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uh thanks very much thank you for staying until the end uh i'm
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very surprised because i saw the swiss what was on time for everything so
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this is a huge uh emotional
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i i've only and just some complex i have had
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a funding from a commercial organisations as well as them
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the n. h. s. um i'm also says on the s.
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can connect again we have for inclusion network is more complex
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and and this is where i come from you cancel here in the north of england about three hundred miles long than
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a population reach about three million we have three nick use thirty five thousand but it's across the region
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and the new costs on the coup takes all the babies with complex
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surgery any see in these things so that's my day to day work
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and uh we have a website he anything new data research dot next if you have a smart phone
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and uh you shine it this set you are correct this will give you all the slides from today
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so you don't need to make any notes uh you can just go there and uh an access the slides
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and and on the on the website as well um you can read a bit about ah
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other research we've been involved in some big trials last year we finish the big black parents study
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the big sift feeding study i'm done with doing work
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with a proactive looking at human no come micro by him
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so we got a lot of activity that um as i say if i go
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around and i do talk to my slides rock bass there's about twenty five different talks
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and you're welcome to go along and you can take all the slides and use them for free
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and uh you can pretend they belong to you and everything out of my so that's fine
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and okay so his the left to control the light tomato the pretend
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babies by which i mean babies born between thirty two and thirty six weeks
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and the many many more these papers in papers plum for a pizza and but only in a two unit most
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stalwart is involved looking after the babies on the thirty
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weeks all twenty eight weeks and we spend very little interest
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in these big papers but likes more repeat i'm i'm gonna show you
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is that they have where sound comes over their entire life of course
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basic there says it was significant health care costs they have was caulking to pout comes
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they have was behavioural problems in infancy have wis metabolic count
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comes in our altered these are a very important uh griffith papers
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undertaken messages that even in this population studies have shown
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that breastfeeding has the potential to choose many these complications
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yeah so i've been to nutrition for many years now and what i find
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is that when you talk about nutrition people get very fixated on the nutrients
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and didn't step back and see nutrition is a slightly more holistic concept
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so what i think is hell freezes to recognise that all of these things uh what go to make up nutrition
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of course it's the machinations somewhat convictions it's also an awareness of the functional components
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that you won't get in french nutrition and you probably don't really getting for the milk
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important interactions with the micro pine we probably interest in this
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in our research program but then think about all the painful
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the social aspects the aspects of breast feeding the technical aspects nasal gastric or gastric
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bogus feeds this is all part of nutrition and it's new nato or just we need
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to see this is the concept and not just get focused on at the nutrient bits
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so you know all this you know that uh i like moderate
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preterm between thirty two and thirty sweets six weeks free preterm extremely pretend
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and the sort of the similar to pray low birth weight on low birth weight but of course
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later model if we turn is a very different concept from being
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low birth weight does a lot of overlap them not the same thing
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and uh so we have to pray web low birth weight does not equal weights whatever you pretend
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when you look at the global proponents of a permit
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to deliver you'll see them lots of parts of africa
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now some of between ten and fifteen we've never fifteen percent of babies supple and treat 'em
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this results in a major bit on hell systems
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is like to have lifelong consequences but these populations
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and when you look at the perimeter that this is the last uh more million babies
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less than twenty eight weeks these the baby is that we focus on the new late again
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apollo then you will see lots more babies born at twenty eight to
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thirty one but in this huge number of babies were born later moderately pretend
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and i can tell you now you will struggle to find
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a single randomised control trial of nutrition this group of papers
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despite the fact that it represents the greatest bit in the health care system
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so read about eight sensible pretend to select smoothly preterm in most countries
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about six or seven percent of all your pets like small group return
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obviously there are variations which reflects population resources maternal factors
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and nato factors with you scan with you and you say that
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are free but also data collection which is politically challenging in resourceful situations
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actually that the needs of light to moderate preterm babies may be similar in terms of
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risks of hype if fame you in high because i seem even pull grace
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uh then needs but similar but again each member that's moved just station age is not the same as low birth weight
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is not the same as i jot is not the same as like moderately preterm we need
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to separate these populations out to understand what we're talking about um what interventions might be relevant
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so if you is back in the u. k. they did a
