Very low birthweight boys at the age of 19

Body composition in adults born preterm with very low birth weight

BACKGROUND

Studies on body composition in preterm very low birth weight (VLBW < 1500 g) survivors are inconsistent and trajectories later in life unknown. We assessed body composition and its change from young to mid-adulthood in VLBW adults.

METHODS

We studied 137 VLBW adults and 158 term-born controls from two birth cohorts in Finland and Norway at mean age 36 years. Body composition was assessed by 8-polar bioelectrical impedance. We compared results with dual-energy x-ray absorptiometry measurements at 24 years.

RESULTS

In mid-adulthood, VLBW women and men were shorter than controls. Fat percentage (mean difference in women 1.1%; 95% CI, -1.5% to 3.5%, men 0.8%; -2.0% to 3.6%) and BMI were similar. VLBW women had 2.9 (0.9 to 4.8) kg and VLBW men 5.3 (2.7 to 8.1) kg lower lean body mass than controls, mostly attributable to shorter height. Between young and mid-adulthood, both groups gained fat and lean body mass (p for interaction VLBW x age>0.3).

CONCLUSION

Compared with term-born controls, VLBW adults had similar body fat percentage but lower lean body mass, largely explained by their shorter height. This could contribute to lower insulin sensitivity and muscular fitness previously found in VLBW survivors and predispose to functional limitations with increasing age.

IMPACT

In mid-adulthood, individuals born preterm with very low birth weight had similar body fat percentage but lower lean body mass than those born at term. This was largely explained by their shorter height. First study to report longitudinal assessments of body size and composition from young to mid-adulthood in very low birth weight adults. Lower lean body mass in very low birth weight adults could contribute to lower insulin sensitivity and muscular fitness and lead to earlier functional limitations with increasing age.

Accelerated Aging and the Life Course of Individuals Born Preterm

Individuals born preterm have shorter lifespans and elevated rates of chronic illness that contribute to mortality risk when compared to individuals born at term. Emerging evidence suggests that individuals born preterm or of low birthweight also exhibit physiologic and cellular biomarkers of accelerated aging. It is unclear whether, and to what extent, accelerated aging contributes to a higher risk of chronic illness and mortality among individuals born preterm. Here, we review accelerated aging phenotypes in adults born preterm and biological pathways that appear to contribute to accelerated aging. We highlight biomarkers of accelerated aging and various resiliency factors, including both pharmacologic and non-pharmacologic factors, that might buffer the propensity for accelerated aging among individuals born preterm.

Growth to early adulthood following extremely preterm birth: the EPICure study

OBJECTIVE

To investigate growth trajectories from age 2.5 to 19 years in individuals born before 26 weeks of gestation (extremely preterm; EP) compared with term-born controls.

METHODS

Multilevel modelling of growth data from the EPICure study, a prospective 1995 birth cohort of 315 EP participants born in the UK and Ireland and 160 term-born controls recruited at school age. Height, weight, head circumference and body mass index (BMI) z-scores were derived from UK standards at ages 2.5, 6, 11 and 19 years.

RESULTS

129 (42%) EP children were assessed at 19 years. EP individuals were on average 4.0 cm shorter and 6.8 kg lighter with a 1.5 cm smaller head circumference relative to controls at 19 years. Relative to controls, EP participants grew faster in weight by 0.06 SD per year (95% CI 0.05 to 0.07), in head circumference by 0.04 SD (95% CI 0.03 to 0.05), but with no catch-up in height. For the EP group, because of weight catch-up between 6 and 19 years, BMI was significantly elevated at 19 years to +0.32 SD; 23.4% had BMI >25 kg/m² and 6.3% >30 kg/m² but these proportions were similar to those in control subjects. EP and control participants showed similar pubertal development in early adolescence, which was not associated with height at 19 years in either study group. Growth through childhood was related to birth characteristics and to neonatal feeding practices.

CONCLUSIONS

EP participants remained shorter and lighter and had smaller head circumferences than reference data or controls in adulthood but had elevated BMI.

Accelerated weight gain, prematurity, and the risk of childhood obesity: A meta-analysis and systematic review

The purpose of this systematic review and meta-analysis of the literature was to analyze and evaluate the impact of prematurity and accelerated weight gain on the risk of childhood and adolescent obesity. CINAHL, Embase, PubMed, and Web of Science databases were searched until December 2019 which yielded 19 studies with a total of 169,439 children enrolled were systematically reviewed. The results revealed that preterm infants had a greater likelihood of childhood obesity (defined as BMI ≥95th percentile for age-sex), than term infants (OR = 1.19, 95% CI [1.13, 1.26]). However, no difference of childhood obesity was found between "small for gestational age"(SGA) and "appropriate for gestational age"(AGA) among preterms. Accelerated weight gain (defined as weight gain velocity during first two years after birth) significantly increased the likelihood of subsequent childhood obesity among preterms (aOR = 1.87, 95% CI [1.57, 2.231]). In conclusion, accelerated weight gain at infancy among preterm children may be a critical contributor to obesity in later life. Establishing optimal growth trajectories and timely referral to health care providers may be of clinical importance.

How does birth weight affect health and human capital? A short- and long-term evaluation

In utero shocks have been shown to have long-lasting consequences. However, we hardly know whether these effects tend to fade out over time and whether they can be compensated by post-natal investments. This paper examines the effect of birth endowment over time by employing a long panel of individuals born in 1983 in Cebu (Philippines) that includes relevant information on the pregnancy. We build a refined health endowment measure netted out from prenatal investments. We find that initial endowments affect trajectories both through the human capital production function and subsequent parental investment. The effect of birth endowment remains until adulthood and the fading out is very limited for health outcomes but more pronounced for educational outcomes. We also find that parents tend to reinforce initial health endowments, but the effect of this behaviour has almost no effect on final outcomes.

