Multidomain Morbidity at 7-8 Years After Very Preterm Birth: Associations with Perinatal and Neonatal Factors

Despite improved neonatal survival among very preterm infants, health problems affecting various organ systems may persist in the long term. The aim of this study was to determine the burden of morbidity and multimorbidity documented by 7-8 years of age among children born at ≤32 weeks' gestation and to investigate the perinatal and neonatal factors associated with these outcomes.

A single-center observational cohort study included 63 children born at ≤32 weeks' gestation and assessed at 7-8 years of age. Perinatal and neonatal data were obtained retrospectively from medical records. Long-term health outcomes were assessed across five morbidity domains: respiratory, neurological/neurodevelopmental, sensory, growth-related, and educational/behavioral. The co-occurrence of two or more morbidity domains was defined as multimorbidity.

The median gestational age was 30 weeks (Q1-Q3, 28-32 weeks), and the birth weight was 1.23 kg (Q1-Q3, 0.9-1.65 kg). At least one morbidity was identified in 69.8% of the children, whilst 38.1% had morbidity involving two or more domains. The most common comorbidities were educational/behavioral (58.7%) and respiratory (42.9%). Neurological/neurodevelopmental morbidity was 31.7%, whilst sensory and growth-related morbidities accounted for 28.6%. Growth-related morbidity was associated with lower birth weight (p = 0.006) and being small for gestational age (SGA) (p < 0.001). Neurological/neurodevelopmental morbidity was associated with chorioamnionitis (p = 0.03), longer duration of CPAP (p = 0.04) and oxygen therapy (p = 0.01), as well as neonatal sepsis (p = 0.03).

In this cohort, morbidities documented by 7-8 years of age occurred across multiple domains, with conditions in two or more domains co-occurring in a considerable proportion of children born at ≤32 weeks' gestation. These findings support multidimensional long-term follow-up, while recognizing the heterogeneity of the 25-32-week gestational-age range.