1. In this retrospective cohort study, birth at earlier gestational age (GA) was associated with worse survival rates and increased hospitalization rates in the first 10 years of life, with respiratory diagnoses being the most common reason for admission.
2. Birth at earlier GA was also associated with higher parental-reported rates of hyperactivity and lower prosocial behaviors as well as lower scores on national high school exams.
Evidence Rating Level: 2 (Good)
Study Rundown: While survival of preterm infants has increased over the past decade and follow-up data beyond early childhood is becoming more readily available. The purpose of this study was to add outcome data through adolescence using contemporary cohorts. This retrospective cohort study examined 2 cohorts of infants born at ≥23 weeks’ GA using data from New Zealand’s Integrated Data Infrastructure (IDI). Epoch 1 (Infants born 2005-2015) assessed survival, 10-year hospitalization data, developmental, and education outcomes. Data from this cohort demonstrated lower rates of survival and higher hospital rates for infants born at 23-24 weeks’ GA compared to controls born at >39 weeks’ GA. Lower GA was also associated with parental reports of hyperactivity without additional developmental concerns noted on a national health survey tool. There were no significant differences in school enrollment at 6-years of age, and >70% extremely preterm children did not require special school support for learning. Epoch 2 (infants born between 1998-2000) was used to evaluated 15-year education outcomes via the National Certificate of Educational Achievement (NCEA). Lower GA was associated with lower enrollment and performance percentiles for the NCEA. Limitations of this study include difficulty in generalization due to use of country-specific academic metrics and small effect size for Epoch 2 outcome data. This study demonstrates that while earlier birth is associated with decreased survival, increased hospitalization, and some academic deficits, prematurity does not always correlate with educational achievement – a consideration that providers and families should be aware of when making decisions for preterm infants.
In-Depth [retrospective cohort]: This study included infants ≥23 weeks’ GA with linked government birth records external to the IDI and excluded those without hospitalization records, Before School Checks (B4SC) national well-being screening tool, or school attendance documentation. Infants were analyzed in 2 cohorts: Epoch 1 included infants born between 2005 and 2015, and Epoch 2 including infants born between 1998 and 2000 with 15-year follow-up. The primary outcomes were mortality, hospitalizations, B4SC, and education outcomes. Epoch 1 included 678 072 live births ≥23 weeks’ GA, of which 613 521 were eligible for analysis. Ten-year survival rates for infants in this cohort born at 23 and 24 completed weeks’ GA were 41.2% and 67.6%, respectively. The hospitalization rate per 10 000 child-years was significantly higher in infants born <39 weeks’ GA, and respiratory diagnoses were the most common reason for admission. On the B4SC, earlier GA was associated with higher scores for hyperactivity and lower scores for prosocial behaviors on the Strengths and Difficulties Questionnaire-Parents. However, the Parents Evaluation of Developmental Status (PEDS) assessment showed that 51% of parents of children born at 23-24 weeks’ GA reported minimal concern about their child’s development. For 6-year educational outcomes, >99% of children were enrolled in primary school with no significant differences in enrollment seen by GA, and more than 70% of extremely preterm infants did not have Reading Recovery support. For Epoch 2, birth at earlier GA was associated with lower rates of taking the NCEA examinations and lower NCEA performance percentiles for those who did take the exam, however, the effect size was small.
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