The long-run effects of pandemic influenza on the development of children from elite backgrounds: Evidence from industrializing Japan

This study estimates the lingering effects of fetal exposure to the 1918 influenza pandemic on the development of secondary school and girls' high school students in industrializing Japan. In order to refine the verification of the fetal origins hypothesis, we tried not only to focus on children from elite schools but also to construct the continuous influenza mortality measure using monthly variations in the number of births and influenza deaths. By utilizing a nationwide multidimensional physical examination dataset, we found that fetal exposure to influenza in the pandemic years reduced the heights of boys and girls by approximately 0.3 cm and 0.1 cm, respectively. While the strongest negative magnitude was observed in the pandemic period, the lingering relapses in the post-pandemic period still had considerable adverse effects on height. In relation to the lowest decile group which experienced normal influenza mortality in non-pandemic years, the heights of the boys and girls who experienced pandemic influenza in the womb are approximately 0.6 and 0.3 cm lower. The lingering influenza relapse in the post-pandemic period has an adverse effect on the boys' height, accounting for roughly 80% of the maximum pandemic effect.

In utero exposure to malaria is associated with metabolic traits in adolescence: The Agogo 2000 birth cohort study

OBJECTIVES

Malaria in pregnancy (MiP) contributes to fetal undernutrition and adverse birth outcomes, and may constitute a developmental origin of metabolic diseases in the offspring. In a Ghanaian birth cohort, we examined the relationships between MiP-exposure and metabolic traits in adolescence.

METHODS

MiP at delivery was assessed in 155 mother-child pairs. Among the now teenaged children (mean age, 14.8 years; 53% male), we measured fasting plasma glucose (FPG), body mass index (BMI), and systolic and diastolic blood pressure (BP). Associations of MiP with the adolescents' FPG, BMI, and BP were examined by linear regression.

RESULTS

At delivery, 45% were MiP-exposed, which increased FPG in adolescence, adjusted for mother's age at delivery, parity and familial socio-economic status (infected vs. uninfected: mean ΔFPG = 0.20 mmol/L; 95% confidence interval (CI): 0.01, 0.39; p = 0.049). As a trend,this was discernible for BP, particularly for microscopic infections (mean Δsystolic BP = 5.43 mmHg; 95% CI: 0.00, 10.88; p = 0.050; mean Δdiastolic BP = 3.67 mmHg; 95% CI: -0.81, 8.14; p = 0.107). These associations were largely independent of birth weight, gestational age and teenage BMI. Adolescent BMI was not related to MiP.

CONCLUSIONS

In rural Ghana, exposure to malaria during fetal development contributes to metabolic conditions in young adulthood.

Long-term effects of premature birth on somatic development in women through adolescence and adulthood

Objectives

To evaluate the long-term consequences of preterm birth on anthropometric parameters in women in adolescence and into adulthood.

Methods

Seventy girls born preterm (age 12.22 ± 1.52 years) and 48 born at term participated in the first stage. Eighteen years later, 13 of the same women participated in a follow-up and were compared with a control group of 27 women. We compared anthropometric results across the two examinations, and in the second stage, also assessed body composition using bioelectrical impedance analysis.

Results

No significant differences were found in anthropometric parameters or the content of individual components of the body between the preterm-born and control groups. However, the preterm-born group showed a tendency for higher average fat mass and lower fat-free and soft lean mass compared with the control group, and had a significantly higher mean waist–hip ratio.

Conclusions

Preterm birth does not adversely affect somatic development in girls during adolescence, but shows a correlation with an elevated waist–hip ratio in adulthood.

Preterm birth and low birth weight continue to increase the risk of asthma from age 7 to 43

BACKGROUND

Perinatal events can influence the development of asthma in childhood but current evidence is contradictory concerning the effects on life-time asthma risk.

OBJECTIVE

To assess the relationship between birth characteristics and asthma from childhood to adulthood.

METHODOLOGY

All available birth records for the Tasmanian Longitudinal Health Study (TAHS) cohort, born in 1961 were obtained from the Tasmanian State Archives and Tasmanian hospitals. Low birth weight (LBW) was defined as less than 2500 grams. Preterm birth was defined as delivery before 37 weeks' gestation. Small for gestational age (SGA) was defined as a birth weight below the 10^th percentile for a given gestational age. Multivariate logistic and cox regression were used to examine associations between birth characteristics and lifetime risk of current and incident asthma, adjusting for confounders.

RESULTS

The prevalence of LBW was 5.2%, SGA was 13.8% and preterm was 3.3%. LBW (OR = 1.65, 95%CI 1.12,2.44) and preterm birth (OR = 1.81, 95%CI 0.99, 3.31) were both associated with an increased risk of current asthma between the ages of 7 to 43 years. There was no association between SGA and current asthma risk. However, SGA was associated with incident asthma (HR = 1.32, 95%CI 1.00, 1.74), and there was an interaction with sex (p value = 0.08), with males having a greater risk of incident asthma (HR = 1.70, 95%CI 1.16-2.49) than females (HR = 1.04, 95%CI 0.70-1.54).

CONCLUSIONS

Preterm birth and LBW were associated with an increased risk of current asthma into middle-age. These findings are the first to demonstrate the continuing impact of these characteristics on asthma risk into middle-age.

Mineral status of premature infants in early life and linear growth at age 3

BACKGROUND

Preterm infants are at significant risk of reduced bone mineral content and subsequent bone disease (metabolic bone disease of prematurity, MBDP). MBDP is frequently found in very low-birthweight (VLBW) infants, but long-term height prognosis is not well known.

METHODS

VLBW infants from two major neonatal intensive care units were studied. Medical records were reviewed. A total of 143 subjects were analyzed after excluding subjects who died, or who had severe complications that could affect linear growth, Silver-Russell syndrome, severe cholestasis, and/or chromosomal abnormality. The relationship between MBDP and height at age 3 was investigated.

RESULTS

Height standard deviation score (SDS) at age 3 negatively correlated with peak serum alkaline phosphatase (ALP) activity in early life (r = -0.30, P = 0.0003) and positively correlated with serum phosphorus (P) at peak ALP (r = 0.33, P = 0.0002). In addition, serum P independently affected height SDS at 3 years of age (β = 0.19, P = 0.018), and was significantly different between infants with and without catch-up growth in height (difference: 0.23 mmol/L, 95%CI: 0.09-0.36, P = 0.0010).

CONCLUSIONS

MBDP, particularly hypophosphatemia in the early period of life, is associated with linear growth until 3 years of age in VLBW infants.

Is preterm birth a human-specific syndrome?

