Periodic Reporting for period 2 - TVPIPD (Trajectories of social, emotional and attention problems following very preterm birth: Individual participant data meta-analyses via international data sharing)
Reporting period: 2023-05-01 to 2024-04-30
Each year over two million babies are born very preterm (VP; before 32 weeks of gestation) and/or with very low birthweight (VLBW; less than 1500g) worldwide. Despite improved neonatal care, these children remain at high risk for developmental problems later in life. Among the most common developmental problems are social, emotional and attention problems which can have a negative impact on a child’s lifelong health and wellbeing. To target interventions to improve outcomes across the lifespan, it is critical to understand trajectories of social, emotional and attention problems after VP/VLBW birth, that is, how these problems develop and change as children grow older. Although a wealth of data has already been collected in cross-sectional studies, there is still a lack of research investigating trajectories of social, emotional and attention problems in very preterm born children and adolescents.
This project thus far drew together data from 18 international birth cohort studies. This includes data about outcomes in childhood and adolescence from approximately 4,500 VP/VLBW and term born participants. I used novel, innovative statistical techniques to harmonise data from mental health assessments to create a unique dataset which will allow me to carry out the largest study of trajectories of attention, social and emotional problems to date. The results will advance theoretical understanding of how social, emotional and attention problems develop in children born VP/VLBW. They are likely to have international impact by informing the development of clinical guidelines for follow-up care, intervention, parental counselling and educational policy and planning.
The scientific objectives were to:
(1) bring together existing international data on social, emotional and attention problems,
(2) apply novel and innovative statistical techniques to harmonise data from two different instruments that measure social, emotional and attention problems,
(3) determine the trajectory of social, emotional and attention problems from childhood to adolescence after VP/VLBW birth,
(4) test whether social, emotional and attention problems are more stable among VP/VLBW than among term-born children and adolescents, and
(5) identify and test factors that may affect the development of social, emotional and attention problems in VP/VLBW children.
The ultimate aim of this research project was to improve lifelong outcomes for children born very preterm.
This project thus far drew together data from 18 international birth cohort studies. This includes data about outcomes in childhood and adolescence from approximately 4,500 VP/VLBW and term born participants. I used novel, innovative statistical techniques to harmonise data from mental health assessments to create a unique dataset which will allow me to carry out the largest study of trajectories of attention, social and emotional problems to date. The results will advance theoretical understanding of how social, emotional and attention problems develop in children born VP/VLBW. They are likely to have international impact by informing the development of clinical guidelines for follow-up care, intervention, parental counselling and educational policy and planning.
The scientific objectives were to:
(1) bring together existing international data on social, emotional and attention problems,
(2) apply novel and innovative statistical techniques to harmonise data from two different instruments that measure social, emotional and attention problems,
(3) determine the trajectory of social, emotional and attention problems from childhood to adolescence after VP/VLBW birth,
(4) test whether social, emotional and attention problems are more stable among VP/VLBW than among term-born children and adolescents, and
(5) identify and test factors that may affect the development of social, emotional and attention problems in VP/VLBW children.
The ultimate aim of this research project was to improve lifelong outcomes for children born very preterm.
The project was carried out across six work packages in order to achieve all scientific and training objectives. In order to draw together international data, I identified and contacted the custodians of potentially eligible birth cohort studies, that is, cohorts that had collected mental health outcome data from birth via two widely used questionnaires in childhood and adolescence. This was done through an existing collaborative group (APIC – Adults born Preterm International Collaboration) and through a systematic literature search. The custodians of 26 cohorts agreed to participate and share their data for this project. The custodian of each cohort was asked to provide information about their study. Legal agreements were drafted and sent out to the custodians. Currently, agreements for 18 cohorts have been signed and agreements for a further 8 cohorts are still in progress.
Based on a literature search and discussions with my supervisory team and scientific advisory group, as well as with other colleagues with expertise and experience in data harmonisation, a statistical analysis plan for data harmonisation was produced. Retrospective harmonisation of data collected using two measures of attention, social, emotional and attention problems was achieved. This work was presented at the 5th Congress of the joint European Neonatal Societies (jENS), in September 2023 in Rome, Italy and subsequently published in a high-quality open access journal that focuses on methods in psychiatric research.
During the final year I discussed, planned and partially performed the main analyses for the planned three manuscripts. These analyses were to answer the following research questions to be addressed across three manuscripts.
Manuscript 1: Do children and adolescents born preterm have more attention, emotional, behaviour and social problems compared to their term born peers?
Manuscript 2: Are there differences in attention, emotional, behaviour and social problems between girls and boys in VP/VLBW and term-born children and adolescents?
Do neonatal and social-environmental factors have an effect on these problems? Do differences vary depending on age?
