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Antenatal Assessment of the Prognosis of Congenital Diaphragmatic Hernia: Ethical Considerations and Impact for the Management. Healthcare (Basel) 2022; 10:healthcare10081433. [PMID: 36011090 PMCID: PMC9408048 DOI: 10.3390/healthcare10081433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Congenital diaphragmatic hernia (CDH) is associated with abnormal pulmonary development, which is responsible for pulmonary hypoplasia with structural and functional abnormalities in pulmonary circulation, leading to the failure of the cardiorespiratory adaptation at birth. Despite improvement in treatment options and advances in neonatal care, mortality remains high, at close to 15 to 30%. Several risk factors of mortality and morbidities have been validated in fetuses with CDH. Antenatal assessment of lung volume is a reliable way to predict the severity of CDH. The two most commonly used measurements are the observed/expected lung to head ratio (LHRo/e) and the total pulmonary volume (TPV) on MRI. The estimation of total pulmonary volume (TPVo/e) by means of prenatal MRI remains the gold standard. In addition to LHR and TPV measurements, the position of the liver (up, in the thorax or down, in the abdomen) also plays a role in the prognostic evaluation. This prenatal prognostic evaluation can be used to select fetuses for antenatal surgery, consisting of fetoscopic endoluminal tracheal occlusion (FETO). The antenatal criteria of severe CDH with an ascended liver (LHRo/e or TPVo/e < 25%) are undoubtedly associated with a high risk of death or significant morbidity. However, despite the possibility of estimating the risk in antenatal care, it is difficult to determine what is in the child’s best interest, as there still are many uncertainties: (1) uncertainty about individual short-term prognosis; (2) uncertainty about long-term prognosis; and (3) uncertainty about the subsequent quality of life, especially when it is known that, with a similar degree of disability, a child’s quality of life varies from poor to good depending on multiple factors, including family support. Nevertheless, as the LHR decreases, the foreseeable “burden” becomes increasingly significant, and the expected benefit is increasingly unlikely. The legal and moral principle of the proportionality of medical procedures, as well as the prohibition of “unreasonable obstinacy” in all investigations or treatments undertaken, is necessary in these situations. However, the scientific and rational basis for assessing the long-term individual prognosis is limited to statistical data that do not adequately reflect individual risk. The risk of self-fulfilling prophecies should be kept in mind. The information given to parents must take this uncertainty into account when deciding on the treatment plan after birth.
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Abstract
Neonatal follow-up studies traditionally report on long-term neurodevelopmental outcomes as a metric of success of neonatal intensive care. Research endpoints are also typically deficit-based, assessing whether disabilities, such as cerebral palsy, cognitive impairment, deafness or blindness, are present or not. These historical approaches have resulted in neonatal follow-up programs that narrowly focus on the early identification of neurodevelopmental problems, possibly to the detriment of other outcomes that matter to parents. This focus on neurodevelopmental disability may also contribute to the negative stereotypes associated with extreme preterm birth. In this article, we discuss parental perspectives regarding important long-term outcomes. We examine limitations with current definitions of outcomes and propose a strength-based approach to generate meaningful findings both for clinicians and families.
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Abstract
BACKGROUND Few understand the experience of having an infant in the neonatal intensive care unit (NICU). This article provides a discussion about the importance of an annual reunion for former NICU infants, their families, and neonatal staff. PURPOSE The purpose of this article is to explain the impact of the NICU reunion on families and neonatal healthcare providers and describe the experience of organizing this reunion over the past 20 years. METHODS This is a description of how a NICU reunion was organized at a regional neonatal center. Graphic-designed invitations were e-mailed to NICU graduates, who previously agreed to being contacted, 2 months prior to the reunion date. Social media were utilized to publicize the event on the hospital's Web site. RESULTS At the reunion, parents and families introduced their NICU graduate to the neonatal staff who cared for them while hospitalized. Sometimes staff found it difficult to recognize the NICU graduates, who were toddlers or older. Parents were relaxed, expressing their appreciation for care received. IMPLICATIONS FOR PRACTICE The impact of seeing an infant, born at 24 weeks, now walking, talking, and running cultivates pride in the NICU healthcare team. The reunion adds a positive dimension to the work of NICU caregivers. Parents look forward to attending the reunion to reconnect with NICU staff and other NICU parents. IMPLICATIONS FOR RESEARCH Directions for future study include a comparison of staff and families who attend the NICU reunion and those who do not, by using a survey or online evaluation tool, to improve future reunions.