Human preterm birth (PTB), a multifactorial syndrome affecting offspring born before 37 completed weeks of gestation, is the leading cause of newborn death worldwide. Remarkably, the degree to which early parturition contributes to mortality in other placental mammals remains unclear. To gain insights on whether PTB is a human-specific syndrome, we examined within- and between-species variation in gestation length across placental mammals and the impact of early parturition on offspring fitness. Within species, gestation length is normally distributed, and all species appear to occasionally give birth before the 'optimal' time. Furthermore, human gestation length, like that of many mammalian species, scales proportionally to body mass, suggesting that this trait, like many others, is constrained by body size. Premature humans suffer from numerous cognitive impairments, but little is known of cognitive impairments in other placental mammals. Human gestation differs in the timing of the 'brain growth spurt', where unlike many mammals, including closely related primates, the trajectory of human brain growth directly overlaps with the parturition time window. Thus, although all mammals experience early parturition, the fitness costs imposed by the cognitive impairments may be unique to our species. Describing PTB broadly in mammals opens avenues for comparative studies on the physiological and genetic regulators of birth timing as well as the development of new mammalian models of the disease.

Height, muscle, fat and bone response to growth hormone in short children with very low birth weight born appropriate for gestational age and small for gestational age

BACKGROUND/AIMS

Growth hormone (GH) treatment is approved for short children born SGA but not for AGA. Our aim was to study the effect of GH in short VLBW SGA and AGA children.

METHODS

The study group comprised 44 prepubertal short children with a birth weight <1,500 g: 27 AGA (12 females) and 17 SGA (6 females). Mean values at GH start were (AGA, SGA): age 6.94, 7.14 years, height standard deviation score (SDS) -3.33, -3.33, and GH dose (mean ± SD) 54 ± 12, 51 ± 11 µg/kg/day. Arm and calf cross-sectional muscle area using peripheral quantitative computer tomography, body composition data using dual-energy X-ray absorptiometry and body impedance assessment, maximal isometric grip force and skin fold thickness, IGF-1 and IGFBP-3 were measured at the start and after 12 months of GH.

RESULTS

At GH start, both groups had similar characteristics with low height, weight, height velocity, muscle mass, bone thickness and content. The first year of GH treatment led to changes in muscle area SDS (AGA, SGA) -2.23 to -0.73 (p = 0.0010), -3.18 to -1.17 (p = 0.060) (AGA vs. SGA p = 0.61), fat area SDS -1.06 to -1.83 (p = 0.054), -0.62 to -1.75 (p = 0.12) (AGA vs. SGA p = 0.65) and height velocity SDS -0.0015 to 4.2 (p < 0.0001), -0.18 to 3.3 (p < 0.0001) (AGA vs. SGA p = 0.36).

CONCLUSIONS

Growth, muscle and fat mass are similarly impaired in short prepubertal AGA and SGA VLBW children. The children born AGA show a similar or better response to GH compared to those born SGA. These results reveal the arbitrary nature of using the criterion 'SGA' for eligibility to GH treatment in children born with a birth weight <1,500 g.

[Evaluation of isometric force in lower limbs and body composition in preterm infants]

INTRODUCTION

Strength is a physical quality with a clear influence on quality of life. It is determined by the structure of the musculoskeletal system, and depends on the muscular structure. It has been described that prematurity conditions both qualities. The aims of this study are to determine whether prematurity is associated with strength or body composition and evaluate the relationship between prematurity, strength and muscle mass.

MATERIAL AND METHODS

Case-control study. Participants were premature 7-to-11 year-old children and full-term birth controls. Strength was measured by a strength gauge and body composition from DEXA (duel-energy X-ray absorptiometry) scans. A total of 89 subjects were included and divided into three groups: 30 prematures with birth-weight ≤ 1500g, 29 prematures with birth-weight 1500-2000g, and 30 controls.

RESULTS

Weight and BMI z-score was lower in the premature group. No differences were found in muscular mass or strength between groups. A ratio was established between strength and weight or muscular mass. It was observed that it was possible for them to move four times their weight, without finding any differences between groups or a relationship with birth-weight.

CONCLUSIONS

Between 7 and 11 years of age, children who were premature have lower weight and BMI than the rest of the children. However, there were no differences in body composition or strength between preterm children and controls.

Does in utero exposure to Illness matter? The 1918 influenza epidemic in Taiwan as a natural experiment

This paper tests whether in utero conditions affect long-run developmental outcomes using the 1918 influenza pandemic in Taiwan as a natural experiment. Combining several historical and current datasets, we find that cohorts in utero during the pandemic are shorter as children/adolescents and less educated compared to other birth cohorts. We also find that they are more likely to have serious health problems including kidney disease, circulatory and respiratory problems, and diabetes in old age. Despite possible positive selection on health outcomes due to high infant mortality rates during this period (18%), our paper finds a strong negative impact of in utero exposure to influenza.

Increased systemic blood pressure and arterial stiffness in young adults born prematurely

Recent studies have shown that a low birth weight is a risk factor for increased systemic blood pressure (BP) in adulthood. Further, systemic BP and arterial stiffness (AS) are reported to be increased in adolescents born prematurely. The purpose of this study was to characterize systemic BP and AS in young adults born preterm. Systemic BP was measured using an automated oscillometric device. AS was assessed by measuring the right carotid-radial pulse wave velocity (PWV) using a validated non-invasive automated method. Systemic BP, pulse pressure, and PWV [mean (confidence intervals)] were compared between 16 adults (age 21 years) born preterm (age at birth 32 weeks of gestation) with a birth weight (1710 g) appropriate for their gestational age and 15 adults (21 years) born at term (40 weeks of gestation) with a birth weight (3430 g) appropriate for their gestational age. Adults born preterm had a significantly higher systolic BP [122 mmHg (114-144) v. 112 (106-127)], mean BP [89 mmHg (86-98) v. 84 (81-91)], diastolic BP [69 mmHg (66-76) v. 65 (62-78)], pulse pressure [54 mmHg (47-72) v. 47 (42-60)], and PWV [7 m/s (6.3-8.6) v. 6.4 (5.8-8)] than did those born at term. Our findings suggest that young adults with a low birth weight due to preterm birth have increased systemic BP and AS. Accordingly, preterm birth may predispose individuals to cardiovascular diseases in adulthood due to increased AS.

