[Quality analyses of the development of preterm infants: results of the Lower-Saxonian preterm infant follow-up project and a comparison group of term infants]

The Development of Extremely Premature Infants

BACKGROUND

Until now, there has been no comprehensive long-term study in Germany on the development of extremely premature infants up to school age.

METHODS

From October 2004 to September 2008, in the German federal state of Lower Saxony, 437 infants born at a gestational age less than 28 weeks were followed up at the ages of 2 and 5 years, and some at the age of 10 years. The 5-year follow-up data were collated with the peri- and neonatological parameters and compared with the 2- and 10-year follow-up data.

RESULTS

The mortality of extremely premature infants was 25.1%. Among the five-year-olds studied, 14.1% showed cognitive impairment and 17.4% had cerebral palsy. 40.4% manifested abnormalities of speech or language, 33.1% had behavioral abnormalities, and 72.5% received therapeutic interventions. Infants in whom severe brain damage was diagnosed by ultrasonography shortly after birth were more likely to develop cerebral palsy (odds ratio [OR] 38.28, 99% confidence interval [12.55; 116.80]) and to have impaired cognitive development (OR 7.36 [2.52; 21.51]). The likelihood of cognitive impairment was also higher among infants whose mothers had a lower level of education (OR 3.83 [1.68; 8.77]). 73.1% (242 out of 331) of the two-year-olds were in the same category of cognitive function at the 5-year follow-up; 82.4% (65 out of 79) of the 5-year-olds were in the same category of cognitive function at the 10-year follow-up.

CONCLUSION

Many of these extremely premature infants had developmental disturbances, and many required therapeutic interventions. The risk factors revealed by this study may help identify patients who are in particular need of support, enabling targeted measures to be taken at the earliest possible stage in order to improve their cognitive and motor abilities. Nationwide, standardized follow-up at the age of 5 years would be desirable.

Early comprehensive care of preterm infants-effects on quality of life, childhood development, and healthcare utilization: study protocol for a cohort study linking administrative healthcare data with patient reported primary data

BACKGROUND

About 9 % of all children in Germany are born preterm. Despite significant improvements of medical care, preterm infants are at a greater risk to develop short and long term health complications. Negative consequences of preterm birth include neurodevelopmental disabilities, behavioral problems or learning disorders. Most data on effects of prematurity are derived from single or multi-center studies and not population-based. Since some of the long term problems of preterm delivery are associated with a disturbed parent-child interaction originating in the neonatal period, several intervention programs became available aiming to strengthen the early parent-child relationship. However, there is insufficient knowledge regarding the psychosocial and socioeconomic impact of these interventions. Prior to introducing them into routine care, those effects have to be rigorously evaluated. The population-based cohort study EcoCare-PIn (Early comprehensive Care of Preterm Infants-effects on quality of life, childhood development, and healthcare utilization) will investigate the following primary research questions: 1) What are the short- and long-term consequences of preterm birth with regard to parental stress, parent-child relationship, childhood development, quality of life and healthcare utilization including costs? 2) Does early family-centered psychosocial care prevent the hypothesized negative consequences of preterm birth on the above mentioned outcomes?

METHODS/DESIGN

EcoCare-PIn examines the research questions by means of a linkage of a) pseudonymized administrative individual-level claims data from the German statutory health insurance AOK PLUS on approximately 140,000 children born between 2007 and 2013 in Saxony, and b) primary data collected from the parents/caregivers of all very low birth weight (<1,500 g; n = 1,000) and low birth weight infants (1,500 to 2,500 g; n = 5,500) and a matched sample of infants above 2,500 g birth weight (n = 10,000).

DISCUSSION

In Saxony, approximately 50 % of all individuals are insured at the AOK PLUS. The linkage of patient-level administrative and primary data is a novel approach in neonatal research and probably the only way to overcome shortcomings of studies solely relying on one data source. The study results are based on an observation period of up to 8 years and will directly inform perinatal healthcare provision in Saxony and Germany as a whole.