Tracking the health, educational and economic impact of gestational age at birth: a longitudinal record linkage study (TIGAR)

一个典型的怀孕持续约40周，在怀孕37周之前出生的婴儿被归类为早产或早产。这些婴儿死亡的几率更高，而那些幸存下来的婴儿在童年和成年时更有可能出现健康和发育问题。早产的孩子也更有可能有特殊的教育需求，或者在学校考试中表现不如同学。最近的研究表明，即使是早产几周的婴儿，与足月妊娠后出生的婴儿相比，在童年时期也可能有更多的问题。早产的长期影响的研究需要包括大量的儿童（至少10万）。有过这样大规模的研究，但他们的发现可能与今天出生的孩子无关。例如，他们是基于20世纪60年代至90年代出生的儿童，他们经历了与今天出生的婴儿不同的新生儿护理。此外，大多数研究都是基于斯堪的纳维亚或美国儿童，他们将经历不同的健康和教育制度，以儿童在英国。有必要进行一项大型英国研究，以评估健康和教育的成果和成本，与21世纪世纪出生的婴儿中早产相关。目的和目标我们的目的是对2005年在英格兰出生的儿童进行研究，6并使用它来调查早产儿与足月妊娠后出生的儿童在健康和教育结果方面的差异。我们的分析将确定早产是否对生活在贫困中或处于社会弱势地位的儿童产生更大的影响。我们还将衡量早产儿的健康和教育service.MethodsThe研究的成本将包括所有在英格兰出生的婴儿在2005-2006年（约100万），并将后续的儿童通过连接在一起不同的常规信息来源。我们将努力获得儿童在10岁之前所经历的任何住院或门诊就诊的数据，以及儿童在5岁、7岁和11岁时进行的国家测试的学校成绩。学校成绩还将表明儿童是否有特殊教育需要以及给予了哪些支持。这些信息将使我们了解每个孩子的健康状况和学习成绩，并使我们能够看到早产对这一点的影响。将成立两个小组就该项目提供咨询意见。一个小组将包括相关专家、利益攸关方（例如，“为早产、过小、过病的婴儿提供布利斯服务”支助小组），并将包括受早产影响的家庭代表。另一组将提供用户对项目所有方面的看法。成员将包括受早产影响的家庭（例如早产儿的父母和早产的年轻人）。潜在的应用和好处这项研究的结果将提供给相关的专业人士。调查结果将告知教师和其他教育专业人员早产儿童可能出现的问题类型，以及需要何种特殊教育需求支持。调查结果还将有助于就可能发生的问题类型向父母提供咨询，使他们能够更好地准备预期发生的事情以及何时寻求专业人员的帮助。我们对早产相关成本的研究结果将有助于在医院、学校或社区规划或提供服务的组织。它们还将有助于确保查明最需要帮助的儿童并给予适当的支助。最后，我们将为正在进行类似记录链接研究的研究人员创建一个资源，该资源将描述我们如何访问，链接和分析这些大型数据集。

BackgroundA typical pregnancy lasts about 40 weeks and babies born before 37 weeks of pregnancy are classified as premature or preterm. These babies have a higher chance of dying and those that survive are more likely to have health and developmental problems in childhood and adulthood. Children who are born early are also more likely to have special educational needs, or may not perform as well as their classmates in their school tests. Recent research suggests that even those babies who are born a few weeks early may have more problems in childhood compared with those who are born after a full term pregnancy.Studies of the long term impact of prematurity need to include a large number of children (at least 100,000). There have been studies as large as this, but their findings may not be relevant to children born today. For example, they are based on children born in the 1960s-90s who experienced different newborn care to babies born today. Also, most of the studies are based on Scandinavian or American children, who will have experienced different health and education systems to children in the UK.There is a need for a large UK study to assess the health and educational outcomes and costs, associated with preterm birth in a population of babies born in the 21st century.Aims and objectivesOur aim is to carry out a study on children born in England in 2005-6 and use it to investigate differences in health and education outcomes for children born early compared with those born after a full term pregnancy. Our analysis will determine whether being born early has a larger impact on children who are living in poverty or are socially disadvantaged. We will also measure the costs of prematurity to health and education services.MethodsThe study will include all babies born in England during 2005-2006 (about 1 million) and will follow-up the children through linking together different routine information sources. We will try to obtain data on any hospital admissions or outpatient visits that the children experience until the age of 10, and their school results from national tests which are performed when the children are 5, 7 and 11 years. The school results will also indicate whether the child has special educational needs and what support is given. This information will give us a picture of each child's health and school results, and will enable us to see how much this is affected by being born early. Two groups will be formed to advise on the project. One group will include relevant experts, stakeholders (e.g. the support group 'BLISS for babies born too soon, too small, too sick') and will include representatives of families affected by premature birth. Another group will provide a user's perspective on all aspects of the project. Members will include families affected by premature birth (e.g. parents of preterm children, and young adults who were born early). Potential applications and benefitsThe results of this study will be made available to the relevant professionals. The results will inform teachers and other education professionals about the type of problems that may occur in children who were born early and what kind of special educational needs support is needed. The results will also assist in counselling of parents about the types of problems that may occur, which will enable them to be more prepared about what to expect and when to seek help from professionals. Our results on the costs associated with prematurity will be helpful to organisations who plan or deliver services in hospital, schools or the community. They will also help ensure that the children who need the most help are identified and given appropriate support. Finally, we will create a resource for researchers who are doing similar record linkage studies, which will describe how we accessed, linked and analysed these large datasets.