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big a population based cohort study looking at lights moderately preterm baby
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and they were able to translate possible link to stay in interventions
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um and they could work out the costs of transferring babe is the cost the marker
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and the post i too costly to this using questionnaires looking at all the drug usage
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what they show is that for molly pretend baby the average cost around about
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twelve thousand pounds compared to any two thousand pounds for babies born to um
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so late to moderate pretend babies cost the health service much much small babies born to him
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and these the reasons why because when possible for longer you
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know all these factors you know that i'm much more like get
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oddly yes hypothermia hapless emailed the much more likely
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we heard a great talk this morning about feeding difficulties
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much more like to suffer weight loss simple groves infections due on this and this results in high rates of
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possible rip missions was perjury problems an increased risk mortality
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as we already understand these are very vulnerable group of papers
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early on again we'll know that they had in which you
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account to regulate you mechanisms that premier prototype try seem yeah
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the maybe not as good it's which opens and supply didn't have good glycogen stores they have low fat stores
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spend much more waste a north this is contributed to by the late feeding
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low volumes of milk and perhaps by low use of
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mothers know where it might be supplemented or place by former
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so we understand why high pricey mate is important risk in these babies
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and this is now from a large scope for conducted by lame boiling u. k. uh for you is gonna
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what she did was look at the risks of moderate pretend these
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of thirty two thirty three compact late preterm thirty four to thirty six
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and compare them to turn babies more you can see is that much more likely to be admitted nick you
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to have a much longer length of stay much more
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likely to need whispered to support high rates of printed tradition
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low rates of breast look at discharge any fifty percent compared to about seventy percent
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a much lower rates of exclusive breastfeeding so only about one in
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three these papers in the u. k. will go home exclusively breastfed
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sophie difficult is much more common again it's easy to understand why they have conjures pretty problems
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the metabolic glucose control or motor function is very interested in these
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babies they haven't on cool would make this stuff can swallow as
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we heard this morning and in the chip every style system much more likely to present us in terms of free flux of pa something
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and it's interesting to know whether these breathing difficulties may assist the
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on the neck you do we see the speeding problems in in one
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so sam johnson and elaine put this co what together of about six hundred
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fifty like a moderately preterm babies needed questionnaires ticket eating behaviours in four different domains
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refusal to eat or waiter problems or hype cents between eating behaviours
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and so used haven't reports but they also did a park
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arches a questionnaire bit like uh bailey and unemotional assessment school
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and what the show was like maury pretend babies a much more like to
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have food refusal but it was about one point five all or most problems
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the independent associations with into difficulties if they hadn't is gastric cheap one two weeks if they also
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have behaviour problems all the lights social competence these
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this sort of autistic tight features some these babies so
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when they look at the data most the feeling difficult to seem
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to be associated with neural developmental problems rocket than being born premature itself
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so this cover current serve feeding problems with behaviour problems is very important
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and the should alerts us the fact that eating difficulties knees impotence
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maybe a marker to more important on the line you would problem
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and having an n. g. g. bar for more than two weeks has
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a very strong respect in this group uh previews does not associated like problems
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okay enough to discharge these infants malden two times as likely to receive
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treatments for re flux when it to dean campus on these things like really the speeding problems persist
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and we know that in very preterm infants these pay this exhibit of phenotype which the
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people to stick in many respects so that's well very well known in the parade preterm babies
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and the not so many good studies we should a man but as we discussed this morning to the
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daily is not a very good measure of paper it's not a very subtle my shirt call the function
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and that social communication difficulties which are very important are actually quite difficult to assess
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but there is this questionnaire couldn't modify checked us but also
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the top list and chart which screens for papers with autistic features
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so they gave us out two years of age too late small impede term
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papers and then they forgot the telephone interview to validate that these results to true
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and the background term population any about point five percent of the population have
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autistic type each is this was about five times higher lights moderately pretend babies
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and there's a trend that seem to be associated with old maternal age whole
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mental health another but importantly not receiving breast look at this chart was another base
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we also did the bailey will the park ave looked
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your sensory outcomes as well they showed that compared with ten
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babies about five times as likely to have in your
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sensory impairment about two times as likely to have cognitive impairment
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these children represents a significant base but set in our population
