
Andrei S MorganFrench Institute of Health and Medical Research | Inserm · Obstetric, Perinatal and Pediatric Epidemiology Research Team
Andrei S Morgan
MBChB, FRCPCH, MSc, PhD
About
79
Publications
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Introduction
I'm a UK-trained neonatologist and epidemiologist who has been based at the Obstetric, Perinatal and Paediatric Epidemiology Unit at INSERM in Paris, France since 2017. My research has a focus on early preterm birth - i.e. those occurring at extremely (below 27 weeks) and very (below 32 weeks) preterm gestations - with a particular interest in the use of federated data analyses to understand the differences and similarities that are to be found between countries.
Additional affiliations
January 2020 - April 2022
September 2017 - present
March 2014 - March 2015
Education
October 2022 - February 2024
Université Paris Cité
Field of study
- Epidemiology / Neonatology
September 2011 - June 2015
September 2007 - September 2008
Publications
Publications (79)
Objectives
To describe neurodevelopmental outcomes at 2 years corrected age for children born alive at 22-26, 27-31, and 32-34 weeks’ gestation in 2011, and to evaluate changes since 1997.
Design
Population based cohort studies, EPIPAGE and EPIPAGE-2.
Setting
France.
Participants
5567 neonates born alive in 2011 at 22-34 completed weeks’ gestati...
Background
Emerging evidence suggests intensity of perinatal care influences survival for extremely preterm babies. We evaluated the effect of differences in perinatal care intensity between centres on sensorimotor morbidity at 2 years of age. We hypothesised that hospitals with a higher intensity of perinatal care would have improved survival with...
Objectives
To develop research priorities on the consequences of very preterm (VPT) birth for the RECAP Preterm platform which brings together data from 23 European VPT birth cohorts.
Design and setting
This study used a two-round modified Delphi consensus process. Round 1 was based on 28 research themes related to childhood outcomes (<12 years) d...
Aim
We investigated timing of survival differences and effects on morbidity for fetuses alive at maternal admission to hospital delivered at 22 to 26 weeks' gestational age (GA).
Methods
Data for from the EXPRESS (Sweden, 2004-07), EPICure-2 (England, 2006), and EPIPAGE-
2 (France, 2011) cohorts were harmonised. Survival, stratified by GA, was ana...
Extreme preterm birth, defined as birth before 28 weeks’ gestational age (box 1),1 affects about two to five in every 1000 pregnancies, and varies slightly by country and by definitions used. Severe maternal morbidity, including sepsis and peripartum haemorrhage, affects around a quarter of mothers delivering at these gestations.2 For the babies, s...
Objective
Extremes of prepregnancy maternal BMI increase neonatal mortality and morbidity at term. They also increase the risk of extremely preterm (EP, i.e., <27 weeks' gestational age) births. However, the association between maternal BMI and outcomes for EP babies is poorly understood.
Methods
We used a cross‐country design, bringing together t...
The importance of maintaining data privacy and complying with regulatory requirements is highlighted especially when sharing omic data between different research centers. This challenge is even more pronounced in the scenario where a multi-center effort for collaborative omics studies is necessary. OmicSHIELD is introduced as an open-source tool ai...
This commentary is on the original articles by Wang et al. and Fogh et al., on pages 59–67 and 68–76 of this issue.
Objective
To report neurodevelopment at age 5.5 years according to developmental delay screening with the Ages & Stages Questionnaire (ASQ) in late infancy in preterm-born children.
Design
Population-based cohort study, EPIPAGE-2.
Setting
France, 2011–2017.
Participants
2504 children born at 24–26, 27–31 and 32–34 weeks, free of cerebral palsy,...
Background: A European research infrastructure – RECAP Preterm – federating observational cohorts permits research about the aetiology, prognosis and care of very preterm (VPT) birth, but randomised controlled trials (RCT) are key for propelling advances; however, increasing feasibility constraints mean their numbers are decreasing. Long-term follo...
Objective
To develop and validate a clinical prediction model for outcomes at 5 years of age for children born extremely preterm and receiving active perinatal management.
Design
The EPIPAGE‐2 national prospective cohort.
Setting
France, 2011.
Population
Live‐born neonates between 24⁺⁰ and 26⁺⁶ weeks of gestation who received active perinatal ma...
Aim:
To describe the circumstances, causes and timing of death in extremely preterm infants.
Methods:
We included from EPIPAGE-2 study infants born at 24-26 weeks in 2011 admitted to neonatal intensive care units (NICU). Vital status and circumstances of death were used to define 3 groups of infants: alive at discharge, death with or without wit...