Grip strength at 4 years in relation to birth weight

Consistent positive relationships have been found between birth weight and grip strength in adults but evidence in children is limited. In a prospective general population birth cohort (Southampton Women's Survey), grip strength and anthropometry (height and weight) were measured in 968 children at the age of 4 years. Mean (standard deviation (s.d.)) birth weight was 3.48 (0.52) kg. Birth weight, adjusted for sex and gestational age, was positively associated with grip strength (β = 0.22 kg/s.d. increase in adjusted birth weight; 95% CI 0.11, 0.34). The relationship was attenuated after adjustment for current height and weight such that it became non-significant (β = 0.03 kg/s.d. increase in adjusted birth weight; 95% CI-0.08, 0.14), suggesting that body size may be on the causal pathway. Early influences on muscle development appear to impact on grip strength in children, as well as adults.

Functional outcomes of very premature infants into adulthood

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.

Child height, health and human capital: Evidence using genetic markers

Height has long been recognized as being associated with better outcomes: the question is whether this association is causal. We use children's genetic variants as instrumental variables to deal with possible unobserved confounders and examine the effect of child/adolescent height on a wide range of outcomes: academic performance, IQ, self-esteem, depression symptoms and behavioral problems. OLS findings show that taller children have higher IQ, perform better in school, and are less likely to have behavioral problems. The IV results differ: taller girls (but not boys) have better cognitive performance and, in contrast to the OLS, greater height appears to increase behavioral problems.

Perinatal factors in non-disabled ELBW school children and later performance

AIM

To determine the association between perinatal events and subsequent motor performance, cardiorespiratory endurance and respiratory function in non-disabled extremely low birthweight (ELBW) school children at 12 years of age.

METHODS

Forty-eight ELBW infants were included in this study. The Movement Assessment Battery for Children (MABC), VO(2) max score as a measure of cardiorespiratory endurance and respiratory function testing were performed and perinatal variables were extracted from the children's hospital files. Children with MABC score ≤ 15th centile were described as having suspect motor performance. Children were classified as being unfit with a VO(2) max > 1 standard deviation below the mean according to gender and age. Perinatal risk factors were explored as risk factors for motor outcome, cardiorespiratory endurance and respiratory function.

RESULTS

MABC category was significantly related with gender (P = 0.005) and chronic neonatal lung disease (P = 0.013). Multiple regression analysis showed motor outcome at 12 years to be independently related to male gender (P = 0.03) and chronic neonatal lung disease (P = 0.045). Sixty-five percent of all the children were identified as unfit. Chronic neonatal lung disease was significantly related to cardiorespiratory endurance (P = 0.03) and predicted VO(2) max at 12 years (P = 0.05). No perinatal factors were significantly related to respiratory function variables.

CONCLUSION

Male gender and chronic neonatal lung disease were associated with later motor outcome of ELBW school children. It is suggested that objective and consistent follow-up from childhood through preadolescence are important to address motor and fitness issues especially for male children born with ELBW.

Birth weight and muscle strength: a systematic review and meta-analysis

OBJECTIVE

Lower muscle strength is associated with a range of adverse health outcomes in later life. The variation in muscle strength between individuals is only partly accounted for by factors in adult life such as body size and physical activity. The aim of this review was to assess the strength of the association between intrauterine development (indicated by birth weight) and subsequent muscle strength.

DESIGN

Systematic review and meta-analysis of studies that assessed the association between birth weight and subsequent muscle strength.

RESULTS

Nineteen studies met inclusion criteria with 17 studies showing that higher birth weight was associated with greater muscle strength. Grip strength was used as a single measure of muscle strength in 15 studies. Meta-analysis (13 studies, 20 481 participants, mean ages 9.3 to 67.5) showed a 0.86 kg (95% CI 0.58, 1.15) increase in muscle strength per additional kilogram of birth weight, after adjustment for age, gender and height at the time of strength measurement.

CONCLUSION

This review has found consistent evidence of a positive association between birth weight and muscle strength which is maintained across the lifecourse. Future work will be needed to elucidate the biological mechanisms underlying this association, but it suggests the potential benefit of an early intervention to help people maintain muscle strength in later life.

Vanishing Twin: A Possible Cause of Cerebral Impairment

Fetal death in a twin conception during second and third trimester is associated with increased risk of cerebral injury in the surviving twin. The aim of this study is to test the hypothesis that even early fetal losses as a ‘vanishing’ twin may be associated with an increased risk of cerebral impairment in the surviving twin. The study population comprised 362 pregnant women attending Liverpool Women's Hospital recruited between 1999 and 2001. Women were classified according to the first ultrasound scan into 3 groups: vanishing twin, twin and singleton. The vanishing twin group was further subdivided into ‘definite’ and ‘probable’. Children from these pregnancies were assessed at 1 year of age for their development and neurological function using the Griffiths Mental and Developmental Scales and Optimality score. Children from 229 pregnancies (63.2%) attended the assessment. Information on children from a further 21 (5.8%) pregnancies was obtained through a review of hospital records. Cerebral impairment was found in 2 children from the vanishing twin group, 2 from the twin group and none from the singleton group. When cases with definite vanishing twin are considered there is a significant difference between the vanishing twin and singleton group (relative risk 6.1; 95% confidence interval 1.5–8.3; p = .03). An additional study with an increased sample size would enable a more robust conclusion.

Long-term consequences of non-optimal birth characteristics

PROBLEM

The intrauterine milieu, gestational length as well as size at birth have a profound impact on the individual's mental, physical health and development both in childhood as well as in adult life.

METHOD OF STUDY

This paper reviews the associations between preterm birth and restricted fetal growth with neuro-developmental sequelae, including increased symptoms of psychiatric disorder in childhood and early adulthood. There is also evidence that physical morbidity such as the metabolic syndrome is more common in adult life. In addition, preterm birth and restricted fetal growth have been shown to be related to respiratory disease, infectious disease, and even malignancy. Morbidity, mental and physical as well as personality/intellectual traits hugely impact on family planning and reproductive performance in adults. As restricted fetal growth may alter organ structure and functions, it is likely to also influence subsequent fertility and/or reproductive health.

RESULTS

Individuals with non-optimal birth characteristics appears to have a reduction in childbearing and a deviant reproduction pattern compared to controls.

CONCLUSION

Future studies with sophisticated models for measuring the most vulnerable period of birth for children who have a low birth weight or who are at risk for being born preterm are needed to be able to explore the underlying biological mechanisms and also to plan for prevention as well as for interventions during pregnancy.

Follow-up studies of very low birthweight children in Sweden

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.

