Neil Marlow

University College London | UCL · Institute for Women's Health

There is mixed evidence on personality differences among those born very preterm or with very low birth weight (VP/VLBW). This meta-analysis of individual participant data aimed to examine differences in personality traits between VP/VLBW ( n = 568) and term-born ( n = 1,060) adults, and the role of neonatal characteristics and neurosensory impairm...

Objective To identify whether maternal and pregnancy characteristics associated with stillbirth differ between preterm and term stillbirth. Design Secondary cohort analysis of the DESiGN RCT. Setting Thirteen UK maternity units. Population Singleton pregnant women and their babies. Methods Multiple logistic regression was used to assess whether...

Aim To compare romantic and sexual relationships between adults born very preterm (VP; <32 weeks of gestation) or with very low birth weight (VLBW; <1500 g) and at term, and to evaluate potential biological and environmental explanatory factors among VP/VLBW participants. Methods This individual participant data (IPD) meta‐analysis included longit...

This study addresses the paucity of research on parents of extremely preterm adolescents (born <27 weeks of gestation) and their experiences within the framework of parental determinism. We conducted semi-structured interviews with twenty-two mothers and one father. Data were analysed thematically, revealing three overarching themes and eight subth...

Background Concerns remain over the long-term safety of vascular endothelial growth factor (VEGF) inhibitors to treat retinopathy of prematurity (ROP). RAINBOW is an open label randomised trial comparing intravitreal ranibizumab (in 0.2 mg and 0.1 mg doses) with laser therapy in very low birthweight infants (<1500 g) with ROP. Methods Of 201 infan...

Objective This study aimed to identify the prevalence of psychiatric disorders in 2 population-based cohorts of children born extremely preterm (EP) 11 years apart to ascertain whether psychiatric outcomes have changed over time following improved survival of EP children. Method In the EPICure2 study, 200 children born EP (22-26 weeks’ gestation)...

Objectives Retrospective harmonisation of data obtained through different instruments creates measurement error, even if the underlying concepts are assumed the same. We tested a novel method for item‐level data harmonisation of two widely used instruments that measure emotional and behavioural problems: the Child Behavior Checklist (CBCL) and the...

Background Neonatal death is the leading category of death in children under the age of 5 in the UK. Many babies die following decisions between parents and the neonatal team; when a baby is critically unwell, with the support of healthcare professionals, parents may make the decision to stop active treatment and focus on ensuring their baby has a...

The preterm phenotype results from the interplay of multiple disorders affecting the brain and cognitive outcomes. Accurately characterising these interactions can reveal prematurity markers. Bayesian Networks (BNs) are powerful tools to disentangle these relationships, as they inherently measure associations between variables while mitigating conf...

Aim There is currently limited evidence on the costs associated with late preterm pre-eclampsia beyond antenatal care and post-natal discharge from hospital. The aim of this analysis is to evaluate the 24-month cost-utility of planned delivery for women with late preterm pre-eclampsia at 34 ⁺⁰ and 36 ⁺⁶ weeks’ gestation compared to expectant manage...

Objective To assess the diagnostic performance of angiogenic biomarkers in determining need for delivery in seven days in women with late preterm preeclampsia. Study design In a prospective observational cohort study in 36 maternity units across England and Wales, we studied the diagnostic accuracy of placental growth factor (PlGF) and sFlt-1 in d...

Objective We evaluated the best time to initiate delivery in late preterm pre-eclampsia in order to optimise long-term infant and maternal outcomes. Design Parallel-group, non-masked, randomised controlled trial. Setting 46 UK maternity units. Population Women with pre-eclampsia between 34 ⁺⁰ and 36 ⁺⁶ weeks’ gestation, without severe disease, w...

Objective To determine whether extremely preterm (EP) birth exerts persisting effects on parents in early adolescence. Design Cross-sectional survey conducted between March 2017 and October 2018. Setting Evaluation of a longitudinal population-based birth cohort in England at 11 years of age (EPICure2@11 Study). Participants Parents of EP (<27 w...

Aim Adults born preterm have increased risk of mental health problems and other neurodevelopmental conditions. We aimed to investigate associations of mental health with pain and tiredness in adults born very preterm (VP; <32 weeks) or very low birthweight (VLBW; <1500 g) and at term, and whether these associations are influenced by physical activi...

