Objectives To evaluate maternal, infant and transport factors associated with intraventricular haemorrhage (IVH) in outborn preterm infants <32 weeks’ gestation in Western Australia.Design Retrospective cohort study.Setting Newborn emergency transport service of Western Australia (NETS WA).Participants Preterm infants <32 weeks’ gestation born outside the tertiary perinatal centre and transported by NETS WA between 2011 and 2021. Exclusions were congenital anomalies, transfer after day 1 of life or death before day 1 cranial ultrasound.Outcomes Outcome was any IVH detected on cranial ultrasound on day 1 and day 7 of life. Perinatal data were analysed comparing infants with and without IVH using bivariate tests and logistic regression to examine differences between these groups.Results IVH occurred in 57/286 (19.9%) on day 1 and 53/275 (19.9%) on day 7; severe IVH occurred in 25/286 (8.7%) and 27/275 (9.9%), respectively. Infants with IVH had lower gestational age and birth weight, greater exposure to intra-amniotic inflammation and less antenatal steroid exposure. In multivariable analyses, intra-amniotic inflammation was associated with increased odds of IVH on day 1 (OR 2.47, 95% CI 1.10 to 5.44). Epinephrine use during resuscitation was associated with higher odds of IVH on day 1 (OR 4.88, 95% CI 1.49 to 17.5). Inotrope use during transport was associated with IVH on day 1 (OR 7.85, 95% CI 1.35 to 54.6) and day 7 (OR 9.11, 95% CI 1.32 to 72.9). Continuous positive airway pressure during transport was associated with lower odds of IVH on day 1 (OR 0.32, 95% CI 0.10 to 0.88). Transport mode, duration and timing intervals were not associated with IVH.Conclusions In outborn preterm infants <32 weeks’ gestation, IVH risk was more strongly associated with perinatal factors than transport characteristics. Collaboration across perinatal networks should aim to support optimal management during preterm labour birth.

OBJECTIVES:To evaluate maternal, infant and transport factors associated with intraventricular haemorrhage (IVH) in outborn preterm infants <32 weeks' gestation in Western Australia. DESIGN:Retrospective cohort study. SETTING:Newborn emergency transport service of Western Australia (NETS WA). PARTICIPANTS:Preterm infants <32 weeks' gestation born outside the tertiary perinatal centre and transported by NETS WA between 2011 and 2021. Exclusions were congenital anomalies, transfer after day 1 of life or death before day 1 cranial ultrasound. OUTCOMES:Outcome was any IVH detected on cranial ultrasound on day 1 and day 7 of life. Perinatal data were analysed comparing infants with and without IVH using bivariate tests and logistic regression to examine differences between these groups. RESULTS:IVH occurred in 57/286 (19.9%) on day 1 and 53/275 (19.9%) on day 7; severe IVH occurred in 25/286 (8.7%) and 27/275 (9.9%), respectively. Infants with IVH had lower gestational age and birth weight, greater exposure to intra-amniotic inflammation and less antenatal steroid exposure. In multivariable analyses, intra-amniotic inflammation was associated with increased odds of IVH on day 1 (OR 2.47, 95% CI 1.10 to 5.44). Epinephrine use during resuscitation was associated with higher odds of IVH on day 1 (OR 4.88, 95% CI 1.49 to 17.5). Inotrope use during transport was associated with IVH on day 1 (OR 7.85, 95% CI 1.35 to 54.6) and day 7 (OR 9.11, 95% CI 1.32 to 72.9). Continuous positive airway pressure during transport was associated with lower odds of IVH on day 1 (OR 0.32, 95% CI 0.10 to 0.88). Transport mode, duration and timing intervals were not associated with IVH. CONCLUSIONS:In outborn preterm infants <32 weeks' gestation, IVH risk was more strongly associated with perinatal factors than transport characteristics. Collaboration across perinatal networks should aim to support optimal management during preterm labour birth.