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Hintz SR, Vohr BR, Bann CM, Taylor HG, Das A, Gustafson KE, Yolton K, Watson VE, Lowe J, DeAnda ME, Ball MB, Finer NN, Van Meurs KP, Shankaran S, Pappas A, Barnes PD, Bulas D, Newman JE, Wilson-Costello DE, Heyne RJ, Harmon HM, Peralta-Carcelen M, Adams-Chapman I, Duncan AF, Fuller J, Vaucher YE, Colaizy TT, Winter S, McGowan EC, Goldstein RF, Higgins RD. Preterm Neuroimaging and School-Age Cognitive Outcomes. Pediatrics 2018; 142:peds.2017-4058. [PMID: 29945955 PMCID: PMC6128951 DOI: 10.1542/peds.2017-4058] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children born extremely preterm are at risk for cognitive difficulties and disability. The relative prognostic value of neonatal brain MRI and cranial ultrasound (CUS) for school-age outcomes remains unclear. Our objectives were to relate near-term conventional brain MRI and early and late CUS to cognitive impairment and disability at 6 to 7 years among children born extremely preterm and assess prognostic value. METHODS A prospective study of adverse early and late CUS and near-term conventional MRI findings to predict outcomes at 6 to 7 years including a full-scale IQ (FSIQ) <70 and disability (FSIQ <70, moderate-to-severe cerebral palsy, or severe vision or hearing impairment) in a subgroup of Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial enrollees. Stepwise logistic regression evaluated associations of neuroimaging with outcomes, adjusting for perinatal-neonatal factors. RESULTS A total of 386 children had follow-up. In unadjusted analyses, severity of white matter abnormality and cerebellar lesions on MRI and adverse CUS findings were associated with outcomes. In full regression models, both adverse late CUS findings (odds ratio [OR] 27.9; 95% confidence interval [CI] 6.0-129) and significant cerebellar lesions on MRI (OR 2.71; 95% CI 1.1-6.7) remained associated with disability, but only adverse late CUS findings (OR 20.1; 95% CI 3.6-111) were associated with FSIQ <70. Predictive accuracy of stepwise models was not substantially improved with the addition of neuroimaging. CONCLUSIONS Severe but rare adverse late CUS findings were most strongly associated with cognitive impairment and disability at school age, and significant cerebellar lesions on MRI were associated with disability. Near-term conventional MRI did not substantively enhance prediction of severe early school-age outcomes.
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Affiliation(s)
- Susan R. Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children’s Hospital, Palo Alto, California
| | - Betty R. Vohr
- Department of Pediatrics, Women and Infants Hospital and Brown University, Providence, Rhode Island
| | - Carla M. Bann
- Social, Statistical, and Environmental Sciences Unit, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - H. Gerry Taylor
- Department of Pediatrics, Rainbow Babies and Children’s Hospital and Case Western Reserve University, Cleveland, Ohio
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, Research Triangle Institute International, Rockville, Maryland
| | | | - Kimberly Yolton
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Victoria E. Watson
- Department of Pediatrics, Women and Infants Hospital and Brown University, Providence, Rhode Island
| | - Jean Lowe
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Maria Elena DeAnda
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children’s Hospital, Palo Alto, California
| | - M. Bethany Ball
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children’s Hospital, Palo Alto, California
| | - Neil N. Finer
- Department of Pediatrics, University of California at San Diego, San Diego, California
| | - Krisa P. Van Meurs
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children’s Hospital, Palo Alto, California
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Athina Pappas
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Patrick D. Barnes
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children’s Hospital, Palo Alto, California
| | - Dorothy Bulas
- Department of Diagnostic Imaging and Radiology, Children’s National Medical Center, Washington, District of Columbia
| | - Jamie E. Newman
- Social, Statistical, and Environmental Sciences Unit, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Deanne E. Wilson-Costello
- Department of Pediatrics, Rainbow Babies and Children’s Hospital and Case Western Reserve University, Cleveland, Ohio
| | - Roy J. Heyne
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heidi M. Harmon
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana
| | | | - Ira Adams-Chapman
- Department of Pediatrics, School of Medicine, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Andrea Freeman Duncan
- Department of Pediatrics, McGovern Medical School, University of Texas at Houston, Houston, Texas
| | - Janell Fuller
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Yvonne E. Vaucher
- Department of Pediatrics, University of California at San Diego, San Diego, California
| | | | - Sarah Winter
- Division of Neonatology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Elisabeth C. McGowan
- Department of Pediatrics, Women and Infants Hospital and Brown University, Providence, Rhode Island;,Division of Newborn Medicine, Department of Pediatrics, Tufts Medical Center, Floating Hospital for Children, Boston, Massachusetts; and
| | | | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Sell K, Rapp M, Muehlan H, Spiegler J, Thyen U. Frequency of participation and association with functioning in adolescents born extremely preterm - Findings from a population-based cohort in northern Germany. Early Hum Dev 2018; 120:67-73. [PMID: 29674248 DOI: 10.1016/j.earlhumdev.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Outcomes after extremely preterm birth (<28 weeks gestation) have been studied intensely, and follow-up into adulthood is well-established. Following the introduction of the International Classification of Functioning, Disability and Health, participation has been recognized to be a relevant outcome in rehabilitation research. During adolescence, participation is crucial to adapting to new social roles. The aim of our study was to investigate participation in the domains Autonomy, Relationships and Community Recreation. METHODS Participation was assessed as part of a cross-sectional, population-based study in a German federal state examining all adolescents born between January 1997 and December 1999 at under 27 weeks gestation. Of the surviving 90 adolescents, 72 (80%) were followed-up at age 14 to 17. Frequency of participation was assessed using the short form of the Questionnaire of Young People's Participation and compared to matched peers. Associations with physical, cognitive, and psychological functioning and contextual factors were examined using multivariate regression. RESULTS Frequency of participation in Autonomy, Relationships, and Community Recreation in adolescents born extremely preterm was significantly lower than that of matched peers from the general population (p < 0,001). Lower frequency of participation in Autonomy and Relationships was associated with severe physical and cognitive impairment, and psychological problems. Fifty-seven percent of the adjusted variance in Autonomy and 31% of the adjusted variance in Relationships was explained by our regression models. CONCLUSION Further research is warranted to investigate additional factors associated with the restricted frequency of participation of adolescents born preterm to design suitable interventions for improving participation.