Background:
Meta-analyses of the voluminous scientific literature on the impact of very preterm (VPT, <32 weeks' gestation) birth on cognition find a marked deficit in intelligence quotient (IQ) among children born VPT relative to term-born peers, but with unexplained between-study heterogeneity in effect size.
Objectives:
To conduct an umbrella...
Objective
To determine whether birth outside a level-3 centre (outborn) is associated with a difference in the combined outcome of mortality or moderate-to-severe neurological impairment at 5.5 years of age compared with birth in a level-3 centre (inborn) when antenatal steroids and gestational age (GA) are accounted for.
Design
Individual matched...
Introduction
Choice of birth setting is important and it is valuable to know how reconfiguring available settings may affect midwifery staffing needs. COVID-19-related health system pressures have meant restriction of community births. We aimed to model the potential of service reconfigurations to offset midwifery staffing shortages.
Methods
We ad...
Background
Preterm delivery is a risk factor for sub-optimal neurodevelopment. Pregnancies conceived after medically-assisted reproduction – which includes in vitro fertilisation, with or without intracytoplasmic insemination, as well as induction of ovulation followed by intra-uterine insemination or timed intercourse – have a higher risk of prete...
Objective:
To assess the impact of public health measures taken during the COVID-19 pandemic on perinatal health indicators.
Design:
Interrupted time series analysis comparing periods of the pandemic with the previous 5 years.
Setting:
Yorkshire and the Humber region, England (2015-2020).
Main outcome measures:
Relative risk (RR) of stillbir...
Introduction
La prématurité est un facteur de risque de développement neurologique non optimal. Les grossesses obtenues après assistance médicale à la procréation (AMP) ont un risque plus important de prématurité. L’objectif de cette étude était d’évaluer le développement cognitif à 5,5 ans des enfants nés prématurés en fonction du mode de concepti...
Introduction
Children born very preterm have an immature sucking reflex at birth and are exposed to neonatal care that can impede proper palate growth.
Objectives
We aimed to describe the frequency of high-arched palate and posterior crossbite at the age of 5 in children born very preterm and to identify their respective risk factors.
Methods
Our...
Introduction
La prématurité est un facteur de risque de développement neurologique non optimal. Les grossesses obtenues après assistance médicale à la procréation (AMP) ont un risque plus important de prématurité. L’objectif de cette étude était d’évaluer le développement cognitif à 5,5 ans des enfants nés prématurés en fonction du mode de concepti...
Background
Meta-analyses of studies on very preterm (VPT) birth and childhood cognition select primary studies using gestational age inclusion criteria only, while others also include birthweight criteria. The consequences of this choice are unknown.
Objective
The objective of this study was to describe the gestational age (GA) and birthweight (BW...
Background:
Studies are sparse and inconclusive about the association between maternal education and cognitive development among children born very preterm (VPT). Although this association is well established in the general population, questions remain about its magnitude among children born VPT whose risks of medical and developmental complicatio...
Background
Despite the limited evidence, accelerated early postnatal growth (EPG) is commonly believed to benefit neurodevelopment for term-born infants, especially those small for gestational age.
Objectives
To investigate the existence of critical time windows in the association of EPG with neurodevelopment, considering birth size groups.
Study...
Background:
Regionalisation programmes aim to ensure that very preterm infants are born in level III units (inborn) through antenatal referral or transfer. Despite widespread knowledge about better survival without disability for inborn babies, 10%-30% of women deliver outside these units (outborn).
Objective:
To investigate risk factors associa...
Objectives: To describe neurodevelopment at age 5 among children born preterm.
Design: Population based cohort study, EPIPAGE-2.
Setting: France, 2011.
Participants: 4441 children aged 5½ born at 24-26, 27-31, and 32-34 weeks.
Main outcome measures: Severe/moderate neurodevelopmental disabilities,
defined as severe/moderate cerebral palsy (Gross Mo...
Introduction: Preterm babies are a vulnerable population that experience significant short and long-term morbidity. Rehospitalisations constitute an important, potentially modifiable adverse event in this population. Improving the ability of clinicians to identify those patients at the greatest risk of rehospitalisation has the potential to improve...
The pathogenesis of late-onset sepsis (LOS) in preterm infants is poorly understood and knowledge about risk factors, especially prenatal risk factors, is limited. This study aimed to assess the association between the cause of preterm birth and LOS in very preterm infants.
2052 very preterm singletons from a national population-based cohort study...