BACKGROUND:Very preterm infants miss the peak in-utero supply of omega-3 docosahexaenoic acid (DHA) and omega-6 arachidonic acid (AA), and are thought to receive low amounts after birth. METHODS:In a randomized controlled trial of 1077 babies born <29 weeks' gestation we assessed the DHA and AA concentrations in whole blood before and after (36 weeks' post menstrual age, PMA) enteral emulsion intervention with 60 mg/kg/d of DHA compared with no DHA soy oil. RESULTS:Prior to the intervention, all infants had similar mean DHA (2.8% of total fatty acids) and mean AA (intervention 10.45%; control 10.42%) concentrations. By 36 weeks', mean DHA of intervention group infants increased to 3.86%, while it decreased to 2.53% in the control group (mean difference 1.33%, 95% CI 1.27 to 1.40, p < 0.0001). AA was lower at 36 weeks' than at enrolment, with the decrease marginally more pronounced in the intervention group (8.11%) compared with the control group (8.84%, mean difference -0.71%, 95% CI -0.86 to -0.57, p < 0.0001). CONCLUSION:All fatty acids regressed towards a new diet-dependent mean at 36 weeks regardless of the initial level. DHA supplementation successfully prevented the typical decline in DHA and modestly exacerbated the decline in AA. TRIAL REGISTRATION:The N3RO Trial is registered at the Australian New Zealand Clinical Trial Registry as ACTRN12612000503820 (anzctr.org.au), 9 May 2012. IMPACT:High-dose DHA supplementation in preterm infants prevents the typical postnatal decline in DHA. This study provides evidence from over 1000 infants across Australia, New Zealand, and Singapore. The findings have direct implications for optimizing neonatal nutrition in very preterm populations.

BACKGROUND:Concentrations of the long-chain polyunsaturated fatty acids, in particular, the ω-3 (n-3) fatty acid DHA and the ω-6 fatty acid arachidonic acid (AA), decrease in infant blood during the first days after very preterm birth. OBJECTIVES:This study aimed to explore factors associated with blood DHA and AA concentrations of very preterm infants receiving standard care, in the days following birth. METHODS:We examined the fatty acid composition of whole blood samples collected on cards at 0-6 d after birth, from a cross-sectional study of 1174 infants born <29 weeks of gestation in Australia, New Zealand, and Singapore. RESULTS:Considerable variation was observed in the proportions of blood AA (1.4%-18.0%) and DHA (0.4%-5.7%) concentrations. Infant blood DHA status was not associated with gestational age at birth, but AA was lower by 0.11% for each week of gestation (95% CI: -0.07%, 0.15%). There was an inverse relationship between age of sampling after birth and DHA (0.07% lower per day; 95% CI: 0.04%, 0.09%) and AA (0.09% lower; 95% CI: 0.04%, 0.14%). A concomitant positive relationship was observed between days after birth and the fatty acids present in the intravenous lipid emulsion administered: ω-6 linoleic acid (range: 2.1%-35.1%) and ω-9 oleic acid (range: 12.2%-52.9%). CONCLUSIONS:Preterm infants whose blood was sampled later after birth have lower DHA and AA status relative to those sampled earlier after birth; samples taken at later timepoints are concurrently higher in the fatty acids of linoleic acid and oleic acid, which are the major compositional components of intravenous lipid emulsions routinely administered to preterm infants. The results support calls to develop intravenous feeds closely matching the fatty acid composition of infant blood at birth. The N3RO Trial is registered at the Australian New Zealand Clinical Trial Registry as ACTRN12612000503820 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000503820).