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Affiliation(s)
- K Sell
- Klinik für Kinder- und Jugendmedizin, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - M Rapp
- Klinik für Kinder- und Jugendmedizin, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany.
| | - H Muehlan
- Department Health & Prevention, Ernst-Moritz-Arndt-University Greifswald, Robert-Blum-Str. 13, 17487 Greifswald, Germany.
| | - J Spiegler
- Klinik für Kinder- und Jugendmedizin, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany.
| | - U Thyen
- Klinik für Kinder- und Jugendmedizin, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany.
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Abstract
There have been amazing changes in outcomes of preterm (PT) infants in the past decades. Whereas early studies reported only survival rates, Dr. Julius Hess published the first outcome study of PT infants in Chicago in 1953. Dr. Lubchenco then published the 10-year follow-up of premature infants born in 1947-1953 and identified a 68% handicap rate. As a result of these early studies, the importance of evaluating NICU graduates both for surveillance and as an outcome of trials was recognized. During the 1970s, there was a gradual expansion in the number of follow-up programs in the United States (US) with an increasing number of follow-up studies published. In the 1980s, the importance of multicenter clinical research networks was recognized and the NICHD Neonatal Research Network (NRN) was initiated in 1986. Follow-up protocols, definitions, and outcomes have evolved over the last 30 years and will be reviewed with a focus on NICHD NRN studies.
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Affiliation(s)
- Susan R Hintz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304
| | - Jamie E Newman
- Public Health Research Division, RTI International, Research Triangle Park, NC
| | - Betty R Vohr
- Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics Women & Infants Hospital of Rhode Island, Providence, RI.
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AlFaleh K, Alluwaimi E, AlOsaimi A, Alrajebah S, AlOtaibi B, AlRasheed F, AlKharfi T, Paes B. A prospective study of maternal preference for indomethacin prophylaxis versus symptomatic treatment of a patent ductus arteriosus in preterm infants. BMC Pediatr 2015; 15:47. [PMID: 25895495 PMCID: PMC4414008 DOI: 10.1186/s12887-015-0353-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 03/20/2015] [Indexed: 12/04/2022] Open
Abstract
Background The management of a patent ductus arteriosus in preterm infants continues to be debated among neonatologists due to the absence of concrete evidence that precisely weighs the long term outcomes of active, early intervention against a conservative approach. In the majority of institutions, parents are encouraged to play an active role in the complex, decision –making processes with regard to the care of their infants. The objective of this study is to elicit maternal preferences for indomethacin prophylaxis versus treatment of a patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants, utilizing a decision aid instrument (DAI). Methods Healthy and high risk pregnant women at 23–28 weeks gestation, and mothers of admitted ELBW infants were enrolled. A computer based, validated DAI was utilized during interviews. The DAI first provides information about prematurity and concurrent morbidities with comprehensive facts of the pros and cons about prophylactic versus treatment options. It subsequently coaches participants how to select values and preferences based on their decisions. A 17-item questionnaire assessed and valued each short and long term morbidity of extreme prematurity and preferred choice for PDA management. Results Two hundred ninety nine subjects were enrolled; 75% were healthy women at 23–28 weeks gestation, 19% were high risk and 6% recently delivered an ELBW infant. Eighty-two percent preferred a prophylactic indomethacin strategy versus symptomatic treatment for the management of PDA. Across a spectrum of potential morbidities, the occurrence of severe intraventricular hemorrhage was viewed by mothers as the most un-wanted outcome irrespective of the two proposed options. Conclusions In contrast to neonatal practitioners, mothers who used this particular DAI strongly endorsed prophylactic indomethacin versus a treatment intervention for the management of PDA in preterm infants. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0353-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Khalid AlFaleh
- Department of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Eman Alluwaimi
- Department of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Ahlam AlOsaimi
- Department of Pediatrics, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Sheikha Alrajebah
- Department of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Bashayer AlOtaibi
- Department of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Fatima AlRasheed
- Department of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Turki AlKharfi
- Department of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, ON, Canada.
