Adult Outcome of Extremely Preterm Infants

Abstract

Survival rates for extremely preterm (<28 weeks’ gestational age) infants have increased and are approaching 3 in 4 with the advent of modern perinatal and neonatal intensive care. In contrast with some children with chronic diseases such as cystic fibrosis, most survivors of extreme prematurity have no ongoing health issues. However, as a group, they do have higher rates of adverse health outcomes, and more of them will present to pediatricians over time and, ultimately, to adult physicians as they grow older. Pediatricians can aid the transition to adult health care by being aware of the nutritional, cardiovascular, respiratory, motor, cognitive, psychiatric, and functional outcomes into adulthood of survivors of extreme prematurity.

Psychosocial Outcomes of Young Adults Born Very Low Birth Weight

“…11,12,27 We did not formally measure IQ in this study, but differences in educational outcomes between the VLBW young adults and controls were more marked in those with previous disability at 7 to 8 years. Similarly, there were clear trends for those with previous disability, and particularly those with moderate or severe disability at age 7 to 8, to have poorer social, occupational, and physical functioning, and to exhibit poorer behavioral regulation than other VLBW young adults.…”

“…[4][5][6][7][8][9][10] Data are now emerging from a growing body of cohort and crosssectional studies, particularly during adolescence but also early adulthood, showing that these impairments may persist and in turn impact the preterm survivor' s longer term functioning and life-course opportunities. [11][12][13][14][15][16][17] In 1986, we enrolled all New Zealand VLBW infants admitted for neonatal intensive care in a prospective study of retinopathy of prematurity, 18 and surviving children were followed up at ages 7 to 8 years. 8,9 This cohort is unique in being populationbased, characterized by high rates of antenatal steroid exposure, and with comprehensive information on child health and development during middle childhood.…”

Catch-up Alveolarization in Ex-Preterm Children. Evidence from 3He Magnetic Resonance

“…This has shifted the focus of research from survival toward long-term sequelae of prematurity (1,2). Infants born extremely preterm are known to have arrested alveolar development, manifesting as fewer and larger alveoli (3,4).…”

Premature Birth and Disease Programming. Contribution of Neonatal Intensive Care

“…В результате у детей, оказавшихся под воздействием таких факторов внутриу-тробного развития, увеличивается вероятность развития и манифестации в более раннем возрасте артериальной гипертензии, ишемической болезни сердца и дислипиде-мии, ожирения и диабета 2-го типа [9]. Эта зависимость была затем продемонстрирована в ходе больших эпи-демиологических исследований, проведенных не только в Великобритании, но и в Голландии, Финляндии, Индии и США [10]. Клеточные механизмы внутриутробного про-граммирования интенсивно изучают на животных моде-лях, что подтвердило существование этого феномена не только у человека [9].…”

“…XX в., еще не достигли зрелого возраста, но те, кто родился в 80-е и застал начало эры успешного выхаживания недоношен-ных новорожденных, уже демонстрируют заболеваемость, согласующуюся с теорией внутриутробного программиро-вания [11]. Значительная часть таких людей, родившихся без существенных повреждений ЦНС, страдает в настоя-щее время бронхиальной астмой, артериальной гипертен-зией, метаболическим синдромом, новообразованиями [10,11]. Более того, преждевременное рождение рас-сматривается сейчас как вероятная причина депрессии взрослых и поведенческих девиаций [5,6].…”