BackgroundIncreasingly, preterm-born children are entering adulthood as survival at earlier gestational ages improves. However, there is little understanding of the lived experience in preterm-born adults.MethodsA cross-sectional descriptive study was conducted including young adults from a regional birth cohort of infants born <33 weeks in Western Australia. Participants provided written reflections of their experiences growing up and included messages for future families experiencing preterm birth. Content analysis was conducted according to SRQR (Standards for Reporting Qualitative Research) guidelines. Ethics approval was granted by the Women and Newborn Health Service Ethics Committee.ResultsForty-one adults reflected on their life experiences, and 31 included messages for future families. Two predominant themes were (1) neonatal experiences and (2) experiences from childhood and adulthood which were divided into ‘positive’ and ‘negative’ subthemes. Participants made 44 references to the neonatal period: 31 (70.5%) ‘challenging’ including sickness (17, 54.8%), uncertainty (10, 32.3%), family separation (4, 12.9%); and 13 (29.5%) ‘positive’ including survival (6, 46.2%), support (5, 38.5%), strength (2, 15.4%). Childhood and adulthood was described as ‘positive’ in 119 (73.5%) references including a good life (41, 33.3%), supportive family (20, 16.3%), success (18, 14.6%), strength (18, 14.6%), gratitude (15, 12.2%), positive self-talk (7, 5.7%); and ‘negative’ in 43 (26.5%) including health challenges (19, 44.2%), school difficulties (10, 23.3%), family difficulties (9, 20.9%). Messages for future families included what to expect (56, 75.7%) and helpful advice (18, 24.3%).ConclusionOur preterm-born young adults predominantly describe positive life experiences of childhood and adulthood balanced with an awareness of particular challenges.

INTRODUCTION:Preterm birth is associated with a 3.3-fold increased likelihood of autism diagnosis, with lower gestational age conferring higher likelihood. In Australia, autism is typically diagnosed at around age four, potentially missing the optimal neuroplasticity window before age two. The Social Attention and Communication Surveillance-Revised (SACS-R) tool identifies early autism signs in children aged 11-30 months, enabling pre-emptive intervention. AIMS:This quality improvement (QI) study assessed the acceptability, and feasibility of SACS-R for early detection of autism traits in 12-month-old infants born very preterm/VP (gestation < 32 weeks), from both caregiver and clinician perspectives. METHODS:From September 2024 to February 2025, 47 VP infants attending the 12-month Neonatal Follow-up Clinic (NNFU) at King Edward Memorial Hospital (KEMH), Western Australia, were assessed using SACS-R. Caregivers completed acceptability and feasibility questionnaires; clinicians completed similar surveys. Forty-seven infants met inclusion criteria; 12 clinicians provided responses. RESULTS:Of 47 infants, 4 (8.5%) were identified as having a high likelihood of autism and referred for early intervention. Among caregivers, 29 (61%) provided complete acceptability responses and 28 (59%) feasibility responses, both predominantly positive. Clinicians reported high satisfaction (83%) and ease of use (91%), with 74% supporting routine implementation. Concerns included parental understanding and overlap with other assessments. CONCLUSIONS:Our QI study indicates that the SACS-R is highly acceptable and feasible in neonatal follow-up for preterm infants. Larger-scale evaluation of diagnostic accuracy and practical refinements based on feedback are warranted to support routine integration in early surveillance programs.

IntroductionAround the world, rates of induction of labour (IOL) among nulliparous mothers have increased in the last 10 years. In Australia, rates have increased over the last decade by 43%, from 32% to 46%. There is growing concern about the rapid rise in IOL before 41 weeks for nulliparous women without medical complications because of the associated increased rates of caesarean section, reduced satisfaction with birth, and birth trauma. Melatonin potentiates the action of oxytocin and may promote the spontaneous onset of labour; therefore, we will test the hypothesis that exogenous melatonin supplementation in late pregnancy will reduce the rate of labour induction by 30% or more.Methods and analysesThis is a double-blind, randomised, placebo-controlled trial in nulliparous pregnant women to reduce IOL rates. We will randomise 530 women to receive either 3 mg oral melatonin or placebo daily from 39+0weeks’ gestation until they give birth. The primary endpoint will be IOL rate after 39 weeks post enrolment. Secondary endpoints will include the following: interval between administration of trial medication and birth; a range of maternal and neonatal outcomes, including birth outcomes; breastfeeding on discharge, at 10 days and at 2 months; maternal satisfaction; child developmental outcomes at 2 months of age; and cost-effectiveness of melatonin compared with standard care. All data will be analysed by intention to treat.Ethics and disseminationThe study is approved by the Western Australia Health Central Human Research Ethics Committee (RGS0000006283). Trial findings will be disseminated through conference presentations and peer-reviewed publications.Trial registration numberThe trial has been prospectively registered on the Australian New Zealand Clinical Trials Registry as ACTRN12623000502639 on 17/05/2023.

