INTRODUCTION: Infants who remain in-utero after their due date are exposed to increasing risk of infection, late stillbirth and delivery complications. Much of the current literature on post-term outcomes is based on short term observations and the impacts may be substantially greater in the long term. The aim of this work is to perform a systematic review and metaanalysis to quantify the cognitive or educational impacts of post term delivery. METHODS: Systematic review was performed by the two authors using MEDLINE database (1960 to 2017). A title search was performed to identify likely relevant literature. Exposure terms were clarified to identify papers where the exposure was related to delivery after the infants' due date. Primary outcome was cognitive score. A quality assessment and data extraction proforma was completed by both reviewers for all studies deemed to satisfy the inclusion and exclusion criteria. Meta-analysis used adjusted results where available. Smallstudy bias was assessed visually using a funnel plot and then formally tested using Egger's regression asymmetry test. RESULTS: MEDLINE was searched on the 12/07/2018; and produced a list of 1318 publications. Of these, 43 abstracts were screened, and of these a total of 10 full-text papers were reviewed. A further 3 papers were identified during this review and contributed to a total of 13 papers. The publications dated from 1969 to 2017. Two studies presented a binary outcome for cognitive measures and combined estimates found that the risk of a low cognitive score was higher in post-term infants compared to term infants (OR 1.06 (1.04-1.08)). Four papers presented the association with mean cognitive measures and post-term delivery, and all demonstrated a mean reduction in scores in the post-term group. A combined estimate showed strong evidence of a reduction in cognitive scores across the four studies (-1.90 (-3.50 to-0.31)). There was little evidence of heterogeneity in the studies which reported cognitive outcomes (other p-values greater than 0.2). CONCLUSION: This meta-analysis has found that post term birth (>41+6 weeks) is associated with small but significant negative effects on cognitive outcomes when compared with delivery at, or around term. The effect, while small, is compounded by a common exposure and appears consistent in the studies identified. Less evidence was found for a measurable impact on early developmental measures or educational outcomes. This may further help inform the debate on the timing of otherwise uncomplicated pregnancies; and further trials in this area.

‘County lines’ is the term used for the proliferating mobile phone lines used by gangs to infiltrate county towns where a profitable drug market is identified. The National Crime Agency reports that 88% of police areas in England and Wales have either an established or emerging County Lines problem in their area. With an estimated 46 053 aged 10–18 years in England in a gang, the activities of gangs and County Lines have a devastating impact on young people, vulnerable adults and local communities. Young people engaged in County Lines activities are at hugely increased risk of child sexual exploitation, criminal conviction, violence, drug addiction and trafficking. It is essential that healthcare staff receive a high standard of training as seen in other organisations and that time is taken to try to identify and intervene with those at risk of gang exploitation at an early stage, to try to prevent significant harm.

BackgroundWhile life-long impacts exist for infants born one or two weeks early little evidence exists for those infants born after their due date. However interventions could be used to expedite birth if the risks of continuing the pregnancy are higher than intervening. It is known that the risk of epilepsy in childhood is higher in infants exposed to perinatal compromise and therefore may be useful as a proxy for intrapartum compromise. The aim of this work is to quantify the likelihood of children developing epilepsy based on their gestational age at birth (37–39 weeks or ≥41 weeks).MethodsThe work is based on term infants born in Sweden between 1983 and 1993 (n = 1,030,168), linked to data on disability pension, child mortality and in-patient epilepsy care. The reference group was defined as infants born at 39 or 40 completed weeks of gestation; compared with infants born at early term (37/38 weeks) or late/post term (41 weeks or more). Primary outcome was defined a-priori as a diagnosis of epilepsy before 20 years of age. Secondary outcomes were childhood mortality (before five years of age), and registered for disability pension before 20 years of age. Logistic regression models were used to assess any association of the outcomes with gestational age at birth.FindingsIn the unadjusted results, infants born 7 or more days after their due date had higher risks of epilepsy and disability pension than the reference group, but similar risks of child death. Early term infants showed higher risks of epilepsy, disability pension and child death. After adjustment for confounders, there remained a higher risk of epilepsy for both early term (OR 1·19 (1·11–1·29)) and late/post term infants (OR 1·13 (1·06–1·22)).InterpretationInfants born at 37/38 week or 41 weeks and above, when compared to those born at 39 or 40 weeks gestation, have an increased risk of developing epilepsy. This data could be useful in helping women and care givers make decisions with regard to the timing of induction of labour.

Survival rates for infants undergoing surgical repair of oesophageal atresia with tracheo-oesophageal fistula (OA-TOF) have improved dramatically, but this condition remains associated with substantial morbidity. Most studies of patients following OA-TOF repair have concentrated on school-age and older people; whereas, the most hazardous period is infancy. We aimed to assess respiratory function in a group of infants following primary operative repair, and to relate the results to clinical findings during the first year of life. We studied 16 infants within 3 months of primary repair of OA-TOF. Measurements were made of maximum expiratory flow at functional residual capacity (VmaxFRC), thoracic gas volume (TGV) and airways resistance (Raw). Ten infants had tests repeated, usually to assess progress alongside continuing symptoms, or to ascertain improvement following additional surgery. Seven infants had essentially normal initial respiratory function tests, and six remained either symptom-free or developed only minor clinical problems. One infant subsequently developed stridor, with spontaneous improvement towards the end of the first year. The remaining nine infants had abnormal initial respiratory function tests: one was symptom-free at that time. The remainder developed respiratory and/or gastro-oesophageal symptoms. The functional abnormalities appeared to reflect the severity of the clinical problems encountered. We conclude that respiratory function testing in infants following OA-TOF repair may augment the value of clinical appraisal, help define postoperative respiratory status, and provide a general guide to likely clinical progress.

Perinatal Excellence to Reduce Injury in Premature Birth (PERIPrem) is an 11-element perinatal care bundle designed to improve outcomes for preterm babies, in line with the National Health Service (NHS) Long Term plan. Designed in collaboration with 12 NHS Trusts (secondary care hospitals), South West and West of England Academic Health Science Networks, South West Neonatal Operational Delivery Network, parent partners and clinical experts, implementation was via bespoke quality improvement (QI) methodology. Before project initiation, there was regional variation in uptake of elements, evidenced by baseline audit. Optimisation of the preterm infant is complex; eligibility for treatments is dependent on gestation and local policies. Preterm infants experience variability in care dependent on the place of birth, and there remains an implementation gap for several effective, evidence-based treatments.The PERIPrem ambition is to reduce severe brain injury and death caused by prematurity by at least 50% through the delivery of a perinatal care bundle. The PERIPrem approach resulted in improved element implementation by 26% (from 3% to 29%) between 2019 and 2021, with dyads significantly more likely to receive the full bundle in 2021 compared with 2019 (probability=0.96 (95% CI 0.87 to 0.99), p<0.001). When examining the impact on psychological safety and team-working of PERIPrem, linear mixed models indicated an improvement in team function (p=0.021), situation monitoring (p=0.029) and communication within teams (p=0.002). Central to success was the development of a committed multiorganisational collaborative that continues to drive perinatal improvement using a common language and streamlining processes. In addition to saving the lives of the most vulnerable babies, PERIPrem aims to improve the chances of disability-free lives and is successfully nurturing high-functioning perinatal teams with enhanced QI skills.