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Soergel P, Makowski L, Schippert C, Staboulidou I, Hille U, Hillemanns P. The cost efficiency of HPV vaccines is significantly underestimated due to omission of conisation-associated prematurity with neonatal mortality and morbidity. Hum Vaccin Immunother 2014; 8:243-51. [DOI: 10.4161/hv.18519] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Walz PC, Hubbell MP, Elmaraghy CA. Voice related quality of life in pediatric patients with a history of prematurity. Int J Pediatr Otorhinolaryngol 2014; 78:1010-4. [PMID: 24768275 PMCID: PMC4166401 DOI: 10.1016/j.ijporl.2014.03.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/16/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine incidence of dysphonia in patients with history of prematurity and evaluate the correlation between dysphonia and risk factors unique to premature infants. The aim of this study is to determine parent-perceived vocal quality in patients with history of prematurity and whether duration of intubation, number of intubations, and incidence of patent ductus arteriosus repair were correlated with these perceptions. METHODS Cohort study of premature patients presenting to outpatient clinics from January 2010 to January 2013 in tertiary care center. Patients gestational age ≤37 weeks at birth without history of tracheostomy or known vocal fold pathology were eligible. A volunteer sample was obtained from patients presenting in Otolaryngology clinics from January 2010 to January 2013 whose parents agreed to complete surveys. Outcomes were assessed via parental completion of pediatric voice outcomes score (pVOS) and pediatric voice-related quality of life (pVRQOL) instruments. The primary outcome assessed was the incidence of dysphonia in infants with a history of prematurity without known vocal pathology. Additionally, patient factors associated with dysphonia were evaluated. The hypothesis tested was formulated prior to data collection. RESULTS Sixty-nine participants were included. Mean age at follow-up was 28 (3-197) months. Mean gestational age was 29 (23-37) weeks. Mean intubation duration was 3 (0-22) weeks and median number of intubations was 1 (range 0-5). Voice outcome scores varied widely with pVRQOL scores demonstrating a mean of 89.2±18.1 (25-100) and pVOS with a mean of 11.4±2.2 (0-13). Univariate analysis utilized Spearman correlation coefficients for continuous variables and Wilcoxon Two-sample test for categorical groups. Significance was set at p<0.05. All significant univariate associations were placed in a multivariate model. Duration of intubation ≥4 weeks was the only factor which correlated with dysphonia on multivariate analysis (p=0.0028, OR=6.4, 95% CI=1.9-21.6). CONCLUSIONS The data suggest that prolonged intubation is associated with poorer long term parent-perceived voice quality in premature patients. Further study is required to correlate parent perceptions with objective vocal quality data and physical findings of vocal pathology. These data may increase the clinician's suspicion for and evaluation of dysphonia in this population.
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Affiliation(s)
- Patrick C Walz
- Ann and Robert H. Lurie Children's Hospital, McGaw Medical Center, Northwestern University, Chicago, IL, United States; Nationwide Children's Hospital, Columbus, OH, United States; Wexner Medical Center at the Ohio State University, Columbus, OH, United States.
| | | | - Charles A Elmaraghy
- Nationwide Children’s Hospital, Columbus, OH,Wexner Medical Center at the Ohio State University, Columbus, OH
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Abstract
The outcomes of very low birth weight survivors born in the early post-neonatal intensive care era have now been reported to young adulthood in several longitudinal cohort studies, and more recently from large Scandinavian national databases. The latter reports corroborate the findings that despite disabilities, a significant majority of very low birth weight survivors are leading productive lives, and are functioning better than expected. This is reassuring, but there are still concerns about future psychopathology, cardiovascular and metabolic problems as they approach middle age. Although these findings may not be directly applicable to the current survivors of modern neonatal intensive care, they do provide a yardstick by which to project the outcomes of future survivors until more contemporaneous data are available.
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Affiliation(s)
- Saroj Saigal
- Neonatal Follow-up Program, McMaster University, Hamilton, Ontario, Canada.
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Quality of life at age 18 years after extremely preterm birth in the post-surfactant era. J Pediatr 2013; 163:1008-13.e1. [PMID: 23885966 DOI: 10.1016/j.jpeds.2013.05.048] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 04/29/2013] [Accepted: 05/24/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the self-reported quality of life, health status, self-esteem, and functional outcomes at age 18 years of extremely preterm (EP; <28 weeks gestation) or extremely low birth weight (ELBW; birth weight <1000 g) adolescents born in 1991-1992 compared with normal birth weight (birth weight >2499 g) controls, and, within the EP/ELBW cohort, to assess whether these outcomes are related to gestational age or birth weight. STUDY DESIGN Self-reported measures of quality of life, health status, self-esteem, and functional outcomes were obtained at age 18 years from a geographic cohort of all survivors born EP/ELBW in 1991-1992 in the state of Victoria, Australia, along with matched normal birth weight controls. RESULTS Data were available from 194 EP/ELBW and 148 control adolescents. EP/ELBW adolescents reported similar overall quality of life, health status, and self-esteem as controls (P > .05). Birth at younger gestational age or lower birth weight were not related to poorer quality of life within the EP/ELBW cohort (P > .05). EP/ELBW adolescents reported less physical activity (OR, 0.5; 95% CI, 0.3-0.8; P < .01), sexual activity (OR, 0.6; 95% CI, 0.4-0.9; P = .01), and alcohol intake (OR, 0.5; 95% CI, 0.3-0.8; P = .01) compared with controls. Other aspects of risk-taking behavior were similar in the 2 groups (P > .05). CONCLUSION EP/ELBW individuals born after the introduction of exogenous surfactant are transitioning well into young adulthood, despite the fact that more of the tiniest and most immature infants survive than ever before. They report similar quality of life, self-esteem, and social and risk-taking behaviors as controls.
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Hack M, Schluchter M, Forrest CB, Taylor HG, Drotar D, Holmbeck G, Youngstrom E, Margevicius S, Andreias L. Self-reported adolescent health status of extremely low birth weight children born 1992-1995. Pediatrics 2012; 130:46-53. [PMID: 22665412 PMCID: PMC3382919 DOI: 10.1542/peds.2011-3402] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare the self-reported health of extremely low birth weight (ELBW, <1 kg) adolescents with that of normal birth weight (NBW) controls and the children's assessments of their general health at ages 8 versus 14 years. METHODS One hundred sixty-eight ELBW children and 115 NBW controls of similar gender and sociodemographic status completed the Child Health and Illness Profile-Adolescent Edition at age 14 years. It includes 6 domains: Satisfaction, Comfort, Resilience, Risk Avoidance, Achievement, and Disorders. At age 8 years, the children had completed the Child Health and Illness Profile-Child Edition. Results were compared between ELBW and NBW subjects adjusting for gender and sociodemographic status. RESULTS ELBW adolescents rated their health similar to that of NBW adolescents in the domains of Satisfaction, Comfort, Resilience, Achievement and Disorders but reported more Risk Avoidance (effect size [ES] 0.6, P < .001). In the subdomain of Resilience, they also noted less physical activity (ES -0.58, P < .001), and in the subdomain of Disorders, more long-term surgical (ES -0.49) and psychosocial disorders (ES -0.49; both P < .01). Both ELBW and NBW children reported a decrease in general health between ages 8 and 14 years, which did not differ significantly between groups. CONCLUSIONS ELBW adolescents report similar health and well-being compared with NBW controls but greater risk avoidance. Both ELBW and NBW children rate their general health to be poorer at age 14 than at age 8 years, possibly due to age-related developmental changes.
