The Lifelong Effects of Premature Birth
Monitoring the development of children born preterm
Every year 15 million children are born prematurely (before 37 weeks gestation) worldwide. Preterm birth is the main cause of child mortality and affects life chances into adulthood. Professor Dieter Wolke’s research has identified lifelong social, physical and mental effects for those born preterm. Professor Wolke’s work has helped to create a screening tool for very preterm children at 2 years of age for cognitive and language problems. He has also contributed to standards of care endorsed by societies and healthcare organisations in Europe. In addition, he has influenced guidelines within the UK on the educational and medical needs of preterm children.
Prematurely born children are the fastest growing group of special needs children. The early identification of those with cognitive problems is important to inform care and schooling. Standard testing by trained professionals to diagnose developmental problems is costly in terms of time and resources. Equally, availability of follow-up care can vary wildly between health systems. In addition, teachers and educational psychologists rarely have the knowledge or training to provide the specific extra support for preterm children. They would like to know more and require training.
The research investigated a wide range of health and social considerations in order to assess the lifelong impacts of preterm birth:
General cognitive development and executive functions
Social development and relationships
School admissions policies
Mental health problems in adulthood
Professor Wolke and colleagues at Leicester and UCL created a screening questionnaire - the Parent Report of Children's Abilities-Revised (PARCA-R). This identifies cognitive and language deficits at 2 years of age to triage follow up care for preterm children. It is now available with norms for screening of all children at 2 years of age.
Healthcare organisations, including NICE have already updated their guidance to include PARCA-R as a screen for cognitive and language problems in the follow-up of very preterm children at 2 years. More than 1,200 people, mainly healthcare and education professionals globally, have used the PARCA-R screening test in their follow-up work, which is available in 14 different languages, to identify children at all stages of gestation who need follow up care. The PARCA-R became a major follow-up tool internationally when face-to-face assessment was not possible during the COVID-19 crisis.
Professor Wolke’s findings have also influenced the European Foundation of the Care of Newborns and Infants’s new standards on follow-up care of preterm children. These have now been endorsed by over 50 European societies and healthcare organisations. In addition, as a result of Professor Wolke’s findings the Department for Education requires that admission authorities consider the age group the child would have fallen into if born on time when commencing primary education. Each year 6,500 parents in England and Wales ask for postponed school entry due to the effects of preterm birth.