Preterm birth and attention-deficit/hyperactivity disorder in schoolchildren

OBJECTIVE

Previous studies have demonstrated an increased risk for attention-deficit/hyperactivity disorder (ADHD) in follow-up studies of preterm survivors from NICUs. In this study we analyzed the effect of moderate as well as extreme preterm birth on the risk for ADHD in school age, taking into account genetic, perinatal, and socioeconomic confounders.

METHODS

Register study in a Swedish national cohort of 1 180 616 children born between 1987 and 2000, followed up for ADHD medication in 2006 at the age of 6 to 19 years. Logistic regression was used to test hypotheses. A within-mother-between-pregnancy design was used to estimate the importance of genetic confounding in a subpopulation of offspring (N = 34 334) of mothers who had given birth to preterm (≤34 weeks) as well as term infants.

RESULTS

There was a stepwise increase in odds ratios for ADHD medication with increasing degree of immaturity at birth; from 2.1 (1.4-2.7) for 23 to 28 weeks' gestation, to 1.6 (1.4-1.7) for 29 to 32 weeks', 1.4 (1.2-1.7) for 33 to 34 weeks', 1.3 (1.1-1.4) for 35 to 36 weeks', and 1.1 (1.1-1.2) for 37 to 38 weeks' gestation compared with infants born at 39 to 41 weeks' gestation in the fully adjusted model. The odds ratios for the within-mother-between-pregnancy analysis were very similar. Low maternal education increased the effect of moderate, but not extreme, preterm birth on the risk for ADHD.

CONCLUSION

Preterm and early term birth increases the risk of ADHD by degree of immaturity. This main effect is not explained by genetic, perinatal, or socioeconomic confounding, but socioeconomic context modifies the risk of ADHD in moderately preterm births.

Low birth weight young adults: quality of life, academic achievements and social functioning

AIM

To compare the quality of life (QOL), academic achievements and social functioning of 134 non-handicapped low birth weight (LBW, birth weight < 2000 g) and 135 normal birth weight (NBW, birth weight > 3000 g) young adults.

STUDY DESIGN

Population-based longitudinal follow-up study.

METHODS

The Norwegian version of the originally US child health questionnaire, child form 87 (CHQ-CF87), a generic health instrument was applied to measure different physical and psychosocial concepts of QOL. Questionnaires and semi-structured interviews were applied to the cohort to register different aspects of social functioning and academic performance.

RESULTS

The LBW group reported well-being in the different aspects of QOL. The LBW group was socially well functioning. The college attendance was similar in the two groups, but more LBW young adults had dropped out of school or attended individually adjusted classes. Performance in mathematics for the LBW women attending academic college was lower. With this exception, the academic performance was comparable in the two groups.

CONCLUSION

Except a somewhat higher rate of school dropouts, the overall outcome of school performance, QOL and social functioning in the LBW young adults was comparable to that of the NBW control group.

Gestational age and basic school achievements: a national follow-up study in Denmark

OBJECTIVE

Children born at <32 weeks' gestation are at increased risk of intellectual impairment. Few studies have focused on the majority of preterm children born at 32 to 36 weeks' gestation. We aimed to investigate the association between the full range of gestational ages at birth and the risk of not completing basic school.

METHODS

This longitudinal, register-based study included all live-born infants in Denmark from 1988 to 1989. Data were obtained from national registers. School achievements were evaluated by using the examination marks. The association between gestational age and not completing basic school was estimated, taking into account the effect of their parents' educational level, being small for gestational age, plurality, and cerebral palsy.

RESULTS

The cohort constituted 120,585 infants, of whom 118,281 (98.6%) were alive in 2007. Of these infants, 5.01% (n = 5.928) were born before 37 weeks' gestation. Of the subjects born before 37 weeks' gestation, 11.5% (95% confidence interval: 10.7-12.4) did not complete basic school compared with 7.5% (95% confidence interval: 7.3-7.6) of those born at term. The percentage of subjects who did not complete basic school increased with decreasing gestational age. The increase was steeper at <31 weeks (4.2% per week) than at 31 to 36 weeks' gestation (0.5% per week).

CONCLUSIONS

The risk of not completing basic school increased with decreasing gestational age. The risk was moderate at ≥31 weeks' gestation and increased steeply at <31 weeks' gestation. The increase at <31 weeks' gestation was only partly explained by cerebral palsy.

Birth weight and adult bone mass: a systematic literature review

SUMMARY

This systematic literature review comprised 16 studies. The association of birth weight with bone parameters was much more evident for bone mineral content (BMC) rather than bone mineral density (BMD). This is an important finding since a reduction in BMC is strongly associated with an increased risk of fractures.

INTRODUCTION

The purpose of this study was to conduct a systematic literature review of studies that have investigated the association between birth weight (BW) and adult bone mass.

METHODS

The search included English language articles, indexed in MEDLINE, using the key words: ("birth size" OR "birth weight" OR birthweight) AND (osteoporosis OR "bone mass" OR "bone density" OR "bone mineral density" OR "bone mineral content" OR "bone area"). A methodological quality appraisal of the reviewed studies was performed.

RESULTS

Sixteen articles were reviewed. Eleven of 13 studies that measured BMC verified a positive effect of BW on this parameter, and nine even after adjustment for adult body size. Among the ten studies that found an unadjusted association between BW and BMD, two reported that the significance remained after adjustment for current body size. Interaction between prenatal and postnatal variables on the determination of adult bone mass was only tested by two studies. The results must be interpreted with caution due to the existence of few papers on the issue, as well as heterogeneous sample characteristics, investigated bone sites, and implemented analysis procedures. The aspects of methodological quality that frequently fail are as follows: representativeness of the planned and actually measured sample as well as proper adjustment for confounding.

CONCLUSION

Based on the amount of accumulated evidence, it is probable that BW have a positive association with adult BMC rather than BMD, which is an important finding for clinical and public health policies since a reduction in BMC is strongly associated with an increased fracture risk.

Adult outcome of extremely preterm infants

Survival rates for extremely preterm (<28 weeks' gestational age) infants have increased and are approaching 3 in 4 with the advent of modern perinatal and neonatal intensive care. In contrast with some children with chronic diseases such as cystic fibrosis, most survivors of extreme prematurity have no ongoing health issues. However, as a group, they do have higher rates of adverse health outcomes, and more of them will present to pediatricians over time and, ultimately, to adult physicians as they grow older. Pediatricians can aid the transition to adult health care by being aware of the nutritional, cardiovascular, respiratory, motor, cognitive, psychiatric, and functional outcomes into adulthood of survivors of extreme prematurity.