Delivery at extreme preterm gestational ages (GA) $$<\;27$$ < 27 weeks is challenging with limited evidence often focused only on neonatal outcomes. We reviewed management and short term maternal, fetal and neonatal outcomes of births for 132 women (22 + 0 to 26 + 6 weeks’ GA) with a live fetus at admission to hospital and in labour or at planned e...
Objective: To systematically review evidence of risk factors and rates for rehospitalisations within one month of discharge for babies born at <37 weeks gestation.
Design: Systematic review and meta-analysis
Data Sources: PubMed (including MEDLINE and life science journals), Web of Science and reference lists of included articles.
Study Selection:...
Iran has been the country most affected by the outbreak of SARS-CoV-2 in the Middle East. With a relatively high case fatality ratio and limited testing capacity, the number of confirmed cases reported is suspected to suffer from significant underreporting. Therefore, understanding the transmission dynamics of COVID-19 and assessing the effectivene...
Objective
To assess whether chorioamnionitis is associated with cerebral palsy (CP) or death at 2 years' corrected age in infants born before 32 weeks of gestation after spontaneous birth.
Study design
EPIPAGE-2 is a national, prospective, population-based cohort study of children born preterm in France in 2011; recruitment periods varied by gesta...
Objectives
To describe patterns of care for very preterm (VP) babies across neonatal intensive care units (NICUs) and associations with outcomes.
Design
Prospective cohort study, EPIPAGE-2.
Setting
France, 2011.
Participants
53 (NICUs); 2135 VP neonates born at 27 to 31 weeks.
Outcome measures
Clusters of units, defined by the association of pr...
BACKGROUND:
Iran has been the hardest hit country by the outbreak of SARS−CoV−2 in the Middle East with 74,877 confirmed cases and 4,683 deaths as of 15 April 2020. With a relatively high case fatality ratio and limited testing capacity, the number of confirmed cases reported is suspected to suffer from significant under-reporting. Therefore, under...
Introduction:
Our main objective was to evaluate whether antenatal corticosteroids increase the risk of small head circumference in children born at term. Secondary objectives were to evaluate whether they increase the risk of small birthweight and birth length among those children.
Material and methods:
A historical cohort included 275 270 live...
We summarise rates of survival and neurodevelopmental impairment in very (<32 weeks’ gestation) and extremely (<28 weeks’ gestation) preterm infants using data from recent meta-analyses. Methodological issues that require consideration when comparing international data are highlighted using examples of population-based or multi-centre cohorts of ch...
Background:
Perinatal decision-making affects outcomes for extremely preterm babies (22-26 weeks' gestational age (GA)): more active units have improved survival without increased morbidity. We hypothesised such units may gain skills and expertise meaning babies at higher gestational ages have better outcomes than if they were born elsewhere. We e...
Background:
Gaining a better understanding of the probability, timing and prediction of rehospitalisation amongst preterm babies could help improve outcomes. There is limited research addressing these topics amongst extremely and very preterm babies. In this context, unplanned rehospitalisations constitute an important, potentially modifiable adve...
Gaining a better understanding of the probability, timing and prediction of rehospitalisation amongst preterm babies could help improve outcomes. There is limited research addressing these topics amongst extremely and very preterm babies. In this context, unplanned rehospitalisations constitute an important, potentially modifiable adverse event. We...
Background Gaining a better understanding of the probability, timing and prediction of rehospitalisation amongst preterm babies could help improve outcomes. There is limited research addressing these topics amongst extremely and very preterm babies. In this context, unplanned rehospitalisations constitute an important, potentially modifiable advers...
Objectives:
To investigate the relation between neonatal intensive care unit (NICU) volume and survival, and neuromotor and sensory disabilities at 2 years in very preterm infants.
Study design:
The EPIPAGE-2 (Etude Epidémiologique sur les Petits Âges Gestationnels-2) national prospective population-based cohort study was used to include 2447 ba...
Objective:
To evaluate the association between active antenatal management and neonatal outcomes in extremely preterm newborns admitted to a neonatal intensive care unit (NICU).
Study design:
This population-based cohort study was conducted in 25 regions of France. Infants born in 2011 between 220/7 and 266/7 weeks of gestation and admitted to a...
( BMJ . 2017;358:j3448)
Although survival of preterm babies has increased worldwide along with a decrease in severe neonatal morbidity, the risk of neurodevelopmental and behavioral disabilities continues to be high in these children. In fact, developmental delay has replaced survival as the major concern for children born preterm. Early identifica...
