Follow up assessment of very preterm infants at five years of age

Simultaneous with the improved survival of very preterm and low birth weight infants, the awareness increased that not all survive without sequelae. Mild developmental disturbances that interfere with the acquisition of everyday skills and normal learning appeared to be very frequent and were not detected until at school age. The expectation was that such developmental disabilities were temporary side effects and would diminish with increasing perinatal knowledge and experience. The data in this thesis show that impairments, disabilities and handicaps remain invariably high, with the exception of the decreased incidence of visual problems. The increased incidence of cerebral palsy of children born in 1993, compared to 1983, is worrisome. Factors that are responsible for a decreased mortality such as antenatal steroids, artificial ventilation and surfactant, do not decrease these developmental problems in the surviving children. The use of dexamethasone in the neonatal period is a serious extra risk factor for developmental problems. Severe developmental problems are mostly diagnosed at the age oaf two years. Diagnosis of mild motor problems, learning disabilities and problem behaviour however, is mostly delayed until school age. When with advancing age the demands imposed by society increase, the problem rate increases even further. Singularly, these deficits may be subtle, but combined, without compensation in other domains, they may pose a lifelong burden. Therefore, long term longitudinal follow up of these children is necessary. Paediatricians who assess very preterm and low birth weight infants with assessments that include structured elements from the Touwen examination, Denver Development Screening Test, Dutch Language Screening Test and a shortlist from the Child behaviour Checklist overlook developmental motor coordination disorders and learning and behavioural problems. As the movement ABC is an accurate and widely used instrument to detect these motor coordination disorders, the movement ABC should be included in the follow up of very preterm and low birth weight infants at the age of five. To detect all neurological problems a neurological assessment is also necessary. Cognitive problems are indicated by the appearance of learning difficulties at school. As the presence of learning difficulties in very preterm and low birth weight infants is an alarm-signal for cognitive delay, referral and formal cognitive assessment by a child psychologist is indicated. Repeating the school year may not be a good solution. To identify cognitive delays that may interfere with learning before school age, formal cognitive assessment before six years of age should be incorporated in a systematic follow up program. As over one half of all very preterm and low birth weight infants show these developmental problems, routine assessment of all very preterm and low birth weight infants before school age is necessary. Standardised and normalised test instruments that cover all developmental domains must have a rigid structure for managing the test process and calculating the results General judgement by paediatricians in a routine outpatient clinic, even when these paediatricians are well trained, is insufficient. Follow up studies that do not include detailed standardised tests for several domains will underestimate developmental problems in survivors of neonatal intensive care. There is no simple way to identify children in need of extra help or to enable a true evaluation of neonatal intensive care. This thesis deals with problems in very preterm and low birth weight infants. It also documented, however, that modern intensive care saves the lives of many children 'born to soon or born too small' 56 and that many of them grow up without any problem at all. Although modern neonatal intensive care will not restore complete integrity of all preterm born infants, it certainly is worthwhile.LUMCZonMW, Friso Kindervoeding, Wetenschapsfonds Máxima Medisch Centrum, Abbott BV, Nycomed Nederland BV, Vygon Nederland BV, Azimed BV(Klinisch) epidemiologisch onderzoek bij kindere

No association between glucocorticoid receptor polymorphisms and long-term respiratory outcome after very preterm birth

Developmen

Gender differences in respiratory symptoms in 19-year-old adults born preterm

Objective: To study the prevalence of respiratory and atopic symptoms in (young) adults born prematurely, differences between those who did and did not develop Bronchopulmonary Disease (BPD) at neonatal age and differences in respiratory health between males and females. Methods: Design: Prospective cohort study. Setting: Nation wide follow-up study, the Netherlands. Participants: 690 adults (19 year old) born with a gestational age below 32 completed weeks and/or with a birth weight less than 1500g. Controls were Dutch participants of the European Community Respiratory Health Survey (ECRHS). Main outcome measures: Presence of wheeze, shortness of breath, asthma, hay fever and eczema using the ECRHS-questionnaire

Foregoing intensive care treatment in newborn infants with extremely poor prognoses : a study in four neonatal intensive care units in the Netherlands

Contains fulltext : 23909___.PDF (publisher's version ) (Open Access

Prognostic models for stillbirth and neonatal death in very preterm birth: A validation study

OBJECTIVES: To validate externally 2 prognostic models for stillbirth and neonatal death in very preterm infants who are either known to be alive at the onset of labor or admitted for neonatal intensive care. PATIENTS AND METHODS: All infants, with gestational age 22 to 32 weeks, of European ethnicity, known to be alive at the onset of labor (n = 17 582) and admitted for neonatal intensive care (n = 11 578), who were born in the Netherlands between January 1, 2000, and December 31, 2007. The main outcome measures were stillbirth or death within 28 days for infants known to be alive at the onset of labor and death before discharge from the NICU for infants admitted for intensive care. Model performance was studied with calibration plots and c statistic. RESULTS: Of the infants known to be alive at the onset of labor, 16.7% (n = 2939) died during labor or within 28 days of birth, and 7.8% (n = 908) of the infants admitted for neonatal intensive care died before discharge from intensive care. The prognostic model for infants known to be alive at the onset of labor showed good calibration and excellent discrimination (c statistic 0.92). The prognostic model for infants admitted for neonatal intensive care showed good calibration and good discrimination (c statistic 0.82). CONCLUSIONS: The 2 prognostic models for stillbirth and neonatal death in very preterm Dutch infants showed good performance, suggesting their use in clinical practice in the Netherlands and possibly other Western countries. Copyrigh