ObjectiveTo compare unintended events in transfers performed by neonatal specialist (NS) and non-neonatal specialist (NNS) teams in Western Australia (WA).Study designRetrospective comparison of neonatal transfers from the Kimberley and Pilbara regions (WA) to tertiary services, King Edward Memorial (perinatal) and Perth Children’s Hospital NICU, in Perth (state capital, distance up to 2200km) between January 2018 - June 2021. NS teams travelled from the tertiary to the referring center and back. NNS travelled from the referring to the tertiary center. Transport time, team composition, total unintended clinical and endotracheal tube (ETT) events were compared. Categorial data are expressed as numbers (%) and compared by chi-squared test; continuous data are expressed as median (interquartile range) and compared by Mann-Whitney U test.ResultsDuring the study period, 3,709 infants were transported in WA to tertiary services for escalation of care: 119/3709 (3.2%) from the Kimberley and Pilbara, 49 with NS and 70 with NNS teams. NNS had shorter transport times than NS teams (508(433 – 610) vs 675(610 – 735) min; p<0.0001). Neonatal nurses were on NS more than NNS teams (36/49(73.5%) vs 6/70(8.6%); RR 5.08 95% CI (3.13 to 8.56), p<0.001). Total unintended clinical and ETT events were less in NS vs. NSS teams (28/49(57%) vs. 54/70(77%); RR 0.66 95%CI (0.40 to 0.92), p=0.03) and (0/26(0%) vs. 7/23(30%); p=0.004).ConclusionAlthough NS teams had longer transport times there were fewer unintended clinical and ETT events. NS teams should be considered as the first choice to undertake neonatal transport.

Importance:Children born at less than 29 weeks' gestation are at risk of behavioral difficulties. This may be due in part to the lack of transplacental supply of docosahexaenoic acid (DHA), a key fatty acid with structural and functional roles in the brain. Objective:To determine whether meeting the neonatal DHA requirement through supplementation is associated with improved behavioral functioning of children born at less than 29 weeks' gestation. Design, Setting and Participants:This was a follow-up of children from 10 Australian participating centers in a multi-center, blinded, parallel group randomized clinical trial of infants born at less than 29 weeks' gestation conducted from June 2012 and September 2015, excluding those with additional fatty acid supplementation or major congenital or chromosomal abnormalities. Follow-up took place from August 2018 to May 2021. Parents of surviving children who had not withdrawn from the original trial were invited to complete questionnaires when the child turned 5 years' corrected age. Interventions:Infants were randomized to receive daily enteral emulsions providing 60 mg/kg/d of DHA or a soy-oil emulsion (with no DHA) from within the first 3 days of enteral feeding until 36 weeks' postmenstrual age or discharge home, whichever occurred first. Main Outcomes and Measures:The primary outcome of this follow-up was parent-rated behavior and emotional functioning as indicated by the Total Difficulties score of the Strengths and Difficulties Questionnaire. Parents also completed questionnaires about their child's behavioral manifestations of executive functioning, as well as a range of health outcomes to assess potential longer-term side effects of DHA intervention. Results:Primary outcome data were available for 731 children (76% of 958 surviving eligible children; 361 in the intervention group and 370 in the control group). Of these 731, 452 (47%) were female, and the mean (SD) corrected age at follow-up was 5.4 (0.5) years. Following imputation for missing data, the mean Total Difficulties score was the same in both groups (intervention group, n = 465; mean [SD], 11.8 [6.3]; control group, n = 493; mean [SD], 11.8 [6.0]; mean difference adjusted for sex, gestational age stratum, and hospital, 0.01; 95% CI, -0.87 to 0.89; P = .98). There was no evidence for differences between the groups in any secondary outcomes of behavior, executive functioning, or health. Conclusions and Relevance:In this follow-up of a randomized clinical trial, enteral DHA supplementation at the equivalent of the estimated in utero dose for infants born at less than 29 weeks' gestation did not improve behavioral functioning at age 5 years. There were no indications of adverse effects with DHA supplementation. Trial Registration:Australian New Zealand Clinical Trial Registry: ACTRN12612000503820.