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we tend not to follow babies optimal in thirty two weeks we just destroys these papers the family doctor
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i mean they look at the correlates they found independent this factors for having code impairment
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good being male socioeconomic status been nonwhite and if the mother happy times yeah
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but most important again not receiving breast milk discharge wasn't independent list for these problems
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again this data just compares all the papers to turn bay businesses compton pair
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of what we see like what we pretend mad about six percent supported payment
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compared twenty two percent to and read about seven percent happy new developmental disability compact twenty two percent
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so much higher right sit in your sensory problems about mental problems in this population
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so when you have added up it comes out to be so mad
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about to know hi-fi two point five i. q. points perhaps the boys
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interestingly yes seven times the base of girls would be quite interesting to
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speculate biologically why the risk is so much higher for boys and girls
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this association past look at discharge is very important and we know that
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the speech is also appear in extremely low birth weight papers as well
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so inadequate breast milk is associated with star come all the possible mechanisms
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and to think about this again i think it helps get back to this model and think about what we mean by nutrition
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and then we can start to understand perhaps nugent profiles and not receiving the
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breast milk you since the fatty acids the proteins might be back up you
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maybe aspects a psycho social functioning open thing that are affected
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maybe sensory aspects of taste and smell his papers that the private so from the first born
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of course would like to be functional aspects from not receiving breast no
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not getting enough liked affair and not enough no part probably membrane lots
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of these other compounds the maybe something to do with the mike voices
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really multiple reasons why the speech is maybe related teachers in these papers
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so why breastfeeding rates low well of course they get exposed to form a quite daily have interrupted skin
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to skin the sensory experiences in terms of taste and
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smell and all types that's to the to very different
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the mothers are different then then more likely to be peace the more likely to have pregnancy complications
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we know that some of them struggle to establish lactation and
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maybe socioeconomic factors basis i didn't know high quality on c.
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t.s despite this representing twelve million babies every in the world
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and i'm very few qualitative studies that really helps on the standard
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and what about the outcomes later on his a sick joke cobalt just like
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pretend babies thirty four to thirty six weeks assessed that six years of age
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still one twice as likely to have a low i. q. compact and babies
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more like kevin pad performance functioning again high levels autistic features
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these difficult to send it possessed a into into like to channel to
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this is data from scotland a long time ago this here represents the spurs sense just showed
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with special education on the c. c. children who need extra help in the school setting to function
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along the side they are on the bottom here you see just station week uh
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so that i'm only about two percent of the term population need special education needs
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again not surprise he went about fifty percent of your papers but what twenty four weeks need special help in school
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but i want you to notice that this is a continual line the reason to point which this risk decreases
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and you can see again the lights more the pretend babies that fits in this summer
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between about six and ten percent these babies alike you need extra help in the school setting
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so let me repeat and they must have whispering type outcomes of the life course
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like a breast feeding is an independent respect that but all observation or data is
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confounded we don't like to accept it because we like to write us that is
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but every observation study is confounded even if you
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adjust the still like it to be residual confounding there
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we don't know what the breast feeding is because uh some
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biological effect uh whether back a breast feeding is the marker
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to something different about them up though on some a market for smarter problem uh dishes experience
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so his one way to think about uh the hapless affect me think about exposures
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maybe these mothers exposed to different factors before they even conceive increase the
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risks in the baby maybe maternal disease all different drugs a lifestyle factors
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see these pages may be experiencing different in uterine
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environment create clam zero percent when you can supply
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and then the post they appeared is exactly know the baby the prototype
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us enough but of course if you're not gonna get these babies french
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nutrition they're not gonna get anywhere near the amount to be unless it's
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the debating you try would get over the past few days and weeks
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so lots of didn't exposures to think about and we can think about what mechanisms could be
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but it's possible that even preconceptions arisen tops exposes the mom
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but increase the risk of having a baby late somebody pretend that may also increase the risk the brain problem
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and there are likely to be a whole host of
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a genetic factors regulated by the i'm appalachian might be important
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we know that when that wanna you instruct brain
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development so thirty four weeks the brains only about sixty
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percent the size the baby it uh of those last four weeks you don't mass amount to bring right
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and and the maybe is the same nutritional factors but again thinking about nutrition the widest concept
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not just new tunes but functional nutrients microbiology and