Repository hosted by TU Delft Library

OBJECTIVE. Young adults who were born very preterm or with a very low birth weight remain at risk for physical and neurodevelopmental problems and lower academic achievement scores. Data, however, are scarce, hospital based, mostly done in small populations, and need additional confirmation. METHODS. Infants who were born at <32 weeks of gestation and/or with a birth weight of <1500 g in the Netherlands in 1983 (Project on Preterm and Small for Gestational Age Infants) were reexamined at age 19. Outcomes were adjusted for nonrespondents using multiple imputation and categorized into none, mild, moderate, or severe problems. RESULTS. Of 959 surviving young adults, 74% were assessed and/or completed the questionnaires. Moderate or severe problems were present in 4.3% for cognition, 1.8% for hearing, 1.9% for vision, and 8.1% for neuromotor functioning. Using the Health Utility Index and the London Handicap Scale, we found 2.0% and 4.5%, respectively, of the young adults to have ≥3 affected areas in activities and participation. Special education or lesser level was completed by 24%, and 7.6% neither had a paid job nor followed any education. Overall, 31.7% had ≥1 moderate or severe problems in the assessed areas. CONCLUSIONS. A total of 12.6% of young adults who were born very preterm and/or with a very low birth weight had moderate or severe problems in cognitive or neurosensory functioning. Compared with the general Dutch population, twice as many young adults who were born very preterm and/or with a very low birth weight were poorly educated, and 3 times as many were neither employed nor in school at age 19. Copyright © 2007 by the American Academy of Pediatrics.

Context: Transient hypothyroxinaemia of prematurity (THoP) has been associated with neurodevelopmental impairment in infancy and childhood. It is not known whether these relations persist into adulthood. Objective: To examine whether there is an effect of THoP on intelligence quotient (IQ) score and motor functioning at young adult age. Design: This study was part of the 19-year follow-up of the Project On Preterm and Small-for-gestational-age birth (POPS) cohort, which included infants born very preterm (i.e., <32 weeks) and/or with a very low birth weight (i.e., <1,500 g). Setting: Multicenter study Patients: 398 19-year-old participants of the POPS cohort, of whom 120 had THoP. Exposure: Thyroxine (T4) concentrations were obtained through the national neonatal screening program for congenital hypothyroidism. THoP was defined as a total T4 concentration <-3 SD of the daily mean (approximately 60 nmol/L). Main outcome measures: IQ and motor functioning, measured with the digital Multicultural Capacities Test-Intermediate Level and a revised version of Touwen’s examination of minor neurologic dysfunction, respectively. Results: THoP was not associated with IQ score (mean difference: 0 (95% confidence interval: -3.8 to 3.8) points) or motor function (mean difference: 0.6 (95% confidence interval: -1.3 to 2.5) points) after adjustment for demographic and perinatal characteristics. Conclusions: No associations between THoP and neurodevelopmental outcome at age 19 years were found.

Veel te vroeg geboren kinderen lopen een groter risico op neurosensorische handicaps en ontwikkelingsproblemen dan op tijd geboren kinderen. Vroeggeboorte, intra-uteriene groeiachterstand, en de combinatie hiervan, zijn ook mogelijke risicofactoren voor lichamelijke ziekten op de volwassen leeftijd. Omdat hier tot nu toe weinig onderzoek naar is verricht, zijn in de pops-cohort (Project On Preterm and Small for gestational age infants) de eerste tekenen hiervan bekeken. Vroeggeboorte lijkt een risicofactor te zijn voor het ontwikkelen van insulineresistentie. Bij een latere neiging tot vetzucht is dat risico extra groot. Nog groter wordt dat als hieraan een intra-uteriene groeiachterstand voorafging. De systolische bloeddruk is gemiddeld hoger bij ex-prematuren maar is niet gerelateerd aan de mate van intra-uteriene groeiretardatie. De nierfunctie (klaring en eiwituitscheiding) is op de jongvolwassen leeftijd minder gunstig voor die individuen die naast de vroeggeboorte ook zijn blootgesteld aan intra-uteriene groeiretardatie. Te vroeg geboren kinderen hebben als jongvolwassenen meer luchtwegklachten en een minder goede longfunctie. De conclusie is dat neonatale follow-up niet alleen noodzakelijk is voor veel te vroeg geboren kinderen maar ook voor kinderen met een ernstige intra-uteriene groeiachterstand. De kinderarts moet in het contact met zowel ouders en kind als met de huisarts benoemen dat een voorgeschiedenis van vroeggeboorte of groeiachterstand ook een mogelijke risicofactor is voor chronische ziekten op de volwassen leeftijd. Bij te vroeg geboren kinderen met intra-uteriene groeiachterstand is actieve preventie van obesitas vanaf jonge leeftijd geïndiceerd. Vanaf jongvolwassen leeftijd zal de huisarts extra alert moeten zijn op het ontstaan van met name hypertensie en microalbuminurie door dit bijvoorbeeld tweejaarlijks te controleren. Voor het kind zelf kan de voorgeschiedenis een extra reden zijn om overgewicht te vermijden, om aan sport te doen en om niet te beginnen met roken.

Objective: To study the prevalence of respiratory and atopic symptoms in (young) adults born prematurely, differences between those who did and did not develop Bronchopulmonary Disease (BPD) at neonatal age and differences in respiratory health between males and females. Methods: Design: Prospective cohort study. Setting: Nation wide follow-up study, the Netherlands. Participants: 690 adults (19 year old) born with a gestational age below 32 completed weeks and/or with a birth weight less than 1500g. Controls were Dutch participants of the European Community Respiratory Health Survey (ECRHS). Main outcome measures: Presence of wheeze, shortness of breath, asthma, hay fever and eczema using the ECRHS-questionnaire Results: The prevalence of doctor-diagnosed asthma was significantly higher in the ex-preterms than in the general population, whereas eczema and hay fever were significant lower. Women reported more symptoms than men. Preterm women vs controls: asthma 13% vs 5% (p<0.001); hay fever 8% vs 20% (p<0.001); eczema 10% vs 42% (p<0.001). Preterm men vs controls: asthma 9% vs 4% (p=0.007); hay fever 8% vs 17% (p=0.005); eczema 9% vs 31% (p<0.001) Preterm women reported more wheeze and shortness of breath during exercise (sob) than controls: wheeze 30% vs 22% (p=0.009); sob 27% vs 16% (p<0.001); 19-year-old women with BPD reported a higher prevalence of doctor diagnosed asthma compared to controls (24% vs 5% p <0.001) and shortness of breath during exercise (43% vs 16% p=0.008). The prevalence of reported symptoms by men with BPD were comparable with the controls. Conclusions: Our large follow-up study shows a higher prevalence of asthma, wheeze and shortness of breath in the prematurely born young adults. 19-year-old women reported more respiratory symptoms than men. Compared to the general population atopic diseases as hay fever and eczema were reported less often. © 2005 Vrijlandt et al., licensee BioMed Central Ltd.