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Changes over time in quality of life of school-aged children born extremely preterm: 1991-2005
Stacey Peart1, Jeanie Ling Yoong Cheong2,3,4, Gehan Roberts5,6
1Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia.
Insights
Children born extremely preterm (EP) experience reduced health-related quality of life (HRQOL) compared to term-born peers. This disparity, measured by parent-reported utilities, appears to be worsening over time in the post-surfactant era.
Area of Science:
- Pediatric Health
- Neonatal Medicine
- Quality of Life Research
Background:
- Extremely preterm (EP) birth (<28 weeks' gestation) poses significant risks for long-term health outcomes.
- Health-related quality of life (HRQOL) is a crucial measure of well-being in childhood.
- Understanding HRQOL trends in EP survivors is essential for improving long-term care.
Purpose of the Study:
- To compare HRQOL at 8 years of age in children born EP versus term-born controls.
- To analyze HRQOL trends across three distinct birth epochs: 1991-92, 1997, and 2005.
- To identify potential worsening of HRQOL deficits in EP survivors over time.
Main Methods:
- Prospective cohort study in Victoria, Australia.
- Inclusion of 475 EP survivors and 570 term-born controls.
- Parent-reported HRQOL assessed using the Health Utilities Index (HUI) v2 and v3 at 8 years of age.
Main Results:
- Parent-reported utilities were consistently lower for EP children compared to controls across all eras.
- Clinically important differences (>0.05) in utilities were observed in all EP cohorts.
- The 2005 EP cohort showed a greater mean difference in utilities compared to the 1991-92 and 1997 cohorts, suggesting a potential worsening trend.
Conclusions:
- Children born EP in the post-surfactant era exhibit significant reductions in parent-reported HRQOL.
- The observed HRQOL deficits in EP survivors may be increasing over time.
- These findings highlight the need for ongoing support and interventions for EP survivors to improve their long-term well-being.
Objective:
To compare health-related quality of life (HRQOL) at 8 years in children born extremely preterm (EP) with contemporaneous term-born controls over three epochs: 1991-92, 1997 and 2005.
Design:
Prospective recruitment of geographic cohorts across three distinct eras. Utilities were calculated from the parent-completed Health Utilities Index (HUI), version 2 (1991-92 and 1997 cohorts) and version 3 (2005 cohort). Differences in utilities >0.05 are clinically important.
Setting:
The state of Victoria, Australia.
Patients:
475 EP (<28 weeks' gestation) and 570 term controls.
Main Outcome Measures:
Utilities of children born EP compared with term controls within each era, and paired differences between an EP and matched controls compared across eras.
Results:
Overall, 86% of survivors had utility data at 8 years of age; 475 EP and 570 controls. In all eras, parent-reported utilities were lower for children born EP compared with controls (difference in medians (95% CIs); 1991-92, -0.053 (-0.071 to -0.035); 1997, -0.053 (-0.072 to -0.034); 2005, -0.082 (-0.097 to -0.068)). Mean differences (MD) between EP children and matched controls within each era were lower in the 2005 cohort compared with both the 1991-92 cohort (MD -0.054, 95% CI -0.097 to -0.010) and the 1997 cohort (MD -0.053, 95% CI -0.097 to -0.009).
Conclusion:
Children born EP in the postsurfactant era have clinically important reductions in parent-reported HRQOL compared with controls, which may be worsening over time.
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