asking, that we notice in our practice, that we don’t know the answers to. “There are always parents asking us to predict ‘will my baby be okay? Is this going to have a long-term outcome? What will it be like growing up?’ It’s really difficult as doctors and clinicians to not have those answers and to say ‘we don’t know and there is a range of outcomes’. “After such a big, difficult Nicu stay, it is really difficult for parents to go away and be untethered from support. They’re looking at this baby and wondering and none of us have any answers to give them. The impetus of this study comes from the idea that we should know more and we should be able to use all this information we have to find out what it means so we have the answers for parents about what they can do to help their child.” The team will look at everything from blood samples to genetic data searching for ‘biomarkers’ that might be used to identify those children at greatest risk and in need of educational support. Aiken said: “Not every child with a tricky start has a problem later on. 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. “What we don’t know is that nuanced detail of ‘what’s different about this kid who does fine and this kid who doesn’t do fine?’. “We know it’s going to be multifactorial. We know from our previous studies that you can’t explain it with genetics alone. We know that you can’t explain it with the degree of prematurity alone.” Aiken is the chief investigator of the babies’ longitudinal outcomes, ‘omics and milestones study (Blooms), which will be funded by a £4 million award from the Wellcome Trust. Professor David Rowitch, of the department of paediatrics at the University of Cambridge, and the principal investigator of Blooms, said learning issues for many children were not discovered until they started school. “Waiting until age five to find out about a problem is not ideal because it’s possible you’ve missed this window,” he said. “The premise of our study is that we can identify babies in the 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’.” The study will also speak to parents about their perceptions of their child’s time in intensive care units, their development and whether they felt their child was ready to go to school when they started. Sara Horrocks, a research scientist at the University of Cambridge, is the mother of identical twin girls, Evie and Annabel, who spent a month in an intensive care unit nine years ago. She will sit on a panel to advise the Blooms project on, for example, at what stage new parents in the unit may want to be told that their child is at a higher risk of learning challenges. She said: “The girls have struggled a bit with maths at school and we have recently got them a maths tutor. Their older brother was born on time and is academically excellent. “It’s difficult for me to say how much of it is natural variation or because they were premature or in a Nicu. It would have been a great help to know there was additional support to help assess if they needed extra help at school. We didn’t have anything.”