Caregiver-reported health-related quality of life of New Zealand children born very and extremely preterm

1. Caregivers reported good health related quality of life of New Zealand children despite their shorter gestational periods

2. Neurodevelopmental impairment and socio-economic deprivation were found to be associated with lower health related quality of life (HRQoL). 

Evidence Rating Level: 2 (Good) 

Children born with shorter gestational periods have been found to have greater morbidity and mortality risk factors. Specifically, preterm births can lead to higher risk of neurodevelopmental impairments (NDI) such as cerebral palsy, visual or hearing impairments, and motor function delays. Children born very or extremely preterm represent approximately 16% of preterm births, however, health related quality of life (HRQoL) of these children have not been extensively studied. This retrospective cohort study aimed to not only address this gap in the research but also to better understand the factors influencing HRQoL as well as long term impacts later in life. In order to do this, data was collected on a cohort of children (n=127) born preterm and very preterm (mean gestational age of 26.7 weeks). This cohort was composed of children born <30 weeks’ gestation or <1500 g birthweight in Auckland, New Zealand between 2005-2008.  Of these children 6% had a diagnosed neurological impairment during their neonatal period and at 7 years, 47% were categorized as having one. The effects of these NDIs lead to reduced individual functioning, socio-economic deprivation, and worse psychosocial HRQoL. The assessment of HRQoL took a holistic approach in order to consider all domains of the children’s health. Specifically, The Wechsler Intelligence Scale for Children 4th Edition (WISC-IV) and the Movement Assessment Battery for Children 2nd Edition (MABC-2) were used to assess the IQ and physical abilities of the children. Visual acuity, neurological examinations, and Gross Motor Function Classification Score (GMFCS) were also utilized. Furthermore, the caregivers completed the Child Health Questionnaire Parent Form 50 Questions (CHQ-PF50) and the modified Health Utilities Index Mark 2 (HUI-2) to assess the children’s perceived physical, social, and emotional wellbeing. Overall, participants reported good HRQoL across all assessed domains. Factors potentially influencing caregiver’s responses may have included their family dynamic and social environments. Caregiver stress and low socioeconomic status may have also impacted their perception of their child’s quality of life. Additionally, for the children themselves, accessibility of social opportunities, anxiety, depression, and cognitive difficulties may all have an impact on their HRQoL. The study results revealed NDI, lower gestational age, and greater socio-economic deprivation have varying levels of association with HRQoL. However, the children’s IQ as well as their motor function were the only independent predictors. Ultimately, this study can help guide strategies to improve HRQoL in preterm children by improving and preventing NDIs as well as improving socio-economic situations of children and their caregivers. The lifelong implications for individuals with NDIs are more significant than the impacts of their shorter gestation periods.

Click to read the study in PLOSONE

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