BACKGROUND Severe, early-onset fetal growth restriction (FGR) causes significant fetal and neonatal mortality and morbidity. Predicting the outcome of affected pregnancies at the time of diagnosis is difficult, thus preventing accurate patient counseling. We investigated the use of maternal serum protein and ultrasound measurements at diagnosis to...

Background Children born extremely preterm (EP) are at increased risk of neurocognitive and behavioural morbidity. Here, we investigate whether behavioural outcomes have changed over time concomitant with increasing survival following EP birth. Methods Comparison of outcomes at 11 years of age for two prospective national cohorts of children born...

Objective To quantify the risks of mortality, morbidity and postnatal characteristics associated with extreme preterm fetal growth restriction (EP-FGR). Design The EVERREST (Do e s v ascular endothelial growth factor gene therapy saf e ly imp r ove outcome in seve r e e arly-onset fetal growth re st riction?) prospective multicentre study of women...

Importance: Globally accepted recommendations suggest that a woman should be between 19 weeks and 25 weeks plus 6 days of pregnancy to be considered eligible for fetal closure of open spina bifida. A fetus requiring emergency delivery during surgery is therefore potentially considered viable and thus eligible for resuscitation. There is little evi...

Objective To determine whether the Growth Assessment Protocol (GAP) affects the antenatal detection of large for gestational age (LGA) or maternal and perinatal outcomes amongst LGA babies. Design Secondary analysis of a pragmatic open randomised cluster control trial comparing the GAP with standard care. Setting Eleven UK maternity units. Popul...

Background The use of bedside cameras in neonatal units facilitates livestreaming of infants to support parental and family bonding when they are unable to be physically present with their baby. This study aimed to explore the experiences of parents of infants previously admitted for neonatal care and who used live video streaming to view their bab...

Aim To validate a touchscreen assessment as a screening tool for mild cognitive delay in typically developing children aged 24 months. Method Secondary analysis of data was completed from an observational birth cohort study (The Cork Nutrition & Microbiome Maternal–Infant Cohort Study [COMBINE]), with children born between 2015 and 2017. Outcome d...

Abstract Congenital anomalies (CAs) are a leading cause of morbidity and mortality in early life. We aimed to assess the incidence, risk factors, and outcomes of major CAs in the State of Qatar. A population-based retrospective data analysis of registry data retrieved from the Perinatal Neonatal Outcomes Research Study in the Arabian Gulf (PEARL-Pe...

Background: Severe early-onset fetal growth restriction (FGR) causes significant fetal and neonatal mortality and morbidity. Predicting the outcome of affected pregnancies at the time of diagnosis is difficult, preventing accurate patient counselling. We investigated the use of maternal serum protein and ultrasound measures at diagnosis to predict...

Objective To investigate individual and concomitant risk factors for hearing loss during neonatal care. Design Case–control study. Setting Community. Population 237 children born <32 weeks of gestation; 57 with hearing loss and 180 with normal hearing born between 2009 and 2013, matched for sex, gestation and year of birth. Main outcome measure...

Importance Variation in attitudes between health care professionals involved in the counseling of parents facing extremely preterm birth (<24 wk gestational age) may lead to parental confusion and professional misalignment. Objective To explore the attitudes of health care professionals involved in the counseling of parents facing preterm birth on...

Aim: To test whether poor childhood pulmonary function explains the relationship between extremely preterm (EP) birth and attention-deficit/hyperactivity disorder (ADHD) symptoms in young adulthood. Methods: EPICure birth cohort participants include children born <26 weeks' gestation in the United Kingdom and Ireland in 1995 and their term-born...

Background In women with late preterm pre-eclampsia (i.e. at 34 ⁺⁰ to 36 ⁺⁶ weeks’ gestation), the optimal delivery time is unclear because limitation of maternal–fetal disease progression needs to be balanced against infant complications. The aim of this trial was to determine whether or not planned earlier initiation of delivery reduces maternal...

Background: Antenatal corticosteroids (ACS) are recommended in threatened preterm labour to improve short term neonatal outcome. Preclinical animal studies suggest detrimental effects of ACS exposure on offspring cardiac development; their effects in humans are unknown. Objectives: To systematically review the human clinical literature to determ...