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Affiliation(s)
- Maureen Hack
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA.
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Sullivan MC, Msall ME, Miller RJ. 17-year outcome of preterm infants with diverse neonatal morbidities: Part 1--Impact on physical, neurological, and psychological health status. J SPEC PEDIATR NURS 2012; 17:226-41. [PMID: 22734876 PMCID: PMC3385002 DOI: 10.1111/j.1744-6155.2012.00337.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to comprehensively examine physical, neurological, and psychological health in a U.S. sample of 180 infants at age 17. DESIGN AND METHODS The World Health Organization International Classification of Functioning, Disability and Health model framed the health-related domains and contextual factors. Assessments included growth, chronic conditions, neurological status, and psychological health. RESULTS Physical health, growth, and neurological outcomes were poorer in the preterm groups. Minor neurological impairment was related to integrative function. Preterm survivors reported higher rates of depression, anxiety, and inattention/hyperactivity. PRACTICE IMPLICATIONS Complex health challenges confront preterm survivors at late adolescence, suggesting the necessity of continued health surveillance.
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Affiliation(s)
- Mary C Sullivan
- University of Rhode Island, College of Nursing/Kingston, Rhode Island, USA.
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14
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Outcome of extremely low birth weight infants: what's new in the third millennium? Neuropsychological profiles at four years. Early Hum Dev 2012; 88:241-50. [PMID: 21962769 DOI: 10.1016/j.earlhumdev.2011.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 08/20/2011] [Accepted: 08/23/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Extremely low birth weight (ELBW) infants, even those not presenting severe neuromotor sequelae, continue to be at risk of developing multiple, complex disorders involving the cognitive, emotional and behavioural domains. Follow-up protocols are able, in the short term, to identify subjects at risk of developing major sequelae, however they fail to identify all children at risk of developing disorders. AIMS To investigate the cognitive, neuropsychological and behavioural outcomes of a sample of ELBW children at the age of four years in order to identify characteristic profiles. STUDY DESIGN Longitudinal study. SUBJECTS 16 healthy ELBW children born in 2005 and followed up until the age of four. OUTCOME MEASURE Performances on standardised tests evaluating intelligence, memory, cognitive visual functions, attention, and executive functions. RESULTS General intelligence was within normal range. Cognitive profile showed mild or moderate deficits with different levels of involvement in many of the examined functions, in particular executive functions, attention and naming. CONCLUSION There emerged a wide-ranging spectrum of weaknesses and deficits involving all the functions examined, which together give rise to a dysexecutive syndrome. Analysis of cognitive profiles showed that the sample could be divided into two subgroups of subjects that differ in the quality of their global cognitive and behavioural functioning. Our results confirm the need to continue follow up of ELBW children until school age, as this will allow early detection of at-risk children and the planning of timely preventive interventions.
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Hallin AL, Bengtsson H, Frostell AS, Stjernqvist K. The effect of extremely preterm birth on attachment organization in late adolescence. Child Care Health Dev 2012; 38:196-203. [PMID: 21535083 DOI: 10.1111/j.1365-2214.2011.01236.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prior studies have examined the impact of preterm birth on the quality of the attachment relationship to the mother in infancy, but few have examined extremely preterm born infants and almost no data have been reported on prematurity and its impact on the attachment organization attained after childhood. METHODS Thirty-nine adolescents born extremely preterm and 39 full-term born control participants were assessed with the Adult Attachment Interview. RESULTS The prematurely born showed lower scores regarding measures of attachment security and, in particular, a higher proportion of insecure dismissive patterns. This difference seemed to be clear and persistent even when controlled for intelligence and socio-economic variables. CONCLUSIONS Because insecure attachment as well as prematurity may be considered as significant risk factors for developing psychopathology, they deserve careful attention in future research and clinical follow-ups.
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Affiliation(s)
- A-L Hallin
- Department of Psychology, Lund University, Lund, Sweden.