First year growth among very low birth weight infants

AIM

The aim of this study was to describe first-year growth among very low birth weight infants and the effect of growth restriction at hospital discharge on first year growth.

METHOD

Anthropometric measures and background information for 118 very low birth weight infants were collected from medical records. Z-scores were calculated based on recent Norwegian growth references.

RESULTS

Significant catch-up growth for weight and length was observed during the first year with mean z-score change (SD) of 0.40 (1.05) and 1.01 (1.25) respectively. However, the very low birth weight infants remained lighter and shorter than full-term peers until 12 months corrected age with mean z-score of -0.93 (1.09) and -0.48 (1.06) respectively. Head circumference followed a normal growth pattern after 2 months. Infants discharged from hospital as growth restricted had increased catch-up in weight and length, but remained smaller than infants not subjected to early growth restriction and full-term peers. Multiple regression showed that weight below the 10th percentile at discharge is important for weight and length during the first year of life.

CONCLUSION

Very low birth weight infants showed catch-up growth during the first year, but their weight and length remained less than full-term peers. Growth deficiencies were more pronounced among infants subjected to early growth restriction, despite increased catch-up growth.

Slower reaction times and impaired learning in young adults with birth weight <1500 g

OBJECTIVE

Children with very low birth weight (VLBW; <1500 g) perform worse on cognitive tests than do children who are born at term. Whether this difference persists into adulthood has been little studied. We assessed core neurocognitive abilities (processing speed, working memory, attention, and learning capacity) in young adults with VLBW and in term-born control subjects.

METHODS

In conjunction with the Helsinki Study of Very Low Birth Weight Adults, 147 VLBW and 171 control subjects who were aged 18 to 27 years and did not have neurosensory impairments performed a computerized test battery (CogState Ltd, Melbourne, Australia). T tests and linear regression models were used. Cohen's d was used to express effect size (ES).

RESULTS

VLBW adults had slower reaction times than did control subjects on all 5 tasks: simple reaction time (mean difference: 4.0% [95% confidence interval (CI): 1.1%-7.0%]; ES: 0.30), choice reaction time (mean difference: 3.2% [95% CI: 0.3%-6.2%]; ES: 0.24), working memory (mean difference: 8.4% [95% CI: 3.7%-13.4%]; ES: 0.40), divided attention (mean difference: 7.2% [95% CI: 2.7%-11.9%]; ES: 0.36), and associated learning reaction time (mean difference: 6.4% [95% CI: 1.3%-11.9%]; ES: 0.28). In addition, VLBW adults showed impaired learning abilities on the associated learning task (percentage of correct responses: 85.7 vs 80.2; P < .001; ES: 0.64). The results were little affected by adjustment for confounders.

CONCLUSIONS

Nonimpaired VLBW individuals exhibited slower psychomotor speed and lower accuracy on the associated learning task. These results indicate that very preterm birth, even when obvious neurosensory deficits are absent, may have long-term consequences on core neurocognitive abilities.

Socio-economic achievements of individuals born very preterm at the age of 27 to 29 years: a nationwide cohort study

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.

Adult outcomes of preterm children

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.

Most very low birth weight subjects do well as adults

AIM

To study health, quality of life, educational level and occupation in very low birth weight (VLBW) children in early adulthood and the relationship of the findings to neonatal risk factors and later handicap.

METHODS

This is a prospective long-term follow-up study of a regional cohort of 20-year-old VLBW subjects (n = 77) of all surviving VLBW children (n = 86) and 69/86 term controls born in 1987-1988 in the south-east of Sweden. Postal questionnaires were used: 1. A study-specific form, 2. Medical Outcomes Study, Short Form (SF-36), 3. Sense of Coherence.

RESULTS

VLBW subjects did not differ significantly from their controls in self-perceived health, use of tobacco, education, occupation and way of living, or scoring on SF-36 and Sense of Coherence. Sixteen had cerebral palsy, attention deficit hyperactivity disorder or isolated mental retardation, and these subjects differed significantly from controls on SF-36 in physical functioning and physical health score, but not on Sense of Coherence. VLBW subjects were significantly lighter and shorter than their controls. Extremely low birth weight (ELBW), bronchopulmonary dysplasia and intraventricular haemorrhage were significantly associated with poorer scores on physical function.

CONCLUSION

The 20-year old VLBW subjects reported perceived health and managed transition to adulthood similar to controls. Handicapped subjects had poorer self-perceived physical function. ELBW and severe neonatal complications were associated with poorer self-perceived physical health.

Decreased bone mineral density in adults born with very low birth weight: a cohort study

BACKGROUND

Very-low-birth-weight (VLBW, <1,500 g) infants have compromised bone mass accrual during childhood, but it is unclear whether this results in subnormal peak bone mass and increased risk of impaired skeletal health in adulthood. We hypothesized that VLBW is associated with reduced bone mineral density (BMD) in adulthood.

METHODS AND FINDINGS

The Helsinki Study of Very Low Birth Weight Adults is a multidisciplinary cohort study representative of all VLBW births within the larger Helsinki area from 1978 to 1985. This study evaluated skeletal health in 144 such participants (all born preterm, mean gestational age 29.3 wk, birth weight 1,127 g, birth weight Z score 1.3), and in 139 comparison participants born at term, matched for sex, age, and birth hospital. BMD was measured by dual energy X-ray absorptiometry at age 18.5 to 27.1 y. Adults born with VLBW had, in comparison to participants born at term, a 0.51-unit (95% confidence interval [CI] 0.28-0.75) lower lumbar spine Z score and a 0.56-unit (95% CI 0.34-0.78) lower femoral neck Z score for areal BMD. These differences remained statistically significant after adjustment for the VLBW adults' shorter height and lower self-reported exercise intensity.

CONCLUSIONS

Young adults born with VLBW, when studied close to the age of peak bone mass, have significantly lower BMD than do their term-born peers. This suggests that compromised childhood bone mass accrual in preterm VLBW children translates into increased risk for osteoporosis in adulthood, warranting vigilance in osteoporosis prevention.