Background and Objective Assessment of health-related quality of life for individuals born very preterm and/or low birthweight (VP/VLBW) offers valuable complementary information alongside biomedical assessments. However, the impact of VP/VLBW status on health-related quality of life in adulthood is inconclusive. The objective of this study was to...

Current methods of cognitive assessment for young children are: time consuming, heavily reliant on language ability. Touchscreen technology allows assessment through play without verbal instruction. The CogniTOT touchscreen application shows strong internally consistency as a nonverbal assessment of early executive function.

Introduction Hypoaccommodation is common in children born prematurely and those with hypoxic ischaemic encephalopathy (HIE), with the potential to affect wider learning. These children are also at risk of longer-term cerebral visual impairment. It is also well recognised that early intervention for childhood visual pathology is essential, because n...

The Babies in Glasses (BiG ) Study: Feasibility and acceptability of early spectacle intervention to babies and parents to improve visual outcomes in infants at risk of perinatal brain insult.

Background Reducing the rate of stillbirth is an international priority. At least half of babies stillborn in high-income countries are small for gestational-age (SGA). The Growth Assessment Protocol (GAP), a complex antenatal intervention that aims to increase the rate of antenatal detection of SGA, was evaluated in the DESiGN type 2 hybrid effect...

Background: Preterm birth is associated with adverse health and developmental sequelae that impose a burden on finite resources and significant challenges for individuals, families and societies. Objectives: To estimate economic outcomes at age 11 associated with extremely preterm birth using evidence from a whole population study (EPICure2 stud...

Aim: There is currently limited evidence on the costs associated with late preterm pre-eclampsia beyond antenatal care and post-natal discharge from hospital. The aim of this analysis is to evaluate the 24-month cost-utility of planned delivery for women with late preterm pre-eclampsia at 34+0-36+6 weeks' gestation compared to expectant management...

Background: While fetal size is associated with adverse perinatal outcome, the relationship between fetal growth velocity and adverse perinatal outcome is unclear. Objectives: To evaluate the relationship between fetal growth velocity and signs of cerebral blood flow redistribution, and their association with birthweight and adverse perinatal ou...

Background Antenatal detection and management of small for gestational age (SGA) is a strategy to reduce stillbirth. Large observational studies provide conflicting results on the effect of the Growth Assessment Protocol (GAP) in relation to detection of SGA and reduction of stillbirth; to the best of our knowledge, there are no reported randomised...

[149/150 words] Recently several studies have reported adult outcomes for individuals born at extremely low gestations, although they tend to be included as part of slightly more mature populations. The growth in collaborative studies allows greater confidence in the identification of persisting risk and allows us to have confidence in the likely o...

Objective: We evaluated the best time to initiate delivery in late preterm pre-eclampsia in order to optimise long-term infant and maternal outcomes. Design: Parallel-group, non-masked, randomised controlled trial SETTING: 46 UK maternity units POPULATION: Women with pre-eclampsia between 34+0 and 36+6 weeks' gestation, without severe disease, w...

Background Antenatal corticosteroids (ACS) are recommended in threatened preterm labour to improve short term neonatal outcome. Preclinical animal studies suggest detrimental effects of ACS exposure on offspring cardiac development; their effects in humans are unknown. Objectives To systematically review the human clinical literature to determine t...

We report the development and assessment of a novel coding framework in the context of research into neonatal end-of-life decision making conversations. Data comprised 27 formal conversations between doctors and parents of critically ill babies, recorded in two neonatal intensive care units. The coding framework was developed from a qualitative ana...

Objective: To examine changes in lung function over time in extremely prematurely born adolescents. Working hypothesis: Changes in lung function during adolescence would vary by ventilation mode immediately after birth. Study design: Longitudinal follow-up study PATIENT SUBJECT SELECTION: Participants from the United Kingdom Oscillation Study...

Background The national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how simil...

Introduction Following the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring in...

Purpose To study the time course of retinopathy of prematurity (ROP) regression and reactivation following treatment with intravitreal ranibizumab or laser in the “RAnibizumab compared with laser therapy for the treatment of Infants BOrn prematurely With retinopathy of prematurity” (RAINBOW) trial. Design Post hoc analysis of a randomized clinical...

