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EPICure: population-based studies of survival and later health status of infants of 25 weeks gestation or less

Document type: Projects: In progress/completed
Document language: English
Uploaded By: Allan Colver (allancolver)
Date Uploaded: 2012/01/12 13:35:31.892 GMT+1
URL to a webpage or document based online:

Basic Information

Authors: Professor N Marlow, University College London UCL
Published on Date: 2005
Funding source project: Medical Research Council (MRC)

Birth at borderline viability (25 weeks gestation or less) poses great clinical and ethical challenges. Death and disability after premature birth become more common at low gestations. Clinical decisions around the time of birth need to be based on reliable contemporary evidence from an appropriate population. The EPICure study apart, there is a paucity of data concerning the long term consequences for babies born at borderline viability.

The EPICure Study recruited a cohort of 308 surviving children from 1289 livebirths before 26 weeks gestation in 1995 across the whole of the UK and Ireland. Impairment-free survival is low, particularly at lower gestational ages. Over 40% have serious cognitive impairment and many outcomes are related to low IQ suggesting underlying global cerebral dysfunction. The baby?s early condition and the use of ante-natal steroids are important predictors of outcome but we have no other data to assess whether outcome is independent of, or is influenced by, staff attitudes or other medical interventions at that time. Although survival may have risen since 1995 but there is no information concerning the risk of disability.

This application comprises five studies involving the established cohort at 10 years, to study the developing pattern of health problems, focussed on their psychological, psychiatric and respiratory status, and also the recruitment, in 2006, of a new cohort including births at 26 weeks that will provide new data to understand the importance of factors around the time of birth and of the pattern of service delivery on outcomes. Taking advantage of new methods of assessing lung function, we will study a sub-set to the age of 21 months to elucidate mechanisms underlying developing lung pathology and we will study the whole population at 2.5 years to identify changes in outcome since 1995. We believe this will confirm static disability rates in survivors and validate the relevance to contemporary practice of following the 1995 cohort into adult life.

The proposal brings together senior staff from 4 academic institutions (Nottingham and Leicester Universities, the Institute of Child Health and Queen Mary, University of London), all with experience and expertise in the study area and with established strong academic links. The results of this programme of work will provide internationally unique epidemiological, clinical and physiological data with which to understand the context of disability at borderline viability and to underpin an area of practice of great public interest.

Riche Classification

Demography: All , 1-4 years , 10-14 years , Gestation: , Conception ,
Child Related Topics: Health care involving children ,
Health issues, determinants and measures: Indicators of disability and need , Family planning; Reproductive Health and Childbirth , Disabilities , Births (live and still) , Pregnancy ,
Languages and Geographical Perspective: Ireland , United Kingdom , English ,
Study type / scale / state of progress / setting: Cohort incidence study , Longitudinal study - cohort, trend, panel , Health care facility , Ongoing ,