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Koldewijn K, van Hus J, van Wassenaer A, Jeukens-Visser M, Kok J, Nollet F, Wolf MJ. Reliability, sensitivity and responsiveness of the Infant Behavioral Assessment in very preterm infants. Acta Paediatr 2012; 101:258-63. [PMID: 21981307 DOI: 10.1111/j.1651-2227.2011.02481.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study is to investigate the reliability, sensitivity and responsiveness of the Infant Behavioral Assessment (IBA) to evaluate neurobehavioural organization in very preterm infants. METHODS Videotaped assessments of very preterm infants participating in a recent trial served to evaluate a standardized IBA observation. Inter-rater reliability was based on 40 videos scored by two independent observers, using percentage agreement and weighted Kappa's. Sensitivity was evaluated by comparing the IBA results of 169 infants at 35-38 weeks postmenstrual age, dichotomized according to two developmental risk factors. For responsiveness, the effect size (ES) was calculated between 0 and 6 months corrected age in all intervention and control infants and in subgroups of high-risk intervention and control infants with oxygen dependency ≥28 days. RESULTS Inter-rater agreement was 93% in the total assessment; Kappa agreement was moderate to good in the behavioural categories. Significant differences were found between groups with or without risk factors. Larger differences between ESs in the randomized groups with oxygen dependency ≥28 days than in the total randomized groups reflect the responsiveness of the IBA. CONCLUSION In this study, we found satisfactory to good clinimetric characteristics of the IBA in very preterm born infants.
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Affiliation(s)
- K Koldewijn
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, The Netherlands.
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Barde LHF, Yeatman JD, Lee ES, Glover G, Feldman HM. Differences in neural activation between preterm and full term born adolescents on a sentence comprehension task: implications for educational accommodations. Dev Cogn Neurosci 2012; 2 Suppl 1:S114-28. [PMID: 22682901 PMCID: PMC3501002 DOI: 10.1016/j.dcn.2011.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 10/19/2011] [Accepted: 10/20/2011] [Indexed: 01/09/2023] Open
Abstract
Adolescent survivors of preterm birth experience persistent functional problems that negatively impact academic outcomes, even when standardized measures of cognition and language suggest normal ability. In this fMRI study, we compared the neural activation supporting auditory sentence comprehension in two groups of adolescents (ages 9-16 years); sentences varied in length and syntactic difficulty. Preterms (n=18, mean gestational age 28.8 weeks) and full terms (n=14) had scores on verbal IQ, receptive vocabulary, and receptive language tests that were within or above normal limits and similar between groups. In early and late phases of the trial, we found interactions by group and length; in the late phase, we also found a group by syntactic difficulty interaction. Post hoc tests revealed that preterms demonstrated significant activation in the left and right middle frontal gyri as syntactic difficulty increased. ANCOVA showed that the interactions could not be attributed to differences in age, receptive language skill, or reaction time. Results are consistent with the hypothesis that preterm birth modulates brain-behavior relations in sentence comprehension as task demands increase. We suggest preterms' differences in neural processing may indicate a need for educational accommodations, even when formal test scores indicate normal academic achievement.
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Affiliation(s)
- Laura H F Barde
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94304, United States.
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Abstract
Neonatal follow-up (NFU) programs provide health services for infants at high risk for developmental problems after they transition home from the neonatal intensive care unit (NICU). The purpose of the study was to assess current patterns of NFU attendance and explore time points when mothers and infants withdrew from NFU programs during the infant's first year of life. The study was conducted in 3 Canadian tertiary-level NICUs that referred to 2 affiliated, regional NFU programs. A total of 357 mothers and 400 infants were consecutively recruited during NICU hospitalization. Attendance at NFU programs was tracked at each of the 3 scheduled appointments from existing NFU databases. Attendance at NFU decreased over time from 84% at the first appointment to 74% by 12 months, with the highest withdrawal from NFU after NICU discharge, followed by withdrawal after the first NFU appointment. Nonattendance at NFU results in less access to required services and underreporting of the developmental outcomes of these infants. Given these findings, mothers should be screened earlier in the NICU to identify those at greatest risk of not attending NFU. Strategies should be implemented to address potential barriers and provide effective transition and access to the NFU program.
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Soergel P, Makowski L, Makowski E, Schippert C, Hertel H, Hillemanns P. Treatment of high grade cervical intraepithelial neoplasia by photodynamic therapy using hexylaminolevulinate may be costeffective compared to conisation procedures due to decreased pregnancy-related morbidity. Lasers Surg Med 2011; 43:713-20. [DOI: 10.1002/lsm.21072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
UNLABELLED Follow-up studies are essential to our knowledge of outcome in very low birthweight (VLBW) or extremely preterm (EPT) infants because those children have a greater risk for developing neurosensory disabilities and behavioural and educational problems and have decreased probability for an optimal transition into adulthood compared to term controls. Outcome data are of interest not only to healthcare professionals but also to parents, schoolteachers and society. The aim of this review is to describe the follow-up studies of seven populations of VLBW or EPT infants performed in Sweden and published between 1995 and 2009. CONCLUSION The time has come to implement evident data from these Swedish follow-up studies into clinical practice and to perform regular and specific follow-up examinations during childhood for all VLBW and EPT children. These assessments, specially designed for high-risk infants, should consider the potential outcomes for neurological, visual, auditory function and cognitive function as well as behaviour and growth, from birth to school-start.
