Quality of Life at a 10-Year Follow-Up of Children Born Preterm with Post-Hemorrhagic Ventricular Dilatation: A Cohort Study.

BACKGROUND: Post-haemorrhagic ventricular dilatation (PHVD) is commonly seen in extremely preterm babies, carries significant morbidity, and may cause neonatal mortality. There is a lack of literature on the subsequent health-related quality of life (HRQoL) in childhood. The aim of this work was to assess the quality of life of preterm babies after PHVD at 10 years of age using two validated questionnaires. METHODS: Children with PHVD were assessed as part of the 10-year follow-up of the drainage, irrigation, and fibrinolytic therapy trial. The HRQoL outcome was measured using parent-reported EQ-5D-5L and HUI-3 questionnaires. Both questionnaires produce a summary score anchored at 1 (best health) and 0 (equivalent to death). RESULTS: Median scores at follow-up were 0.65 (IQR 0.36-0.84; n = 44) for the EQ-5D-5L and 0.52 (IQR 0.22-0.87; n = 51) for the HUI-3. Similar proportions had a score below 0.2 (HRQoL [20%], HUI-3 [21%]), while 20% had a HRQoL score above 0.80 compared to 34% using HUI-3. The most severe problems from the EQ-5D-5L were reported in the self-care, mobility, and activity domains, while the HUI-3 reported worse problems in ambulation, cognition, and dexterity domains. Infants with worse (grade 4) intraventricular haemorrhage had poorer HRQoL than those with grade 3 bleeds. CONCLUSION: Children who survive to 10 years of age after PHVD have on average lower HRQoL than their peers. However, the reported range is wide, with a quarter of the children having scores above 0.87 (similar to population norms), while a fifth have very low HRQol scores. Impact was not uniform across domains, with mobility/ambulation a concern across both measures.

Movement outcomes of infants born moderate and late preterm.

AIM: To investigate whether children born between 32 and 36 weeks of gestation have an increased risk of motor coordination difficulties or cerebral palsy (CP) at age 7 years. METHODS: A cohort study based on the Avon Longitudinal Study of Parents and Children (ALSPAC). The primary outcomes were poor motor coordination, defined as an ALSPAC coordination test score <5th centile or the presence of CP. Exposure groups were defined as moderate or late preterm (32-36 weeks of gestation) or term (37-42 weeks). Regression models were used to investigate the association between gestational age and outcomes. Multiple imputation was used to account for missing covariate data. RESULTS: In the fully adjusted model, there was strong evidence that children born at moderate or late preterm had worse coordination (OR 1.41 (1.14-1.74)) and higher risk of CP (OR 6.38 (2.28-17.76)) than term peers. However, restricting the analysis to well-grown infants born vaginally, in good condition, the associations attenuated substantially. CONCLUSIONS: Moderate or late preterm infants were at increased risk of developing coordination problems and cerebral palsy. After restricting the analysis to 'well' infants the associations of gestation with the coordination measures and CP reduced substantially, suggesting that antenatal, intrapartum and neonatal causal pathways are likely to be involved.

Long-term cognitive outcomes of infants born moderately and late preterm.

AIM: To investigate whether infants born late preterm have poorer cognitive outcomes than term-born infants. METHOD: A cohort study based on the Avon Longitudinal Study of Parents and Children. Cognitive measures were assessed between the ages of 8 and 11 years. Exposure groups were defined as moderate/late preterm (32-36 weeks' gestation) or term (37-42 wk). Regression models were used to investigate the association between gestational age and IQ. RESULTS: Seven hundred and forty-one infants (5.4% of total eligible population; 422 males, 319 females; mean (SD) birthweight 2495 g [489]) were born between 32 and 36 weeks' gestation. The analysis was based on 6957 infants with IQ data at age 11 (50% of eligible infants). In the adjusted model, children born moderately and late preterm had similar IQ scores to peers born at term (mean difference [95% confidence interval] -0.18 [-1.88 to 1.52]). However, the preterm infants had a higher risk of having special educational needs at school (odds ratio 1.56 [1.18-2.07]). INTERPRETATION: Despite an increased risk of special educational needs, there is little evidence of a reduction in IQ, memory, or attention measures at school age in children born between 32 and 36 weeks' gestation. Although interpretation is limited by the amount of missing data, further work is needed to identify why these infants have increased educational needs.

Long-term impact of poor birth condition on social and economic outcomes in early adulthood.

OBJECTIVE: The goal of this study was to investigate the association of poor birth condition with long-term social and economic outcomes at 25 to 31 years of age. METHODS: This was a population-based cohort study using data derived from linkage of routinely collected Swedish data. All term infants born in Sweden between 1973 and 1979 identified from the Swedish birth registry (n = 651 615) were included in the study. Infants were categorized into 3 groups: (1) infants with a normal (>7) Apgar score at 1 or 5 minutes of age without encephalopathy; (2) infants with a low (<7) Apgar score at 1 and 5 minutes of age without encephalopathy; and (3) infants with a low (<7) Apgar score at 1 and 5 minutes with evidence of encephalopathy. The main outcome measures were achievement of a university education and participant's income in early adulthood. RESULTS: Infants with low Apgar scores who did not develop encephalopathy were less likely to have attended university (odds ratio [OR]: 1.14 [95% confidence interval (CI): 1.05-1.23]) and were more likely to have no income from work (OR: 1.19 [95% CI: 1.07-1.32]) than those born in good condition. Infants who developed encephalopathy also had greater risks of these adverse outcomes (not attended university, OR: 1.94 [95% CI: 1.13-3.33]); no income from work, OR: 3.08 [95% CI: 1.89-5.01]). CONCLUSIONS: Infants born in poor condition had worse measures of social performance than their peers, and this association was not restricted to those infants who developed obvious neurologic symptoms in the neonatal period. However, even in infants with likely encephalopathy, more than half obtained employment and one third attended university.