In this follow-up at 2.5 years of children from the STRIDER NZAus Trial (N = 112), in which women with singleton pregnancies affected by severe early fetal growth restriction were randomized to sildenafil citrate 75 mg daily or placebo until 32 weeks, there was no difference between groups in survival without neurosensory impairment, defined as any of cerebral palsy, deafness, blindness, cognitive delay (Bayley III cognition or language score >1 SD below mean) or motor delay: 30/56[54%] vs. 34/56[61%]; aOR = 0.74, 95%CI: 0.31, 1.77. However, children exposed to sildenafil appeared to be more likely to have cognitive delay (13/45[29%] vs. 4/40[10%]; aOR = 3.71, 95% CI: 1.01, 13.63) but less likely to have emotional-behavioural difficulties (2/43[5%] vs. 8/38[21%]; aOR = 0.19, 95%CI: 0.03, 1.00). Conclusion: maternal sildenafil treatment for severe early-onset FGR was not associated with altered survival free of neurosensory impairment at 2.5 years’ corrected age.

Objective We compared mortality and morbidity of inborn versus outborn very preterm infants <32 weeks’ gestation in Western Australia (WA) between 2005 and 2018. Design Retrospective cohort study. Patients Infants <32 weeks’ gestation who were born in WA. Main outcome measures Mortality was assessed as death before discharge home from the tertiary neonatal intensive care unit. Short-term morbidities included combined brain injury (intracranial haemorrhage grade ≥3 and cystic periventricular leukomalacia) and other major neonatal outcomes. Developmental assessments at age 2, 3 and 5 years were evaluated. We performed multivariable logistic regression analysis of outborn status on outcomes, controlling for gestational age, birth weight z-score, sex and multiple birth. Results A total of 4974 infants were born in WA between 22 and 32 weeks’ gestation between 2005 and 2018 of which 4237 (89.6%) were inborn and 443 (10.4%) were outborn. Overall mortality to discharge was higher in outborn infants (20.5% (91/443) vs 7.4% (314/4237); adjusted OR (aOR) 2.44, 95% CI 1.60 to 3.70, p<0.001). Outborn infants had higher rates of combined brain injury than those inborn (10.7% (41/384) vs 6.0% (246/4115); aOR 1.98, 95% CI 1.37 to 2.86), p<0.001). No difference in up to 5-year developmental measures was detected. Follow-up data were available for 65% of outborn and 79% of inborn infants. Conclusions Outborn preterm infants <32 weeks in WA had increased odds of mortality and combined brain injury than those inborn. Developmental outcomes up to 5 years were similar between groups. Loss to follow-up may have impacted the long-term comparison.