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Development of preschool and academic skills in children born very preterm. J Pediatr 2011; 158:51-6. [PMID: 20708749 DOI: 10.1016/j.jpeds.2010.06.052] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/08/2010] [Accepted: 06/23/2010] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine performance in preschool and academic skills in very preterm (gestational age ≤ 30 weeks) and term-born comparison children aged 4 to 12 years. STUDY DESIGN Very preterm children (n = 200; mean age, 8.2 ± 2.5 years) born between 1996 and 2004 were compared with 230 term-born children (mean age, 8.3 ± 2.3). The Dutch National Pupil Monitoring System was used to measure preschool numerical reasoning and early linguistics, and primary school simple and complex word reading, reading comprehension, spelling, and mathematics/arithmetic. With univariate analyses of variance, we assessed the effects of preterm birth on performance across grades and on grade retention. RESULTS In preschool, very preterm children performed comparably with term-born children in early linguistics, but perform more poorly (0.7 standard deviation [SD]) in numerical reasoning skills. In primary school, very preterm children scored 0.3 SD lower in complex word reading and 0.6 SD lower in mathematics/arithmetic, but performed comparably with peers in reading comprehension and spelling. They had a higher grade repeat rate (25.5%), although grade repeat did not improve their academic skills. CONCLUSIONS Very preterm children do well in early linguistics, reading comprehension, and spelling, but have clinically significant deficits in numerical reasoning skills and mathematics/arithmetic, which persist with time.
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Wehby GL, Prater K, McCarthy AM, Castilla EE, Murray JC. The Impact of Maternal Smoking during Pregnancy on Early Child Neurodevelopment. JOURNAL OF HUMAN CAPITAL 2011; 5:207-254. [PMID: 22272363 PMCID: PMC3262676 DOI: 10.1086/660885] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Early child neurodevelopment has major impacts on future human capital and health. However, not much is known about the impacts of prenatal risk factors on child neurodevelopment. This study evaluates the effects of maternal smoking during pregnancy on child neurodevelopment between 3 and 24 months of age and interactions with socioeconomic status (SES). Data from a unique sample of children from South America are employed. Smoking has large adverse effects on neurodevelopment, with larger effects in the low SES sample. The study results highlight the importance of early interventions beginning before and during pregnancy for enhancing child development and future human capital attainment.
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Affiliation(s)
- George L. Wehby
- Dept. of Health Management and Policy, College of Public Health, University of Iowa, 200 Hawkins Drive, E205 GH, Iowa City, IA 52242, Phone: 319- 384-5133, Fax: 319-384-5125
| | - Kaitlin Prater
- Dept. of Health Management and Policy, College of Public Health, University of Iowa, 200 Newton Road, 5231, WL, Iowa City, IA 52246
| | - Ann Marie McCarthy
- Parent, Child & Family Nursing, College of Nursing, NB 344, The University of Iowa, Iowa City, IA 52245
| | - Eduardo E. Castilla
- INAGEMP (Instituto Nacional de Genética Médica Populacional) and ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congénitas), at Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil, and CEMIC: Centro de Educación Médica e Investigación Clinica, Buenos Aires, Argentina., Av. Brazil 4365, Pav. 26, sala 617. 21045-900, Rio de Janeiro. Brazil
| | - Jeffrey C. Murray
- Department of Pediatrics, College of Medicine, University of Iowa, Iowa City, IA, 52242
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Taylor HG. Persisting cognitive deficits in survivors of very low birthweight and their implications for adult functioning. Dev Med Child Neurol 2010; 52:1078-9. [PMID: 21175464 DOI: 10.1111/j.1469-8749.2010.03773.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Goddeeris JH, Saigal S, Boyle MH, Paneth N, Streiner DL, Stoskopf B. Economic outcomes in young adulthood for extremely low birth weight survivors. Pediatrics 2010; 126:e1102-8. [PMID: 20974793 DOI: 10.1542/peds.2010-1242] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to compare educational attainment and labor market outcomes in young adulthood (21-26 years of age) for a Canadian, population-based cohort of 149 extremely low birth weight (ELBW) (<1000 g) survivors and a normal birth weight (NBW) cohort of 133 young adults from the same geographic area who were matched to the ELBW cohort in childhood. METHODS We estimated the effects of ELBW status, according to gender, on continuous outcomes through least-squares regression and those on binary outcomes through logistic regression. We controlled for family background and considered neurosensory impairment and IQ as mediating variables. RESULTS Controlling for family background, ELBW male subjects were less likely to complete high school or to attend a university than were their NBW counterparts, and their educational attainment was reduced by >1 year. Among subjects who were working, weekly earnings were ∼27% lower. ELBW female effects on education were not significant, but ELBW female subjects were less likely than NBW subjects to be employed or in school and they also seemed to experience lower earnings. CONCLUSION Our findings suggested that ELBW survivors are somewhat less productive as adults, on average, than are subjects born NBW and that effects are not confined to subjects with severe neurosensory impairments. In accord with other studies, however, we found that productivity deficits for most ELBW subjects were not large.
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Affiliation(s)
- John H Goddeeris
- Michigan State University, Department of Economics, East Lansing, MI 48824, USA.
