Health status development in a cohort of preterm children

doi:10.1067/mpd.2000.108446

The Journal of Pediatrics

Volume 137, Issue 4, October 2000, Pages 534-539

https://doi.org/10.1067/mpd.2000.108446 Get rights and content

Abstract

Objective: To determine the impact of preterm birth on health status (HS) development at the ages of 5 and 10 years in a cohort of children born before term. Sample: Six hundred eighty-eight children, born in 1983 with a gestational age of <32 weeks and a birth weight of <1500 g. Design: Prospectively collected HS variables, obtained from the parents, were analyzed in a longitudinal perspective by using principal component analyses. Results: One third of the sample had minor to severe HS problems at both ages of measurement. One third had problems on one assessment only. The remainder of the sample had no HS problems at either age. The analyses grouped the HS variables into 3 combinations. Problems in basic functioning, such as mobility or speech, decreased with age. Negative moods substantially increased, and concentration problems increased slightly. Specifically at risk were preterm born children with handicaps, boys, and children who were small for gestational age. Conclusion: According to the parents, one third of the cohort had no HS problems at either age. The pattern of HS problems of the preterm born children changed between 5 and 10 years of age. (J Pediatr 2000;137:534-9)

Section snippets

Sample

In a nationwide cohort of VPT and VLBW infants, 94% (n = 1338) of all infants, born alive in 1983 in The Netherlands, with a gestational age of <32 completed weeks and/or a birth weight <1500 g were enrolled. Prospective data collection was performed during infancy and at 5 and 10 years of age. Of the 966 survivors, 96% (n = 927) could be enrolled at 5 years of age, and 74% (n = 688) at 10 years of age. The non-response group at 10 years of age included more children with low social economic

Relationships Between HS Variables With Age

The average proportion of variance accounted for by the principal component analysis in 2 dimensions is 31%. Dimension 1 accounts for 21%, which is equivalent to a Cronbach’s α of.76, and dimension 2 accounts for 10%, which is equivalent to an α of.46.¹⁸ According to the principal component analysis, 35% of the children had HS problems at both ages and 32% had no HS problems at either age. The remaining third either had problems at age 5 years (16%) or at age 10 years (17%). The variables were

Discussion

Two thirds of the study group had HS problems, which were mostly minor, at either one or both assessments. Not surprisingly, children without handicaps have far fewer basic functioning and concentration problems than children with handicaps do, and children with a combination of handicaps show the most problems. Negative moods are relevant at 10 years of age in children with a cognitive or a sensory handicap, but also in preterm children without a handicap. A similar result with respect to this

Acknowledgements

We thank all participants from the Collaborative Project on Preterm and Small for Gestational Age (POPS) Infant in The Netherlands. We also thank Dr G. H. W. Verrips for his critical review of the manuscript. We are indebted to the parents for their participation.

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Objective: To compare pregnancy complications and neonatal outcome of 85 triplet gestations cared for during the 15 years in a single perinatal unit. Methods: Pregnancies were divided in two groups according to the differences in the management plan and their outcomes were compared. Group I (N=44) consisted of pregnancies cared from 1986 to 1995, using standard model of care: preventive hospitalization from the early second trimester or home bed rest with routine hospitalization after 28–32 weeks of pregnancy, routine clinical and ultrasound examinations, biophysical profile and non-stress tests starting at 28 weeks, expert neonatal care without free access to surfactant or to parenteral nutrition. Group II (N=41) consisted of pregnancies cared for from 1986 to 2000 using modified care: preventive hospitalization from early second trimester or home bed rest with routine hospitalization after 32 weeks of pregnancy, biophysical profile, non-stress tests and pulsed doppler analysis of fetal umbilical artery, fetal aorta and middle cerebral artery blood flow from as early as 26 weeks, and neonatal care improved by free access to surfactant and parenteral nutrition. Results: The mean gestational age, mean birth weight, the proportion of growth-retarded infants, the incidence of various maternal complications and immediate neonatal conditions as judged by APGAR scores did not differ between the groups. The incidence of deliveries up to 28 weeks was lower in the group II in comparison to group I, but the proportion of term and near term deliveries was lower. The incidence of cesarean sections was high (91.8%), but significantly increased cesarean delivery rate because of fetal distress was observed in the group II (P=0.014). Infants in the group II had less frequently uneventful early neonatal period, mainly due to significantly increased conatal infection (P=0.007) and neonatal encephalopathy rate (P=0.001). However, perinatal mortality was decreased from 235% in the group I to 142% in the group II for newborns that reached 24 weeks of gestation or more. The decrease of perinatal mortality was observed also in the newborns born after 28 weeks of gestation (123% in the group I and 99% in the group II). None of the children weighing <1000 g died in utero in the group II. Early neonatal death of infants weighing >1500 g was significantly reduced in the group II (P=0.048). Conclusion: Advances in neonatal care, but also the delivery of infants in better overall condition must be the explanation for improved outcome of triplet gestations managed by modified care. A higher cesarean section rate because of imminent fetal jeopardy as judged by not only fetal heart rate tracings, but also umbilical, aortic and middle cerebral artery flow analysis, could be the explanation for lowered perinatal mortality and significantly improved outcome in very preterm infants from triplet gestations.
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^☆: Reprint requests: Nicolet C. M. Theunissen, PhD, Department of Health Psychology, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands (e-mail:[email protected] ).

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Original ArticlesHealth status development in a cohort of preterm children☆

Abstract

Section snippets

Sample

Relationships Between HS Variables With Age

Discussion

Acknowledgements

Lancet

Early Hum Dev

J Pediatr

J Pediatr

J Pediatr

J Am Acad Child Adolesc Psychiatry

Brain Dev

Changing prognosis for babies of less than 28 weeks’ gestation in the north of England between 1983 and 1994. Northern Neonatal Network

Br Med J

School attainment, cognitive ability and motor function in a total Scottish very-low-birthweight population at eight years: a controlled study

Dev Med Child Neurol

Birthweight and health and development at the age of 7 years

Child Care Health Dev

Emotional and behavioral adjustment in children born prematurely

J Clin Child Psychol

Social competence and behavior problems in premature children at school age

Pediatrics

Measuring health-related quality of life in children: the development of the TACQOL-Parent Form

Qual Life Res

Stand der Forschung zur gesundheitsbezogenen Lebensqualität von Kindern: eine Literaturanalyse [German: State of the art of health-related quality of life research in children: a literature review]

Präv Rehab

Mortality in very preterm and very low birth weight infants according to place of birth and level of care: results of a national collaborative survey of preterm and very low birth weight Infants in the Netherlands

Pediatrics

Original Articles
Health status development in a cohort of preterm children☆