The New Zealand 1986 very low birth weight cohort as young adults: mapping the road ahead

Abstract

BackgroundVery low birth weight (less than 1500 g) is associated with increased morbidity and costs of health care in childhood. Emerging evidence suggests these infants face a range of health and social problems as young adults. We studied all New Zealand very low birth weight infants born in 1986 (when 58 % were exposed to antenatal corticosteroids) in infancy, with later follow-up at 7 to 8 years and 23 to 24 years. We now aim to assess the cohort at 26–28 years compared with controls.Methods/designThe case sample will comprise a minimum of 250 members of the 1986 New Zealand national very low birth weight cohort (77 % of survivors). Outcomes will be compared with a control group of 100 young adults born at term in 1986. Following written informed consent, participants will travel to Christchurch for 2 days of assessments undertaken by experienced staff. Medical assessments include growth measures, vision, respiratory function, blood pressure and echocardiogram, renal function, dental examination and blood tests. Cognitive and neuropsychological functioning will be assessed with standard tests, and mental health and social functioning by participant interview. A telephone interview will be conducted with a parent or significant other person nominated by the respondent to gain a further perspective on the young person’s health and functioning. All those born at less than 28 weeks’ gestation, plus a random subset of the cohort to a total of 150 cases and 50 controls, will be offered cranial magnetic-resonance imaging. Statistical analysis will examine comparison with controls and long-term trajectories for the very low birth weight cohort.DiscussionThe research will provide crucial New Zealand data on the young adult outcomes for very low birth weight infants and address gaps in the international literature, particularly regarding cardiovascular, respiratory, visual and neurocognitive outcomes. These data will inform future neonatal care, provide evidence-based guidelines for care of preterm graduates transitioning to adult care, and help shape health education and social policies for this high risk group.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12612000995875. Registered 1 October 2012Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0413-9) contains supplementary material, which is available to authorized users.

Vision in former very low birthweight young adults with and without retinopathy of prematurity compared with term born controls: the NZ 1986 VLBW follow-up study

“…The prospective New Zealand VLBW Follow-up Study cohort included all 413 VLBW infants born in 1986 and admitted to a neonatal unit, of whom 338 (82%) survived to discharge home 7. Of these infants, 313 were examined for ROP; any ROP occurring in 67 (21%) and stage 3 or more in 12 (3.8%), including six children, all with birth weight <1000 g, who were bilaterally blind 8.…”

Outcomes of preterm birth: a lifespan perspective

“…1,2 The risks for these adverse outcomes are especially high for very preterm or very low birthweight children (gestational age <32wks or birthweight <1500g). But these children are also at higher risk than their normal birthweight peers born at term for cognitive weaknesses, problems in physical health, social-emotional adjustment, independent functioning, and more limited adult educational and vocational attainments.…”

“…1,3 The latter outcomes may be more closely related to deficits in specific skills, such as executive functioning or social cognition, and the availability of social and family supports, than to reductions in IQ. 1,3 The latter outcomes may be more closely related to deficits in specific skills, such as executive functioning or social cognition, and the availability of social and family supports, than to reductions in IQ.…”

“…Long-term consequences of preterm birth may originate from early biological perturbations to the brain and systems underlying regulation of sleep and responses to stress. 1,5 Utilization of qualitative as well as quantitative methods will be useful in detailing the range of challenges faced by individuals born preterm as they transition to early and then later adulthood, and in assessing the effectiveness of different ways of addressing these challenges. 5 Further progress in characterizing adult outcomes of preterm birth and identifying key contributors to variability in these outcomes will require assessments of multiple dimensions of adult functioning, comprehensive evaluation of the environmental context and social relationships, and consideration of developmental antecedents.…”

Cardiac disease in pregnancy and consequences for reproductive outcomes, comorbidity and survival

“…Long-term complications of preterm birth include impaired cognitive skills, vision and hearing problems, and behavioral and psychological problems, such as attention-deficit/hyperactive disorder 55,56 . Children who experienced preterm birth are also more likely to have chronic health issues such as asthma and infections than full-term children 54,55 .…”