BACKGROUND:Having a preterm (<37 weeks' gestation) birth may increase a woman's risk of early mortality. Aboriginal and Torres Strait Islander (hereafter Aboriginal) women have higher preterm birth and mortality rates compared with other Australian women.OBJECTIVES:We investigated whether a history of having a preterm birth was associated with early mortality in women and whether these associations differed by Aboriginal status.METHODS:This retrospective cohort study used population-based perinatal records of women who had a singleton birth between 1980 and 2015 in Western Australia linked to Death Registry data until June 2018. The primary and secondary outcomes were all-cause and cause-specific mortality respectively. After stratification by Aboriginal status, rate differences were calculated, and Cox proportional hazard regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cause-specific mortality.RESULTS:There were 20,244 Aboriginal mothers (1349 deaths) and 457,357 non-Aboriginal mothers (7646 deaths) with 8.6 million person-years of follow-up. The all-cause mortality rates for Aboriginal mothers who had preterm births and term births were 529.5 and 344.0 (rate difference 185.5, 95% CI 135.5, 238.5) per 100,000 person-years respectively. Among non-Aboriginal mothers, the corresponding figures were 125.5 and 88.6 (rate difference 37.0, 95% CI 29.4, 44.9) per 100,000 person-years. The HR for all-cause mortality for Aboriginal and non-Aboriginal mothers associated with preterm birth were 1.48 (95% CI 1.32, 1.66) and 1.35 (95% CI 1.26, 1.44), respectively, compared with term birth. Compared with mothers who had term births, mothers of preterm births had higher relative risks of mortality from diabetes, cardiovascular, digestive and external causes.CONCLUSIONS:Both Aboriginal and non-Aboriginal women who had a preterm birth had a moderately increased risk of mortality up to 38 years after the birth, reinforcing the importance of primary prevention and ongoing screening.

BACKGROUND:Childhood outcomes following preterm birth are widely published, however long-term adult outcomes are less well described. We aimed to determine the quality of life and burden of co-morbidities experienced by preterm-born young adults in Western Australia. METHODS:A retrospective observational study was conducted. Participants born at 23-33 weeks gestation cared for at King Edward Memorial Hospital during 1990 and 1991 were recruited from a historical birth cohort. Participants completed general, medical and reproductive health questionnaires. Results were compared with contemporaneous cohort data and/or population statistics. RESULTS:Questionnaires were received from 73 young adults aged 28 to 30 years. The majority of respondents completed high school (94.5 %), were employed fulltime (74.0 %) and had close friends and family relationships. Almost all the participants considered their health to be good (94.0 %) and participated in light exercise (90.0 %). Increased hypertension, hypercholesterolaemia, asthma, neuropsychiatric conditions and visual impairment were reported. Depression Anxiety and Stress Scale (DASS-21) scoring identified increased mild anxiety. Increased consultation with healthcare workers and use of prescription medications were reported. CONCLUSION:The group of preterm-born adults surveyed reported a good quality of life, supportive interpersonal relationships and they provided significant contributions to society. They did report increased medical and psychological conditions than the general population.

Importance High-dose omega-3 docosahexaenoic acid (DHA) supplementation of children born at less than 29 weeks’ gestation has been shown to improve IQ despite increasing the risk of bronchopulmonary dysplasia (BPD). Given that BPD is associated with poorer cognitive outcomes, it is unclear whether the increased risk of BPD with DHA supplementation is associated with decreased benefit to IQ. Objective To investigate whether the increased risk of BPD with DHA supplementation was associated with diminished IQ benefit. Design, Setting, and Participants This cohort study used data collected from a multicenter, blinded, randomized controlled trial of DHA supplementation in children born at less than 29 weeks’ gestation. Participants were recruited from 2012 to 2015 and followed up until 5 years’ corrected age. Data were analyzed from November 2022 to February 2023. Interventions Enteral DHA emulsion (60 mg/kg/d, to match the estimated in-utero requirement) or a control emulsion from the first 3 days of enteral feeds until 36 weeks’ postmenstrual age or discharge home. Main Outcomes and Measures Physiological BPD was assessed at 36 weeks’ postmenstrual age. IQ was assessed at 5 years’ corrected age using the Wechsler Preschool and Primary Scale of Intelligence, 4th Edition ; children from the 5 highest-recruiting Australian hospitals were assessed. The total effect of DHA supplementation on IQ was divided into direct and indirect effects using mediation analysis, with BPD as the presumed mediating variable. Results Among 656 surviving children from hospitals involved in IQ follow-up (mean [SD] gestational age at birth, 26.8 [1.4] weeks; 346 males [52.7%]), there were 323 children with DHA supplementation and 333 children in the control group. Mean IQ was 3.45 points (95% CI, 0.38 to 6.53 points) higher in the DHA group than the control group, despite an increase in the risk of BPD (160 children [49.7%] vs 143 children [42.8%] with BPD). The indirect effect of DHA on IQ via BPD was not statistically significant (−0.17 points; 95% CI, −0.62 to 0.13 points), with most of the effect of DHA on IQ occurring independently of BPD (direct effect = 3.62 points; 95% CI, 0.55 to 6.81 points). Conclusions and Relevance This study found that associations of DHA with BPD and IQ were largely independent. This finding suggests that if clinicians supplement children born preterm with high-dose DHA, any resulting increase in BPD risk would not be associated with meaningful reductions in the IQ benefit.

