Follow-up after very preterm birth in Europe

Abstract

Inverse probability weights after multiple imputation were used for all analyses. *Using intrauterine charts modelled for the Effective Perinatal Intensive care in Europe cohort. †Intraventricular haemorrhage grades III and IV, cystic periventricular leucomalacia, retinopathy of prematurity stages III-V or necrotising enterocolitis needing surgery. aRRR, adjusted relative risk ratio; GA, gestational age; ISCED, International Standard Classification of Education.

Motor‐related health care for 5‐year‐old children born extremely preterm with movement impairments

“…47 Children born EPT with perinatal risk factors for health and developmental problems had increased use of specialized health care, including MRHC, as also found in our sample at 2 years. 15 In contrast, children of non-Europeanborn mothers were less likely to receive MRHC, which is consistent with data showing these children are less likely to use routine follow-up services 16 and with reports of barriers to accessing appropriate health care faced by migrant parents with newborn infants or young children. 48 Having at least one parent unemployed was associated with greater use of MRHC, but causality is hard to assess because parents may drop out of the workforce when children require a lot of care.…”

“…16 The proportion of children with SMD receiving MRHC was higher in France and Portugal, which have higher rates of routine follow-up at the age of 5 years (31.2% and 58.4%), compared with Italy and the UK (12.3% and 17.0%). 16 Longer systematic follow-up beyond 2 years of age may be needed to identify children with movement difficulties, since about one-third of children born preterm with CP are only diagnosed after 2 years 6 months of age 32 and because motor skills may decline until at least the age of 5 years in children born very preterm, especially for those who had higher scores on tests of motor performance at the age of 2 years. 33 A second hypothesis is that movement difficulties may not be assessed as part of routine clinical follow-up protocols.…”

“…Large differences in the use of MRHC for children with SMD were observed by country which may be explained by variability in routine follow-up protocols and intervention approaches, as described above, or potentially by service availability. 17 Heterogeneity is known to exist between countries in routine follow-up policies and programmes, 16 but we did not collect information on the specific follow-up protocols used for motor function assessment for the children in our sample. Our data come from selected regions in each country -except for Estonia where the entire country is represented -and therefore results may not be representative of the situation in the whole country given regional differences in the organization of follow-up services and health care provision.…”

“…We hypothesized that many children born EPT with movement difficulties would receive multidisciplinary care 14 because of the co-occurrence of movement difficulties with other developmental difficulties and that MRHC use would vary across countries, given differences in routine health care follow-up and specialist use. [15][16][17]…”

Parental perspective on important health outcomes of extremely preterm infants

“…21 In a recent European survey, only 27% of very preterm children were receiving follow-up care at 5 years. 22 Furthermore, as previously shown, children of lower socioeconomic status were less likely to attend follow-up. 23 24 Despite the association between lower socioeconomic status and neurodevelopmental vulnerabilities, especially in children at higher biological risk, 25 a lower level of parental education, in our study, was associated with parents explicitly or implicitly responding that nothing needed to be improved with their child.…”