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Health related quality of life after extremely preterm birth: a matched controlled cohort study
Bente J Vederhus1, Trond Markestad, Geir E Eide
1Department of Paediatrics, Haukeland University Hospital, Bergen, Norway. bente.vederhus@helse-bergen.no
Insights
Children born extremely preterm have lower health-related quality of life (HRQoL), especially boys. Learning and attention problems significantly impact HRQoL for these children and their families.
Area of Science:
- Pediatrics
- Neonatology
- Quality of Life Research
Background:
- Growing number of infants born before the last trimester survive.
- Limited data exists on the long-term health-related quality of life (HRQoL) for these children.
- This study compares HRQoL in extremely preterm children versus term-born controls.
Purpose of the Study:
- To compare HRQoL in 10-year-old children born extremely preterm with term-born controls.
- To assess the relationship between HRQoL and perinatal/neonatal morbidity.
- To examine the influence of current clinical and sociodemographic factors on HRQoL.
Main Methods:
- Population-based cohort study in Western Norway (1991-92).
- Inclusion criteria: gestational age < 28 weeks or birth weight < 1000 grams.
- Utilized the Child Health Questionnaire (CHQ-PF50) and general questionnaires; employed McNemar test, paired t-tests, and regression models for analysis.
Main Results:
- 71% of preterms experienced learning/attention problems vs. 20% of controls (OR: 7.0).
- Preterm children scored lower on 8 CHQ-PF50 sub-scales and summary scores.
- HRQoL was significantly associated with learning/attention problems, particularly in preterms, impacting health and parental burden.
Conclusions:
- Parent-reported HRQoL is inferior for extremely preterm children, especially boys, affecting daily life.
- Learning and/or attention problems are prevalent in preterms and strongly influence their HRQoL.
- Perinatal and neonatal morbidity showed minimal association with HRQoL within the preterm group.
Background:
The majority of infants born before the last trimester now grow up. However, knowledge on subsequent health related quality of life (HRQoL) is scarce. We therefore aimed to compare HRQoL in children born extremely preterm with control children born at term. Furthermore, we assessed HRQoL in relation to perinatal and neonatal morbidity and to current clinical and sociodemographic characteristics.
Method:
The Child Health Questionnaire (CHQ-PF50) and a general questionnaire were applied in a population based cohort of 10 year old children born at gestational age < or = 28 weeks or with birth weight < or = 1000 grams in Western Norway in 1991-92 and in term-born controls, individually matched for gender and time of birth. The McNemar test and paired t-tests were used to explore group differences between preterms and matched controls. Paired regression models and analyses of interaction (SPSS mixed linear model) were used to explore potential effects of sociodemographic and clinical characteristics on HRQoL in the two groups.
Results:
All 35 eligible preterm children participated. None had major impairments. Learning and/or attention problems were present in 71% of preterms and 20% of controls (odds ratio (OR): 7.0; 95% confidence interval (CI): 2.2 to 27.6). Insufficient professional support was described by 36% of preterm vs. 3% of control parents (OR: infinite; CI: 2.7 to infinite). Preterms scored lower on eight CHQ-PF50 sub-scales and the two summary scores, boys accounting for most of the deficits in areas of behavior, psychosocial functioning and parental burden. HRQoL was associated with learning and/or attention problems in both preterm and control children, significantly more so in preterms in areas related to health and parental burden. Within the preterm group, HRQoL was mostly unrelated to perinatal and neonatal morbidity.
Conclusions:
HRQoL for children born extremely preterm, and particularly for boys, was described by parents to be inferior to that of children born at term, and sufficiently poor to affect the daily life of the children and their families. Learning and/or attention problems were reported for a majority of preterms, strongly influencing their HRQoL.
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