Long-Term Healthcare Outcomes of Preterm Birth: An Executive Summary of a Conference Sponsored by the National Institutes of Health

Abstract

Barker pioneered the novel idea that common chronic diseases result not only from bad genes and an unhealthy lifestyle, but also from alterations in the intrauterine and early postnatal environment. 1 The timing of these alterations, either during a "critical" period of growth and maturation or accumulating over longer intervals, can have a permanent effect on the organism. The impact of birth weight, maternal habitus, nutrition, and smoking, and the role of the placenta on developmental programming of metabolic syndrome, obesity, hypertension, and organ development have been well-studied. More recent studies have suggested that developmental programming on the background of preterm birth may be far more important than suboptimal intrauterine growth. In the US, about 10%-12% of births occur before 37 completed weeks of postmenstrual age. 2 Worldwide rates vary. Today, more than 95% of these "preterm infants" survive to adulthood in most industrialized nations owing to remarkable advances in perinatal, neonatal, and pediatric care. 3-6 Survival may come at the expense of future adverse health and social risks characterized by failure to achieve optimal development or more rapid rates of decline in cardiovascular, pulmonary, and renal function or "accelerated aging." 7 Individuals born preterm are at an increased risk for type 2 diabetes, cardiovascular and cerebrovascular diseases, hypertension, chronic kidney disease, asthma and pulmonary function abnormalities, and neurocognitive and psychosocial disorders and poorer social adaptation. 8-12 Even a modest increase (eg, 10%-20%) in risk for these chronic conditions can translate into a substantial population burden. Because of this, the US National Institutes of Health convened a conference of multidisciplinary experts to elucidate the evidence for the epidemiologic, public health, and societal burden of diseases among those born preterm, to review potential mechanisms and to consider future research priorities. An understanding of these areas is crucial for developing prevention and treatment strategies. This report summarizes the key concepts discussed at the conference, and poses many unanswered questions that may serve to guide future research endeavors in each domain (Table). Epidemiology and Preterm Outcomes Much of our knowledge about individuals born preterm has come from prospective birth cohort studies of large populations. Although longitudinal cohort studies have many advantages, there are significant challenges, such as the long duration of follow-up (and need for long-term funding) necessary to provide meaningful associations, lack of information on confounders, changes in classification of diseases and outcomes over time, and loss to follow-up. With a few exceptions, our knowledge of the longer term outcomes of preterm birth comes from cohorts born outside of the US 13-15 who were followed through adulthood. A Swedish study of 679 981 singleton live births between 1973 and 1979, examined the association between preterm birth and allcause and cause-s...

Adults born preterm: a review of general health and system-specific outcomes

“…In August 2015, the US National Institutes of Health convened a conference of multi–disciplinary experts to address the issues related to adults born preterm and to propose a research agenda to address knowledge gaps. Because an executive summary from this meeting has been published, we will not repeat those recommendations here .…”

“…We thank the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Heart Lung and Blood Institute and the National Institute of Diabetes, Digestive and Kidney Diseases for sponsoring a conference in August 2015 on Adults Born Preterm: Epidemiology and Biological Basis for Outcomes . We thank Dr. Satyan Lakshminrusimha, Professor of Pediatrics, State University of New York at Buffalo, Buffalo, NY, for permission to use the figure in this publication.…”

Childhood and adolescent mental health of NICU graduates: an observational study

“…Children and adolescents who were admitted to the NICU/special care nursery appear to have a general propensity to developing psychiatric disorders. Existing follow-up guidelines of preterm infants describe surveillance for psychosocial disorders,37 and this work provides preliminary evidence that in the future it may one day be prudent to expand this to NICU infants regardless of birth status. While NICU admission is an easily determined dichotomous classification, more data are likely required before this information is used to identify at-risk individuals.…”

Mapping vascular and glomerular pathology in a rabbit model of neonatal acute kidney injury using MRI

“…Furthermore, there are no clinically tools that can integrate the vascular and glomerular compartments to map simultaneous changes. As the survival rates of the most preterm infants improve (Marlow et al, 2014), it is critical to focus on how to improve the morbidity associated with impairment of ongoing organogenesis in an ex utero environment, where the effects of preterm birth and kidney disease may be detectable years after birth Raju, Pemberton, et al, 2017). Clinicians need tools to predict which preterm neonates will develop renal disease as adults.…”