In 2018, Her Majesty's Government published statutory and operational guidance setting out how children’s deaths are reviewed in England, aiming to ensure practice is standardised and review of each child’s death is of uniform quality.
ObjectiveA national survey of paediatric intensive care units (PICUs) to review the implementation of the statutory guidance.
DesignOnline survey exploring child death review (CDR) practices against expected operational standards across three domains: (1) Logistics and administration of the CDR process, (2) the CDR meeting and (3) communication with bereaved families.
Results19/21 (91%) English PICUs, 1/1 Welsh and 1/1 Northern Irish PICUs responded to the survey request. 6/21 PICUs reported no remuneration for their CDR work. 18/21 reported routinely notifying the local child death overview panel of a child death within 48 hours as per statutory guidance. 8/21 (38%) achieved the current National Health Service England quality outcome target of holding the CDR meeting within 3 months of a child’s death. 17/21 (81%) PICUs appointed a ‘key worker’ as a single point of access to bereaved families. 12/21 (52%) PICUs routinely offered families the option to be informed of the outcome of the CDR meeting at bereavement follow-up.
ConclusionsThis survey is the first to report on CDR practices in PICUs. It highlights significant variation between units in the application of national guidance. It suggests that further recommendations are required in the application of the statutory guidance to ensure greater parity between units, that learning is shared effectively between agencies and that all bereaved families receive the appropriate information and support.
To explore how birth weight and size-for-gestation may contribute to school absences and educational attainment and whether there are different associations across sex and income groups.
DesignLongitudinal linked cohort study.
MethodsData were drawn from the Millennium Cohort Study, a nationally representative cohort of children born in 2000–2001; percentage of authorised and unauthorised absences from Year 1 to Year 11, and Key Stage test scores at ages 7, 11 and 16 in English and Maths were linked from the National Pupil Database. Birth outcomes and covariates were derived from the 9-month survey, and linear regressions with complex survey weights were fitted.
ResultsBeing born small-for-gestational-age (vs average-for-gestational-age) was associated with an increase of 0.47%, 0.55% and 0.40% in authorised absences in Years 1, 3 and 4 (n=6659) and with a reduction of 0.16–0.26 SD in all English and Maths test scores (n=6204). Similar associations were found for birth weight. After adjusting for prior test scores, English (b=0.07) and Maths (b=0.05) performance at age 11 remained associated with birth weight. Socioeconomic status modified the associations: there were larger disparities in test scores among higher-income families, suggesting that higher income did not compensate for being born small-for-gestational-age.
ConclusionChildren born smaller missed slightly more classes (~1 day per year) during primary school and had lower English and Maths performance across compulsory education. Exploring specific health conditions and understanding how education and health systems can work together to support children may help to reduce the burden.
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