Health-related quality of life of children born very preterm: a multinational European cohort study

Abstract

Purpose This study aims to (1) describe the health-related quality of life (HRQoL) outcomes experienced by children born very preterm (28–31 weeks’ gestation) and extremely preterm (< 28 weeks’ gestation) at five years of age and (2) explore the mediation effects of bronchopulmonary dysplasia (BPD) and severe non-respiratory neonatal morbidity on those outcomes. Methods This investigation was based on data for 3687 children born at < 32 weeks’ gestation that contributed to the EPICE and SHIPS studies conducted in 19 regions across 11 European countries. Descriptive statistics and multi-level ordinary linear squares (OLS) regression were used to explore the association between perinatal and sociodemographic characteristics and PedsQL™ GCS scores. A mediation analysis that applied generalised structural equation modelling explored the association between potential mediators and PedsQL™ GCS scores. Results The multi-level OLS regression (fully adjusted model) revealed that birth at < 26 weeks’ gestation, BPD status and experience of severe non-respiratory morbidity were associated with mean decrements in the total PedsQL™ GCS score of 0.35, 3.71 and 5.87, respectively. The mediation analysis revealed that the indirect effects of BPD and severe non-respiratory morbidity on the total PedsQL™ GCS score translated into decrements of 1.73 and 17.56, respectively, at < 26 weeks’ gestation; 0.99 and 10.95, respectively, at 26–27 weeks’ gestation; and 0.34 and 4.80, respectively, at 28–29 weeks’ gestation (referent: birth at 30–31 weeks’ gestation). Conclusion The findings suggest that HRQoL is particularly impaired by extremely preterm birth and the concomitant complications of preterm birth such as BPD and severe non-respiratory morbidity.

Health‐related quality of life in two birth cohorts of extremely preterm born adults

“…A study of EP-born children from 11 European countries revealed that HRQoL was particularly impaired both by BPD as well as by other severe non-respiratory morbidities. 15 We also observed a correlation between poorer HRQoL and the administration of postnatal steroids. However, it is important to bear in mind that neonates treated with postnatal steroids constitute a particularly vulnerable group who require steroids to facilitate weaning from ventilatory support, and therefore are at heightened risk of adverse outcomes, that is bias by indication is probably at play here.…”

“…Bronchopulmonary dysplasia (BPD) and intraventricular haemorrhage (IVH) were associated with poorer physical health in early adulthood in a Swedish VLBW cohort. 14 A recent article by Kim et al 15 reported lower HRQoL in very preterm children with BPD and severe non-respiratory morbidity. Moreover, EP-born children from our 91-92 cohort, who received neonatal steroids scored lower in the domain for role/social functioning at 10 years of age.…”

Major Morbidity and Survival of Extremely Preterm Infants in Tertiary Hospital

“…Various studies approve of this trend; however, absolute morbidity and mortality rate at the earliest gestational age is variable (Lee et al, 2020;Rysavy et al, 2020). Extremely preterm infants are at increased risk of developing sepsis, necrotizing enterocolitis, also retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia, and white matter damage (Kim et al, 2023). This poses a significant challenge for neonatologists.…”

“…This poses a significant challenge for neonatologists. According to research, the premature birth rate in developed countries like UK, Greece, Turkey, and Germany was 73%, 75%, 69%, and 63%, respectively (Kim et al, 2023). Such infants' survival rate has significantly improved over the last twenty years.…”

“…Such infants' survival rate has significantly improved over the last twenty years. The survival rate in Germany increased from 42% to 54% during 1996-2018 (Kim et al, 2023). Russia has had a 3% increase in survival rate every year from 19096 to 2019 (Nørgaard et al, 2021).…”