Preterm birth and paediatric intensive care: Using national data to examine critical illness in early childhood

Preterm or premature birth is when a baby is born before 37 weeks of pregnancy. Around 8% of babies born in the United Kingdom (UK) each year are preterm (60,000 babies annually). Very preterm children, those born before 32 weeks (1.2% of all births and 17% of preterm births), require specialist neonatal care before going home. They can have complications from preterm birth, affecting organs including the lungs, the brain, and the gut. Paediatric intensive care units (PICUs) provide specialist critical care for children of all ages. After going home from neonatal care, if children become very unwell they may require admission to PICU, however there are limited data on the numbers of pretermborn children needing PICU, or their outcomes. In this thesis, I aimed to use large-scale national datasets to examine PICU admissions of preterm-born children, focusing particularly on those born <32 weeks. This thesis is comprised of four workstreams:

1. Systematic review of existing literature examining PICU admissions of pretermborn children, and their clinical outcomes within PICU. Meta-analysis was performed where possible.

2. Analysis of trends in all PICU admissions aged under two years in England between 2008 and 2018, using data from the Paediatric Intensive Care Audit Network (PICANet). Outcomes within PICU for preterm and term-born children were compared using multivariable analysis.

3. Retrospective cohort study using linkage of data from the National Neonatal Research Database (NNRD) and PICANet to examine PICU admissions of children born <32 weeks, and factors associated with this.

4. Co-design of infographics summarising my results in an accessible format describing my results, to aid communication between healthcare professionals and families, developed with stakeholders including healthcare staff, academics, and families of preterm children.