Importance: Children born preterm (<37 weeks' gestation) have a higher risk of visual impairment and ocular morbidities compared peers born at full term. However, the long-term ocular sequelae in adulthood for those born extremely preterm (EP), who have the highest risk of neonatal retinopathy, are unknown. Objective: To evaluate visual function...

Children born extremely preterm (EP) have poorer academic attainment than their term-born peers. There is a need to identify the specific cognitive mechanisms that are associated with poor academic attainment in preterm populations to inform the development of intervention strategies. A parallel mediation analysis was conducted with cross-sectional...

Background This study examined differences in ADHD symptoms and diagnosis between preterm and term-born adults (≥18 years), and tested if ADHD is related to gestational age, birth weight, multiple births, or neonatal complications in preterm borns. Methods (1) A systematic review compared ADHD symptom self-reports and diagnosis between preterm and...

(Abstracted from Health Technol Assess 2021;25:1–66) In England and Wales, approximately 16 of every 1000 women have a multiple gestation. Multiple pregnancies are associated with higher rates of stillbirth and neonatal and infant mortality, as well as child disability compared with singleton pregnancies.

Aim To investigate the strength of the independent associations of mathematics performance in children born very preterm (<32wks' gestation or <1500g birthweight) with attending postsecondary education and their current employment status in young adulthood. Method We harmonized data from six very preterm birth cohorts from five different countries...

Background Data on psychiatric disorders in survivors born very preterm (VP; <32 weeks) or very low birthweight (VLBW; <1500 g) are sparse. We compared rates of psychiatric diagnoses between VP/VLBW and term-born, normal birthweight (term/NBW) control participants. Methods This individual participant data (IPD) meta-analysis pooled data from eligi...

Care of pregnant women and their infants at extremely low gestational ages challenges clinical teams. The continuing rise in survival at gestational ages below 25 weeks has prompted re-evaluation of practice guidelines within the UK and other countries. This paper describes the background data that have guided our practice, the approach that has be...

Context: There is a lack of research on individual perceptions of social experiences and social relationships among very preterm (VP) adults compared with term-born peers. Objective: To investigate self-perceived social functioning in adults born VP (<32 weeks' gestation) and/or with very low birth weight (VLBW) (<1500g) compared with term-born...

Objective To compare health-related quality of life (HRQL) in childhood for extremely preterm (EP) births before 26 weeks of gestation in England in two eras: 1995 and 2006. Design Prospective cohort studies. Setting School or home-based assessments at 11 years of age. Participants Available data for 88 EP children born before 26 weeks of gestat...

Background Neonatal nurses are ideally placed in practice to undertake research enhancing the care of families. More information is required, however, around neonatal nursing led research to advance leadership in this area. The aim of this study was to determine neonatal nursing led research activity within the UK. Methods The study used a web-bas...

This secondary analysis of the PHOENIX trial (evaluating planned delivery against expectant management in late preterm preeclampsia) demonstrates that in women who started induction of labour, 63% of women delivered vaginally (56% at 34 weeks’ gestation). Compared to expectant management, planned delivery was associated with higher rates of neonata...

Prematurity and preterm stressors severely affect the development of infants born before 37 weeks of gestation, with increasing effects seen at earlier gestations. Although preterm mortality rates have declined due to the advances in neonatal care, disability rates, especially in middle-income settings, continue to grow. With the advances in MRI im...

Objective: Adverse event (AE) monitoring is central to assessing therapeutic safety. The lack of a comprehensive framework to define and grade maternal and fetal AEs in pregnancy trials severely limits understanding risks in pregnant women. We created AE terminology to improve safety monitoring for developing pregnancy drugs, devices and intervent...

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...

Children born very preterm (VP; <32 weeks’ gestation) have poorer mathematics achievement than term-born peers. This study aimed to determine whether VP children’s mathematics difficulties persist from primary to secondary school and to explore the nature of mathematics difficulties in adolescence. For this study, 127 VP and 95 term-born adolescent...

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...

Background Cervical cerclage is a recognised treatment to prevent late miscarriage and pre-term birth (PTB). Emergency cervical cerclage (ECC) for cervical dilatation with exposed unruptured membra