Very-low-birth-weight children at school age: academic achievement, behavior and self-esteem and relation to risk factors

OBJECTIVE

To investigate school performance, behavior and self-esteem of children with very low birth weight (VLBW).

METHODS

All children with birth weight below 1501 g (VLBW) and normal birth weight controls, born in the south-east region of Sweden during a 15-month period in 1987-88, were enrolled in a prospective follow-up study. At the age of 9 years, 81% and 82%, respectively, were re-examined regarding growth, neurofunctional classification, academic achievement tests, need for special education and behavioral problems. At 12 years, 89% and 76%, respectively, were re-examined regarding growth, neurofunctional classification, visual acuity and self-esteem.

RESULTS

VLBW children were shorter and lighter, and differed from the controls with regard to neurological functional classification. They produced poorer results in most academic achievement tests. When the comparison was restricted to children with normal intelligence, almost all the differences in other academic achievements disappeared. VLBW children had more reading difficulties but were less often than expected defined as dyslexics compared to control children. We did not find any major disparity in visual acuity and self-esteem between the groups. Low Apgar scores, intracranial hemorrhage and the need for mechanical ventilation neonatally were associated with poorer results in most outcome measures. Neurofunctional assessments in early childhood were associated with most outcome measures. The mother's education was related to delayed reading skills and need for special education.

CONCLUSIONS

Although VLBW children performed less well in most academic achievement tests and on some behavioral subscales, those who had a normal intellectual capacity did not differ in any important aspects from the controls.

Psychiatric morbidity in adolescents and young adults born preterm: a Swedish national cohort study

OBJECTIVE

Increasing numbers of infants born preterm survive into adulthood. Previous studies have reported increased levels of neurologic and cognitive disabilities in these children. In this study, we analyzed the effect of having been born preterm on psychiatric morbidity.

METHODS

A Swedish national cohort of 545628 individuals born in 1973-1979 was followed up in the national registers during 1987-2002. Multivariate Cox analysis of proportional hazards was used to estimate the hazard ratios of hospital admissions for psychiatric disorders and alcohol/illicit drug abuse.

RESULTS

There was a stepwise increase in psychiatric hospital admissions with an increasing degree of preterm birth. A total of 5.2% of children born at 24 to 28 weeks' gestation and 3.5% born at 29 to 32 weeks' gestation had been hospitalized because of a psychiatric disorder. The hazard ratios for psychiatric disorders were 1.68 in the group of very preterm children (gestational weeks 24-32), 1.21 in the moderately preterm group (gestational weeks 33-36), and 1.08 in the early term group (gestational weeks 37-38) after adjustment for socioeconomic confounders. Moderately preterm and early term birth accounted for 85% of the risk attributed to preterm/early term birth. The effect of preterm birth was greater in households with low socioeconomic status.

CONCLUSION

Preterm birth carries some risk for psychiatric disorders requiring hospitalization in adolescence and young adulthood (ages 8-29 years). Even if this risk increases with degree of preterm birth, most subjects are moderately preterm, a group in need of more attention in research and secondary prevention.

Long-term medical and social consequences of preterm birth

BACKGROUND

Advances in perinatal care have increased the number of premature babies who survive. There are concerns, however, about the ability of these children to cope with the demands of adulthood.

METHODS

We linked compulsory national registries in Norway to identify children of different gestational-age categories who were born between 1967 and 1983 and to follow them through 2003 in order to document medical disabilities and outcomes reflecting social performance.

RESULTS

The study included 903,402 infants who were born alive and without congenital anomalies (1822 born at 23 to 27 weeks of gestation, 2805 at 28 to 30 weeks, 7424 at 31 to 33 weeks, 32,945 at 34 to 36 weeks, and 858,406 at 37 weeks or later). The proportions of infants who survived and were followed to adult life were 17.8%, 57.3%, 85.7%, 94.6%, and 96.5%, respectively. Among the survivors, the prevalence of having cerebral palsy was 0.1% for those born at term versus 9.1% for those born at 23 to 27 weeks of gestation (relative risk for birth at 23 to 27 weeks of gestation, 78.9; 95% confidence interval [CI], 56.5 to 110.0); the prevalence of having mental retardation, 0.4% versus 4.4% (relative risk, 10.3; 95% CI, 6.2 to 17.2); and the prevalence of receiving a disability pension, 1.7% versus 10.6% (relative risk, 7.5; 95% CI, 5.5 to 10.0). Among those who did not have medical disabilities, the gestational age at birth was associated with the education level attained, income, receipt of Social Security benefits, and the establishment of a family, but not with rates of unemployment or criminal activity.

CONCLUSIONS

In this cohort of people in Norway who were born between 1967 and 1983, the risks of medical and social disabilities in adulthood increased with decreasing gestational age at birth.

Young adults with very low birth weight: leaving the parental home and sexual relationships--Helsinki Study of Very Low Birth Weight Adults

OBJECTIVE

Although most children and adults who are born very preterm live healthy lives, they have, on average, lower cognitive scores, more internalizing behaviors, and deficits in social skills. This could well affect their transition to adulthood. We studied the tempo of first leaving the parental home and starting cohabitation with an intimate partner and sexual experience of young adults with very low birth weight (<1500 g).

METHODS

In conjunction with the Helsinki Study of Very Low Birth Weight Adults, 162 very low birth weight individuals and 188 individuals who were born at term (mean age: 22.3 years [range: 18.5-27.1]) and did not have any major disability filled out a questionnaire. For analysis of their ages at events which had not occurred in all subjects, we used survival analysis (Cox regression), adjusted for gender, current height, parents' ages at the birth, maternal smoking during pregnancy, parental educational attainment, number of siblings, and parental divorce/death.

RESULTS

During their late teens and early adulthood, these very low birth weight adults were less likely to leave the parental home and to start cohabiting with an intimate partner. In gender-stratified analyses, these hazard ratios were similar between genders, but the latter was statistically significant for women only. These very low birth weight adults were also less likely to experience sexual intercourse. This relationship was statistically significant for women but not for men; however, very low birth weight women and men both reported a smaller lifetime number of sex partners than did control subjects.

CONCLUSIONS

Healthy young adults with very low birth weight show a delay in leaving the parental home and starting sexual activity and partnerships.

