Children admitted to a neonatal intensive care unit as babies are more than twice as likely to fail their school readiness assessment at age five, with consequences that last into adulthood. A new Cambridge-led study will explore why this happens and how to change it.
Of more that 600,000 babies born in the UK each year, around one in 10 may spend time in a neonatal intensive care unit (NICU).
In the UK, all children aged 5 undergo the school readiness assessment, which covers key skills including behaviour, communication, the ability to follow instructions and to perform daily physical tasks like tying shoe laces. It is used to evaluate a child's readiness to begin formal education.
Around one in six children currently fail the assessment but, Cambridge research shows that, for children that spent time in a NICU as a baby, this doubles to around one in three.
The new study, is one of the first to look at how health impacts school readiness.
Called BLOOMS (Babies’ Longitudinal Outcomes, Omics and Milestones Study), the study aims to predict which babies in NICU are most likely to need additional help to prepare them for school, and to understand how that support could be provided.
BLOOMS is led by Professor Catherine Aiken, an honorary consultant in maternal and fetal medicine at Cambridge University Hospitals NHS Foundation Trust (CUH) and academic clinical lecturer in the Department of Obstetrics and Gynaecology, University of Cambridge.
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.
If we could better identify which children are going to need help to meet their potential earlier on then there are support interventions that can be put in place when they are very young to get them to a place where they're ready to learn by the time they go to school.
Professor Catherine Aiken, honorary consultant in maternal and fetal medicine at CUH and Chief Investigator for the BLOOMS study
The BLOOMS study aims to recruit 1,000 babies in the East of England. The team hope to follow their development for many years from their time in NICU possibly through to the end of compulsory education at age 16.
A range of tools, including genome sequencing, will be used to study how early life shapes future development. This will allow the team to spot early warning signs, which can be used to identify children that could benefit from extra support.
Support could be provided through existing initiatives such as the Sure Star programmes, and the UK Department of Education has already taken an interest in the research and how it could help provide the right support to the children that need it.
“There's lots that can be done if we know which children will need the extra support,” says Professor Aiken, “but if we don't know who they are, then we're just waiting for problems to happen. [BLOOMS will allow] a proactive approach to make sure that every child has the opportunity to fulfil their potential and to be as ready to learn as they can.”
[School readiness] is one of the most important outcomes that we can focus on because it packs so much in about a child’s later trajectory across the life course.
Waiting until age five to find out about a problem is not ideal because it’s possible you've missed this window. The premise of our study is that we can identify babies in NICU during an actionable time frame.
David Rowitch, Professor of Paediatrics at the University of Cambridge
Professor David Rowitch, who is also involved in the study, says that early intervention is vital, with learning interventions becoming less effective in older children.
In addition to being Professor of Paediatrics at the University of Cambridge, he is a Principal Investigator for BLOOMS and Deputy Director of Research at Cedars-Sinai Guerin Children’s in Los Angeles.
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.’ If we use techniques such as genomics, we can go beyond the clinical record alone to be even more specific about this assessment, targeting help to those most likely to benefit.
David Rowitch, Professor of Paediatrics at the University of Cambridge
According to Professor Rowitch, children who fail their school readiness assessments are more likely to experience problems in their adult life including poorer physical and mental health, higher rates of deprivation and incarceration and a reduced life expectancy.
Babies are admitted to NICUs for many reasons, including prematurity, low birth weight, breathing difficulties or a need for surgery.
A preview of research at the Cambridge Children's Hospital
BLOOMS will be one of the flagship programmes at the Cambridge Children's Research Institute (CCRI), which will be housed inside Cambridge Children's Hospital (opens in a new tab).
Construction on the hospital is expected to begin shortly and it will be a visionary hospital looking to identify the origins of physical and mental health conditions, and treating these as two sides of the same coin.
Professor Rowitch says that this vision is well demonstrated by BLOOMS. It starts with an outcome - failing the school readiness assessment - and tries to establish what lead to it, and how this outcome could be mitigated or prevented.
The study is very much in line with the overarching prevention medicine research strategy of the Cambridge Children's Hospital.
David Rowitch, Professor of Paediatrics at the University of Cambridge
BLOOMS is funded by a £4 million award from Wellcome. The team also hope to draw on data from national records of neonatal care and educational outcomes. UK Research and Innovation are also providing funding to explore the interventions that might help.
With arguably the largest national system for assessing children’s development in the world, the team believe the UK is an ideal place to start this research. The project is also being met with widespread enthusiasm in Singapore, Canada and the United States, and it is possible that further BLOOMS sites will be added as part of an international consortium.