Background
To investigate perinatal decision-making and the use of obstetric interventions, we examined the effects of antenatal steroids, tocolysis, and delivery mode on birth in a good condition (defined as presence of an infant heart rate >100 at five minutes of age) and delivery-room (DR) death in extremely preterm deliveries.
Methods
Prospect...
Background:
A 44 % increase was observed in admissions to neonatal intensive care of babies born ≤26 weeks completed gestational age in England between 1995 and 2006. Hospital Episode Statistics (HES) may provide supplementary information to investigate this. The methods and results of a probabilistic data linkage exercise are reported.
Methods:...
Objective To estimate the effect of the provision of a one-to-one nurse-to-patient ratio on mortality rates in neonatal intensive care units.
Design A population-based analysis of operational clinical data using an instrumental variable method.
Setting National Health Service neonatal units in England contributing data to the National Neonatal Rese...
Objective To examine the effects of designation and volume of neonatal care at the hospital of birth on mortality and morbidity outcomes in very preterm infants in a managed clinical network setting.
Design A retrospective, population-based analysis of operational clinical data using adjusted logistic regression and instrumental variables (IV) anal...
Objective To investigate effects of changes in neonatal service provision on nurse staffing ratios, admissions and provision of respiratory support (CPAP or mechanical ventilation).
Design Retrospective, cross-sectional surveys of units providing neonatal intensive care (1997) or all care (2006 and 2011) in English maternity units.
Results The resp...
Objective To evaluate the relationship of steroid, tocolysis and caesarean delivery to the chances of the baby being born with a heart rate >100 at 5 min after birth (“good condition”) and of death in labour or the delivery room (“perinatal death”).
Design Prospective cohort of all singleton births in England in 2006 at 22–26 weeks of gestation whe...
Expertise and resources may be important determinants of outcome for extremely preterm babies. We evaluated the effect of place of birth and perinatal transfer on survival and neonatal morbidity within a prospective cohort of births between 22 and 26 weeks of gestation in England during 2006.
We studied the whole population of 2460 births where the...
Achieving health benefits while reducing greenhouse gas emissions from transport offers a potential policy win-win; the magnitude of potential benefits, however, is likely to vary. This study uses an Integrated Transport and Health Impact Modelling tool (ITHIM) to evaluate the health and environmental impacts of high walking and cycling transport s...
Non-travel MET hours per week by quintile of active travel from the Health Survey for England 2008. Estimated weekly MET values for activity from all the other domains for each quintile of walking and cycling activity in HSE within each demographic group. The quintile of active travel is based on estimated walking plus cycling time taken from the H...
CO2 emission factors, grams per vehicle kilometre. Emission factors taken from the UK National Air pollution Emissions Inventory for 2008.
(DOCX)
Schematic of road traffic injury model. This figure illustrates the key data sources and stages in the road traffic injury module component of ITHIM implemented in Excel.
(TIF)
Schematic of air pollution model. This figure illustrates the key data sources and stages in the air pollution module component of ITHIM implemented in Excel. (CRA: Comparative Risk Assessment)
(TIF)
Schematic of physical activity model. This figure illustrates the key data sources and stages in the physical activity module component of ITHIM implemented in Excel.
(TIF)
Baseline Serious Injuries by victim mode and striking vehicle for minor roads in urban areas in England and Wales. This table shows the estimated annual average number of serious injuries by the victim mode and striking vehicle in urban areas outside London between 2002 and 2008. All other data by severity (fatalities) and by road type (major roads...
PM 2.5 emission factors per km by vehicle type and road type. Emission factors taken from the UK National Air pollution Emissions Inventory for 2008.
(DOCX)
Objectives To examine the effects of antenatal steroids, tocolysis, and delivery mode on extremely preterm delivery; to identify other potential antecedents through a hypothesis-generating analysis.
Design National cohort study.
Setting England.
Participants Singleton pregnancies delivering before 27 weeks gestation during 2006.
Main outcome measur...
Cycling fatalities in London by year, 1992 - 2006.
Vehicle information for collisions involving a cyclist fatality in London, 1992 - 2006.
Cyclist fatalities before and after the introduction of the Central London Congestion Charging Zone (CCZ).
Traffic flows and corresponding estimated cycling fatality rates, 1992 - 2006.
Cycling is an increasingly important mode of transport for environmental and health reasons. Cycling fatalities in London were previously investigated in 1994 using routinely collected data. Since then, there have been shifts in the modes of transport used, and in transport policies. We sought to replicate the previous work using data on cyclist de...