Background and aim: Extremely preterm (EP) infant survival has significantly improved with advanced neonatal care; however outcomes of infants born with birth weight (BW) <500 g remain poor. We aimed to review outcomes of this cohort in our institution. Methods: Retrospective study of all inborn preterm infants born at >22 weeks gestational age (GA) and weighing <500 g between January 2001-December 2017. Outcomes included short-term morbidity, mortality, neurodevelopmental impairment and growth up to five years of age. Results: Of a total 438 eligible infants, 92 livebirths were admitted to intensive care [median (range) GA: 24 (22-30) weeks; median (IQR) BW: 427.5 (380-499) grams]. Majority [78/92 (84.7%)] were small for gestational age (SGA). In 50% of non-survivors, median (IQR) age of death was 3.5 (1-17.5) days with no late deaths. Medical morbidities were common. Follow-up, including standardised cognitive assessments, was available for 41/46 (89%) infants. At a median age of 5.06 years, 17/41 (41.5%) had moderate-severe disability; non statistically higher in SGA compared to appropriate for gestational age/AGA (48.6% vs. 33.3%) group. Cerebral palsy (4/41; 10%), deafness needing amplification (1/41; 2.4%) were noted. Weight (32/41, 78%) and height (27/41, 66%) of most children remained at >2 SD below normal. Conclusions: In a cohort of preterm infants weighing <500 g at birth, 50% survived after admission to intensive care. Medical morbidities were common and 54% were free from moderate to severe disability at five years. SGA infants had higher rates (48.6%) of moderate to severe disability. Ongoing suboptimal growth in childhood is common.

BACKGROUND:Docosahexaenoic acid (DHA) is a component of neural tissue. Because its accretion into the brain is greatest during the final trimester of pregnancy, infants born before 29 weeks' gestation do not receive the normal supply of DHA. The effect of this deficiency on subsequent cognitive development is not well understood.METHODS:We assessed general intelligence at 5 years in children who had been enrolled in a trial of neonatal DHA supplementation to prevent bronchopulmonary dysplasia. In the previous trial, infants born before 29 weeks' gestation had been randomly assigned in a 1:1 ratio to receive an enteral emulsion that provided 60 mg of DHA per kilogram of body weight per day or a control emulsion from the first 3 days of enteral feeds until 36 weeks of postmenstrual age or discharge home, whichever occurred first. Children from 5 of the 13 centers in the original trial were invited to undergo assessment with the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) at 5 years of corrected age. The primary outcome was the full-scale intelligence quotient (FSIQ) score. Secondary outcomes included the components of WPPSI.RESULTS:A total of 1273 infants underwent randomization in the original trial; of the 656 surviving children who had undergone randomization at the centers included in this follow-up study, 480 (73%) had an FSIQ score available - 241 in the DHA group and 239 in the control group. After imputation of missing data, the mean (±SD) FSIQ scores were 95.4±17.3 in the DHA group and 91.9±19.1 in the control group (adjusted difference, 3.45; 95% confidence interval, 0.38 to 6.53; P = 0.03). The results for secondary outcomes generally did not support that obtained for the primary outcome. Adverse events were similar in the two groups.CONCLUSIONS:In infants born before 29 weeks' gestation who had been enrolled in a trial to assess the effect of DHA supplementation on bronchopulmonary dysplasia, the use of an enteral DHA emulsion until 36 weeks of postmenstrual age was associated with modestly higher FSIQ scores at 5 years of age than control feeding. (Funded by the Australian National Health and Medical Research Council and Nu-Mega Ingredients; N3RO Australian New Zealand Clinical Trials Registry number, ACTRN12612000503820.).