Manuscript 3: Do the trajectories of attention, emotional, behaviour and social problems across childhood and adolescence differ between VP/VLBW individuals and their term-born counterparts and are these problems more stable among VP/VLBW than term-born children and adolescents?
The first manuscript uses individual participant data meta-analyses to test and compare emotional, peer relationship, attention/hyperactivity and conduct problems in children and adolescents born VP/VLBW and term-born peers. The preliminary findings from this work were disseminated through presentations at the Universities of Leicester and Warwick, UK. The manuscript has been drafted and will be circulated to co-authors and international collaborators for comment in July 2024. The statistical analyses for Manuscript 2 and 3 will answer the remaining research questions. These analyses have been planned and partially programmed during the reporting period and I am planning to finalise the analyses and write up of all planned manuscripts by April 2025.
Based on a literature search and discussions with my supervisory team and scientific advisory group, as well as with other colleagues with expertise and experience in data harmonisation, a statistical analysis plan for data harmonisation was produced. Retrospective harmonisation of data collected using two measures of attention, social, emotional and attention problems was achieved. This work was presented at the 5th Congress of the joint European Neonatal Societies (jENS), in September 2023 in Rome, Italy and subsequently published in a high-quality open access journal that focuses on methods in psychiatric research.
During the final year I discussed, planned and partially performed the main analyses for the planned three manuscripts. These analyses were to answer the following research questions to be addressed across three manuscripts.
Manuscript 1: Do children and adolescents born preterm have more attention, emotional, behaviour and social problems compared to their term born peers?
Manuscript 2: Are there differences in attention, emotional, behaviour and social problems between girls and boys in VP/VLBW and term-born children and adolescents?
Do neonatal and social-environmental factors have an effect on these problems? Do differences vary depending on age?
Manuscript 3: Do the trajectories of attention, emotional, behaviour and social problems across childhood and adolescence differ between VP/VLBW individuals and their term-born counterparts and are these problems more stable among VP/VLBW than term-born children and adolescents?
The first manuscript uses individual participant data meta-analyses to test and compare emotional, peer relationship, attention/hyperactivity and conduct problems in children and adolescents born VP/VLBW and term-born peers. The preliminary findings from this work were disseminated through presentations at the Universities of Leicester and Warwick, UK. The manuscript has been drafted and will be circulated to co-authors and international collaborators for comment in July 2024. The statistical analyses for Manuscript 2 and 3 will answer the remaining research questions. These analyses have been planned and partially programmed during the reporting period and I am planning to finalise the analyses and write up of all planned manuscripts by April 2025.
One of the main objectives of this project, which has been fully achieved, was to apply novel and innovative statistical techniques to harmonise data from two instruments that measure social, emotional and attention problems (Objective 2). This work progresses the field beyond the state of the art as this has not been done before using item-level data.
Importantly, this work enables the main analyses (that is, individual participant data meta-analysis) to be carried out which were the focus of Objectives 3, 4 and 5 of this project. First results from these analyses have already been produced and presented.
Although the fellowship ended in April 2024, the findings according to the Scientific Objectives 3 to 5 will continue to be disseminated as planned.
The work carried out during the project period creates new opportunities for pooling, data harmonisation and statistical analyses across a variety of samples and research topics within national and international collaborative groups and projects. The findings from this project will strengthen Europe’s approach to comprehensive data collection, in particular on mental health outcomes of children and adolescents. The findings will inform stakeholders on the risk, prevalence and course of mental health problems, which will be of benefit to society as well as for children and adolescents born preterm and their families. The project results will be useful for academics and health professionals. The findings from the novel data harmonisation work as well as from the individual participant data meta-analysis on mental health outcomes in VP/VLBW individuals are particularly important for researchers and clinicians interested in assessing children’s and adolescents’ mental health.
Importantly, this work enables the main analyses (that is, individual participant data meta-analysis) to be carried out which were the focus of Objectives 3, 4 and 5 of this project. First results from these analyses have already been produced and presented.
Although the fellowship ended in April 2024, the findings according to the Scientific Objectives 3 to 5 will continue to be disseminated as planned.
The work carried out during the project period creates new opportunities for pooling, data harmonisation and statistical analyses across a variety of samples and research topics within national and international collaborative groups and projects. The findings from this project will strengthen Europe’s approach to comprehensive data collection, in particular on mental health outcomes of children and adolescents. The findings will inform stakeholders on the risk, prevalence and course of mental health problems, which will be of benefit to society as well as for children and adolescents born preterm and their families. The project results will be useful for academics and health professionals. The findings from the novel data harmonisation work as well as from the individual participant data meta-analysis on mental health outcomes in VP/VLBW individuals are particularly important for researchers and clinicians interested in assessing children’s and adolescents’ mental health.