School performance of adolescents born preterm: neuropsychological and background correlates

In this longitudinal study the development of preterm and control children was followed from infancy until adolescence. School performance at the age of 16 in subjects born very preterm with a gestational age (GA) of <or= 32 weeks was compared with the performance of adolescents born full-term. None of the subjects had major disabilities. The study groups performed similarly in most school subjects, including mathematics, the second foreign language and the native language (Finnish). Subjects in the preterm group achieved significantly higher grade points in the first foreign language than control subjects. In particular, the difference was evident between the preterm and control boys. The extremely preterm group with a GA <or= 29 weeks did not differ from the more mature group with a GA between 30 and 32 weeks in terms of the school grade points. Verbal and performance scale IQs as assessed at the age of 9 were of primary importance in predicting school success in adolescence. The results suggest a good outcome, measured by school grade scores at 16 years of age, of the subjects born very preterm.

Growth of low birth weight preterm children

Very low birth weight premature (VLBWPT) infants demonstrate growth patterns in the early years of life which differ from those of term and large low birth weight preterm (LBWPT) peers. Optimal post natal growth of VLBWPT children is associated with more positive later health and neurodevelopmental outcomes. The neonatologist engaged in the follow of care of VLBWPT infants after discharge from the Neonatal Intensive Care Unit should monitor over time the velocity of weight, length, head circumference and weight/length ratio utilizing appropriate growth references. VLBW children who demonstrate atypically low weight gain in the early years of life have a higher probability of less than optimal cognitive development over time, while those with excessive weight gain have a greater likelihood of later childhood and adult obesity, cardiovascular disease, and diabetes. Nutritional planning should provide adequate calories for gradual normalization in all growth variables, while attempting to avoid atypically low or excessive weight gain. This nutritional planning should take into account the child's genetic growth potential, small for gestational age (SGA) or at gestational age (AGA), and clinical issues such as the presence of diseases like gastroesophageal (GE) reflux or chronic lung disease. Whatever nutritional approach is used, the neonatologist in follow up should track weight, length, head circumference, and weight/length ratio and adjust the nutrition plan and caloric intake to assure gradual return to normal in all growth variables while avoiding excessive weight gain.

An overview of mortality and sequelae of preterm birth from infancy to adulthood

Survival rates have greatly improved in recent years for infants of borderline viability; however, these infants remain at risk of developing a wide array of complications, not only in the neonatal unit, but also in the long term. Morbidity is inversely related to gestational age; however, there is no gestational age, including term, that is wholly exempt. Neurodevelopmental disabilities and recurrent health problems take a toll in early childhood. Subsequently hidden disabilities such as school difficulties and behavioural problems become apparent and persist into adolescence. Reassuringly, however, most children born very preterm adjust remarkably well during their transition into adulthood. Because mortality rates have fallen, the focus for perinatal interventions is to develop strategies to reduce long-term morbidity, especially the prevention of brain injury and abnormal brain development. In addition, follow-up to middle age and beyond is warranted to identify the risks, especially for cardiovascular and metabolic disorders that are likely to be experienced by preterm survivors.

Stature and status: Height, ability, and labor market outcomes

The well-known association between height and earnings is often thought to reflect factors such as self esteem, social dominance, and discrimination. We offer a simpler explanation: height is positively associated with cognitive ability, which is rewarded in the labor market. Using data from the US and the UK, we show that taller children have higher average cognitive test scores, and that these test scores explain a large portion of the height premium in earnings. Children who have higher test scores also experience earlier adolescent growth spurts, so that height in adolescence serves as a marker of cognitive ability.

Functional outcomes and participation in young adulthood for very preterm and very low birth weight infants: the Dutch Project on Preterm and Small for Gestational Age Infants at 19 years of age

OBJECTIVE

Young adults who were born very preterm or with a very low birth weight remain at risk for physical and neurodevelopmental problems and lower academic achievement scores. Data, however, are scarce, hospital based, mostly done in small populations, and need additional confirmation.

METHODS

Infants who were born at < 32 weeks of gestation and/or with a birth weight of < 1500 g in The Netherlands in 1983 (Project on Preterm and Small for Gestational Age Infants) were reexamined at age 19. Outcomes were adjusted for nonrespondents using multiple imputation and categorized into none, mild, moderate, or severe problems.

RESULTS

Of 959 surviving young adults, 74% were assessed and/or completed the questionnaires. Moderate or severe problems were present in 4.3% for cognition, 1.8% for hearing, 1.9% for vision, and 8.1% for neuromotor functioning. Using the Health Utility Index and the London Handicap Scale, we found 2.0% and 4.5%, respectively, of the young adults to have > or = 3 affected areas in activities and participation. Special education or lesser level was completed by 24%, and 7.6% neither had a paid job nor followed any education. Overall, 31.7% had > or = 1 moderate or severe problems in the assessed areas.

CONCLUSIONS

A total of 12.6% of young adults who were born very preterm and/or with a very low birth weight had moderate or severe problems in cognitive or neurosensory functioning. Compared with the general Dutch population, twice as many young adults who were born very preterm and/or with a very low birth weight were poorly educated, and 3 times as many were neither employed nor in school at age 19.

Growth during the first two years predicts pre-school height in children born with very low birth weight (VLBW): results of a study of 1,320 children in Germany

Children born with very low birth weight (VLBW) are at risk of impaired growth. We aimed to study VLBW survivors (90.8%) born in 1998/1999 in the state of Baden-Württemberg (n = 2103) for whom growth data were available up to age six. Classification as appropriate for gestational age (AGA) or small for gestational age (SGA) depended on size at birth. Models to predict height SDS at 5 y were developed using data for 1 yr (Model 1) and 2 yrs (Model 2). The data of 1320 (63%) children were available: SGA: n = 730, AGA: n = 590. At 6 yrs, 8.3% AGA and 13.4% SGA children were short (<-2.0 SDS). The following factors explained Ht SDS at 5 (and 6) yrs (order of importance): (a) Model 1 (n = 1033; R2 = 0.52; error: 0.84 SDS): 1st yr Ht SDS, mid-parental height (MPH) SDS, 1 yr weight SDS, birth weight SDS; (b) Model 2 (n = 991; R2 = 0.72; error: 0.65 SDS): 1st yr Ht SDS; change (2nd yr) in Ht and weight SDS; MPH SDS; 1st yr weight SDS; birth weight SDS. Thus, some AGA and SGA children born VLBW remain short and preventive strategies need to be developed for those at risk.