AIM:To assess knowledge of our neonatal intensive care unit clinical staff regarding preterm neurodevelopmental outcomes using the 33-item Preterm Birth Knowledge Scale (PB-KS). METHODS:An anonymous convenience sampling survey of clinical staff in the Neonatal Directorate was conducted between July and December 2019. PB-KS, demographic information and prior staff education on long-term outcomes in very preterm infants were collected. RESULTS:There were 56 responses (five neonatologists, eight paediatric trainees, 41 neonatal nurses and two allied health staff). Responses were scored as correct or incorrect. The mean score on the PB-KS was 19.5 (range: 4-29 out of 40) with 50% correct answers. Accuracy was highest (96%) for rates of cerebral palsy and lowest (11%) for estimation of quality of life among preterm survivors. Staff reported training in long-term outcomes of preterm infants through attending a conference/seminar (20%) or a combination of formal training and seminars (41.1%). Over half of our clinical staff reported a lack of formal training. Formally trained clinical staff scored significantly better in this survey. Didactic seminars were indicated as preferred choice for staff education. CONCLUSIONS:Results of our survey will assist in developing a customised educational programme to address identified gaps in the knowledge of clinical staff as our survey also showed significantly better scores among staff who were formally trained about long-term outcomes in very preterm infants. Staff responses indicated that knowledge on long-term outcomes was variable but more accurate with regard to more severe disabilities and shorter-term developmental outcomes.

INTRODUCTION:The current diagnostic pathways for cognitive impairment rarely identify babies at risk before 2 years of age. Very early detection and timely targeted intervention has potential to improve outcomes for these children and support them to reach their full life potential. Early Moves aims to identify early biomarkers, including general movements (GMs), for babies at risk of cognitive impairment, allowing early intervention within critical developmental windows to enable these children to have the best possible start to life.METHOD AND ANALYSIS:Early Moves is a double-masked prospective cohort study that will recruit 3000 term and preterm babies from a secondary care setting. Early Moves will determine the diagnostic value of abnormal GMs (at writhing and fidgety age) for mild, moderate and severe cognitive delay at 2 years measured by the Bayley-4. Parents will use the Baby Moves smartphone application to video their babies' GMs. Trained GMs assessors will be masked to any risk factors and assessors of the primary outcome will be masked to the GMs result. Automated scoring of GMs will be developed through applying machine-based learning to the data and the predictive value for an abnormal GM will be investigated. Screening algorithms for identification of children at risk of cognitive impairment, using the GM assessment (GMA), and routinely collected social and environmental profile data will be developed to allow more accurate prediction of cognitive outcome at 2 years. A cost evaluation for GMA implementation in preparation for national implementation will be undertaken including exploring the relationship between cognitive status and healthcare utilisation, medical costs, health-related quality of life and caregiver burden.ETHICS AND DISSEMINATION:Ethics approval has been granted by the Medical Research Ethics Committee of Joondalup Health Services and the Health Service Human Research Ethics Committee (1902) of Curtin University (HRE2019-0739).TRIAL REGISTRATION NUMBER:ACTRN12619001422112.