Evaluating the relationship between newborn adversity and early years outcomes: a whole nation birth cohort using linked administrative data for England
“By 2028, we want a record proportion - 75% - of children to reach a good level of development by the end of reception.”
This study is being led by Rashmi D'Souza, Dr Ruth Blackburn, Prof Ruth Gilbert (UCL) and Dr Astrid Guttmann (University of Toronto). It is funded by Child Health Research CIO. The study started in March 2024 and aims to finish in December 2027.
This project was reviewed and approved through ECHILD's data access process. Learn how ECHILD data is kept safe.
-
We want to understand the relationship between newborn medical adversity and school readiness, and how the context of maternal and social adversity changes this relationship
-
1 in 3 children are not school-ready at the start of school. While newborns with certain conditions are offered standardised, multidisciplinary support in the early years, most newborns at-risk of needing support are not currently identified.
-
We will use linked mother-baby health records, and the infants linked educational records to evaluate the relationship between problems identified at birth and school readiness and health at 5 years.
Find out more
-
Why does this matter?
Currently only a small minority of the 1 in 3 children who start Reception year not school-ready are identified at birth.
What do we want to find out?
We want to better identify priority newborn populations who are likely to need support in the early years period.
What we will do
To equitably give children the best start in life, early years systems should pre-emptively support children at greatest need. Identifying adversity factors at birth would help target support as early as possible. This study aims to describe adversity factors experienced in the newborn period in relation to early years outcomes:
Newborn adversity will be evaluated according to the problems babies face, including medical, social, and pregnancy-related problems in the first 28 days of life
Early years outcomes will include school readiness at age 5 and health in the early years period
-
Background and aims
In England, 1 in 3 children are not school-ready in Reception year aged 5. The newborn period offers a critical window to identify priority populations for early years support. Current evidence explores individual perinatal conditions or cohorts, limiting generalisability to the full population.
This study aims to help practitioners caring for newborns about who might benefit from early support for potential additional learning needs. We used a birth cohort derived from the Education and Child Health Insight from Linked Data (ECHILD) database to determine the probability of being assessed as not school ready at age five according to validated indicators at postnatal discharge.
Methods and analysis
Primary exposures are newborn medical adversity measured using diagnostic and procedural codes for the English Newborn Adverse Outcome Indicator (NAOI) and Major Congenital Anomalies (MCA) recorded during hospital admissions in the neonatal period. The outcome is school readiness indicated by the national Early Years Foundation Stage Profile Good Level of Development at 5 years of age. Primary analyses describe minimally adjusted logistic regression models and predicted probabilities for not achieving school readiness. Secondary analyses further characterise patterning of this association in relation to maternal chronic health and psychosocial adversities, area-level deprivation, birth gestation and sex.
ECHILD data used
HES: Admitted Patient Care records including mother-baby linked delivery and birth admissions, maternal admissions before delivery
NPD records including the Early Years Foundation Stage Profile Good Level of Development assessment outcome