Implementation of a nation-wide automated auditory brainstem response hearing screening programme in neonatal intensive care units

Aim: As part of a future national neonatal hearing screening programme in the Netherlands, automated auditory brainstem response (AABR) hearing screening was implemented in seven neonatal intensive care units (NICUs). The objective was to evaluate key outcomes of this programme: participation rate, first stage success rate, pass/referral rates, rescreening compliance, diagnostic referral rates, age of first diagnostic evaluation and prevalence of congenital hearing loss (CHL). Methods: This prospective cohort study collected data on 2513 survivors. NICU graduates with one or more risk factors according to the Joint Committee on Infant Hearing were included in a two-stage AABR hearing screening programme. Conventional ABR was used to establish a diagnosis of CHL. Results: A total of 2513 newborns enrolled in the programme with a median gestational age of 31.6 (range 24-43) wk and a median birthweight of 1450 (range 510-4820) g. In 25 (1%) cases parents refused screening. Four out of 2513 newborns were initially lost; 2484 newborns have been tested initially. A final 98% participation rate (2465/2513) was obtained for the whole programme. After a median postmenstrual age at the first test of 33.7 (range 27-54) wk, a pass rate of 2284/2484 (92%) resulted at the first stage. The rescreening compliance after the first test was 92% (184/200). A referral rate for diagnostic ABR of 3.1% (77/2484) resulted. Of the 77 referrals 14 (18.2%) had normal screening thresholds, 15 (19.5%) had unilateral CHL and 48 (62.3%) had bilateral CHL. The prevalence of unilateral CHL was 0.6% (15/2484) and of bilateral CHL 1.9% (48/2484). Conclusion: A financially supported two-stage AABR hearing screening programme can be successfully incorporated in NICU centres and detects a high prevalence of CHL in NICU graduates. Neonatal hearing screening should be part of standard clinical practice in all NICU infants

Vroeggeboorte, intra-uteriene groeiachterstand en lichamelijke ziehten op de volwassen leeftijd; resultaten van 19 jaar POPS-follow-up [Premature birth, intrauterine growth retardation and physical disease in adulthood: Results of 19 years POPS follow-up]

Veel te vroeg geboren kinderen lopen een groter risico op neurosensorische handicaps en ontwikkelingsproblemen dan op tijd geboren kinderen. Vroeggeboorte, intra-uteriene groeiachterstand, en de combinatie hiervan, zijn ook mogelijke risicofactoren voor lichamelijke ziekten op de volwassen leeftijd. Omdat hier tot nu toe weinig onderzoek naar is verricht, zijn in de pops-cohort (Project On Preterm and Small for gestational age infants) de eerste tekenen hiervan bekeken. Vroeggeboorte lijkt een risicofactor te zijn voor het ontwikkelen van insulineresistentie. Bij een latere neiging tot vetzucht is dat risico extra groot. Nog groter wordt dat als hieraan een intra-uteriene groeiachterstand voorafging. De systolische bloeddruk is gemiddeld hoger bij ex-prematuren maar is niet gerelateerd aan de mate van intra-uteriene groeiretardatie. De nierfunctie (klaring en eiwituitscheiding) is op de jongvolwassen leeftijd minder gunstig voor die individuen die naast de vroeggeboorte ook zijn blootgesteld aan intra-uteriene groeiretardatie. Te vroeg geboren kinderen hebben als jongvolwassenen meer luchtwegklachten en een minder goede longfunctie. De conclusie is dat neonatale follow-up niet alleen noodzakelijk is voor veel te vroeg geboren kinderen maar ook voor kinderen met een ernstige intra-uteriene groeiachterstand. De kinderarts moet in het contact met zowel ouders en kind als met de huisarts benoemen dat een voorgeschiedenis van vroeggeboorte of groeiachterstand ook een mogelijke risicofactor is voor chronische ziekten op de volwassen leeftijd. Bij te vroeg geboren kinderen met intra-uteriene groeiachterstand is actieve preventie van obesitas vanaf jonge leeftijd geïndiceerd. Vanaf jongvolwassen leeftijd zal de huisarts extra alert moeten zijn op het ontstaan van met name hypertensie en microalbuminurie door dit bijvoorbeeld tweejaarlijks te controleren. Voor het kind zelf kan de voorgeschiedenis een extra reden zijn om overgewicht te vermijden, om aan sport te doen en om niet te beginnen met roken

Long-Term Neurodevelopmental and Functional Outcomes of Infants Born Very Preterm and/or with a Very Low Birth Weight

Clinical epidemiolog