Unrecognised and unmet physical health problems in a national cohort of very low birthweight young adults and controls

Abstract

INTRODUCTIONYoung adults are often reluctant to seek medical attention. Compared with full-term controls, very low birthweight (<1500 g; VLBW) young adults may have more health problems. AIMTo assess the frequency of unrecognised or unmet physical health needs during a comprehensive health and welfare assessment of a national cohort of VLBW adults born in 1986 compared with full-term controls. METHODSThe VLBW cohort (n = 229; 71% of those alive) and controls (n = 100) aged 27–29 years were assessed in one University Hospital over 2 days. Physical health assessments included growth, respiratory function, blood pressure, echocardiogram, renal function, blood tests and an interview. Cranial MRI scans were performed on 150 VLBW adults and 50 controls. Significant unrecognised or unmet health needs were defined as including a body mass index (BMI) >30 plus raised fasting insulin >80 pmol/L; any two of moderate respiratory obstruction, or reduced diffusing capacity, or being a regular smoker; cardiovascular: hypertension or abnormal echocardiogram. RESULTSAmong the VLBW cohort and controls; 61% versus 73% (P < 0.05) rated their overall health as very good or excellent. A general practitioner (GP) referral letter was sent for 44% VLBW adults and 38% controls, concerning metabolic problems in 20% and 17% respectively; respiratory problems in 12% and 4% (P < 0.05) respectively; cardiovascular problems in 14% and 12% respectively; abnormal renal function in 7% in both groups; and anaemia in 3% and 5% respectively. DISCUSSIONUnrecognised or unmet health needs were frequent in both VLBW young adults and controls. Respiratory problems and hypertension were more frequent in the former. Continuity of care is important for VLBW adults who require a regular GP. GPs should routinely ask about gestation and birthweight and VLBW graduates should volunteer this information.

Health perception by young adults born very preterm

“…Two Australian studies showed that the rehospitalisation rate for individuals born preterm at less than 32 weeks was higher during infancy and childhood compared with term-born controls, but this difference was considerably attenuated at 14-18 years. 25,26 Contrary to our findings, another study reported that preterm-born adults were less likely to have consulted their family doctor in the last 12 months than their term-born counterparts, 22 especially males. The fact that 73% of all responders to our follow-up survey were female might explain why we did not observe a similar trend.…”

“…Indeed, different studies have reported that 16%-31% of people born preterm smoke. 20,22,24 Although this rate was not different from the general population, individuals born preterm are at risk for chronic diseases.…”

Dental status of young adults born with very low birthweight: A national cohort study

“…The groups were broadly comparable in terms of sex, ethnicity and family socioeconomic background but, as adults, VLBW participants had lower educational attainment and socioeconomic status. Controls had a similar profile of characteristics (education, employment, healthcare utilization) to national data for same age peers (data not shown) 27 . In the VLBW group, the 68 (27.2%) were extremely low birthweight (ELBW; <1000 g), and 65 (26.0%) were extremely preterm (EP; <28 weeks' gestation).…”

“…Controls had a similar profile of characteristics (education, employment, healthcare utilization) to national data for same age peers (data not shown). 27 In the VLBW group, the 68 (27.2%) were extremely low birthweight (ELBW; <1000 g), and 65 (26.0%) were extremely preterm (EP; <28 weeks' gestation).…”

From the Editor: Aspirations, innovations and reality

“…5 Young adults are the population age group least likely to consult in general practice 6 and while in general this may be because they are also the population age group with the least need for health care, in study following up a cohort of very low birthweight (VLBW) babies at 2729 years of age Darlow and colleagues found a reasonably high level of unmet need for general practice care. 7 These researchers suggest that knowing the birthweight of their registered young adult patients might be helpful in sensitising general practices to the health needs of all young adults, and especially patients who started life as VLBW babies, many of whom have a surfeit of ongoing health issues.…”