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Mathiasen R, Hansen BM, Nybo Anderson AM, Greisen G. Socio-economic achievements of individuals born very preterm at the age of 27 to 29 years: a nationwide cohort study. Dev Med Child Neurol 2009; 51:901-8. [PMID: 19459908 DOI: 10.1111/j.1469-8749.2009.03331.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To describe the socio economic achievement of individuals born very preterm (VPT) at the age of 27 to 29 years. METHOD Demographic and social data were extracted from national registers for all individuals born between 1974 and 1976 in Denmark (n=208 656). Of these, 203 283 individuals were alive in 2006. We compared VPT individuals (gestational age <33wks, n=1422; 51.8% males, n=736) with individuals born at term (>36wks, n=192 223; 51.1% males, n=98 240), of whom 4.08% (n=58) of the VPT and 0.19% (n=373) of the term individuals had a diagnosis of cerebral palsy (CP). RESULTS Overall results in the two groups were similar, but significant differences appeared. The VPT group had a lower educational level than the term group: 23.9% versus 16.3% had a basic education (corresponding to attendance at basic school for 9y or less; odds ratio [OR] =1.61, 95% confidence interval [CI] 1.42-1.82). Similarly, 31.9% versus 37.6% had a tertiary education (corresponding to different levels of professional education; OR=0.77, CI 0.69-0.86). Net income was 11% lower in the VPT group and 10.8% versus 5.3% were receiving welfare support (OR=2.14, CI 1.81-2.55). In the VPT group 59% versus 52% did not have children (p<0.001) and there were more individuals living alone without children (28.8% vs 21.8%; OR=1.45, CI 1.29-1.63). INTERPRETATION VPT birth in the 1970s in Denmark is associated with a highly statistically significant educational and social disadvantage persisting into young adulthood. CP increased the relative risk of social disadvantage in VPT individuals. However, the majority of the survivors are well integrated in society.
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Affiliation(s)
- René Mathiasen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Denmark.
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Abstract
The survivors of the initial years of neonatal intensive care of preterm infants reached adulthood during the last decade. Reports of their adult outcomes examined have included neurodevelopmental, behavioral and health outcomes as well as social functioning and reproduction. Despite statistically significant differences between preterm young adults and controls in most outcomes studied, the majority of preterm survivors do well and live fairly normal lives. The two major predictors of adult outcomes are lower gestational age that reflect perinatal injury and family sociodemographic status which reflects both genetic and environmental effects.
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Aarnoudse-Moens CSH, Weisglas-Kuperus N, van Goudoever JB, Oosterlaan J. Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics 2009; 124:717-28. [PMID: 19651588 DOI: 10.1542/peds.2008-2816] [Citation(s) in RCA: 1080] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Sequelae of academic underachievement, behavioral problems, and poor executive function (EF) have been extensively reported for very preterm (<or=33 weeks' gestation) and/or very low birth weight (VLBW) (<or=1500 g) children. Great variability in the published results, however, hinders the field in studying underlying dysfunctions and developing intervention strategies. We conducted a quantitative meta-analysis of studies published between 1998 and 2008 on academic achievement, behavioral functioning, and EF with the aim of providing aggregated measures of effect size for these outcome domains. METHODS Suitable for inclusion were 14 studies on academic achievement, 9 studies on behavioral problems, and 12 studies on EF, which compared a total of 4125 very preterm and/or VLBW children with 3197 term-born controls. Combined effect sizes for the 3 outcome domains were calculated in terms of Cohen's d. Q-test statistics were performed to test homogeneity among the obtained effect sizes. Pearson's correlation coefficients were calculated to examine the impact of mean birth weight and mean gestational age, as well as the influence of mean age at assessment on the effect sizes for academic achievement, behavioral problems, and EF. RESULTS Combined effect sizes show that very preterm and/or VLBW children score 0.60 SD lower on mathematics tests, 0.48 SD on reading tests, and 0.76 SD on spelling tests than term-born peers. Of all behavioral problems stacked, attention problems were most pronounced in very preterm and/or VLBW children, with teacher and parent ratings being 0.43 to 0.59 SD higher than for controls, respectively. Combined effect sizes for parent and teacher ratings of internalizing behavior problems were small (<0.28) and for externalizing behavior problems negligible (<0.09) and not significant. Combined effect sizes for EF revealed a decrement of 0.57 SD for verbal fluency, 0.36 SD for working memory, and 0.49 SD for cognitive flexibility in comparison to controls. Mean age at assessment was not correlated with the strength of the effect sizes. Mathematics and reading performance, parent ratings of internalizing problems, teacher ratings of externalizing behavior, and attention problems, showed strong and positive correlations with mean birth weight and mean gestational age (all r values > 0.51). CONCLUSIONS Very preterm and/or VLBW children have moderate-to-severe deficits in academic achievement, attention problems, and internalizing behavioral problems and poor EF, which are adverse outcomes that were strongly correlated to their immaturity at birth. During transition to young adulthood these children continue to lag behind term-born peers.
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Taylor HG, Espy KA, Anderson PJ. Mathematics deficiencies in children with very low birth weight or very preterm birth. ACTA ACUST UNITED AC 2009; 15:52-9. [PMID: 19213016 DOI: 10.1002/ddrr.51] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- H Gerry Taylor
- Department of Pediatrics, Case Western Reserve University, Rainbow Babies and Children's Hospital, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, OH 44106-6038, USA.
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Saigal S, Tyson J. Measurement of quality of life of survivors of neonatal intensive care: critique and implications. Semin Perinatol 2008; 32:59-66. [PMID: 18249241 DOI: 10.1053/j.semperi.2007.12.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In recent years, an increasing number of studies on the quality of life (QoL) of adults and children have been published, mostly describing outcomes of various medical conditions. Yet, despite the wide interest, there is no universal consensus even on the very definition of what constitutes QoL, particularly for children. Herein, we discuss the conceptual framework and operational definitions of QoL and health-related quality of life (HRQL), address some methodological issues, and review the literature on QoL studies among premature infants. We also describe areas of research that are likely to be fruitful in advancing the consideration of QoL in future studies and in clinical practice.
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Affiliation(s)
- Saroj Saigal
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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