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Perinatal characteristics and parents' perspective of health status of NICU graduates born at term

Abstract

Objective:

Long-term outcomes of preterm infants have been extensively studied, but few studies have examined long-term outcomes of term infants who require neonatal intensive care unit (NICU). Our objectives were to assess perinatal characteristics and health status of preschool age term babies using data from a population-based study of NICU graduates.

Study Design:

Retrospective cross-sectional survey. All babies were born in 1996 to 1997 in BC (Canada). The Health Status Classification System Preschool (HSCS-PS) questionnaire was completed by parents at 42 months of age. HSCS-PS was grouped in four categories (neurosensory, learning, motor and quality of life). Logistic regression was used to identify perinatal risk factors associated with moderate/severe problems at 42 months of age.

Result:

Completed surveys were received for 261 term NICU survivors and 393 control children. Term infants represent 32% of all NICU admissions. Mean birth weight of NICU graduates was 3458 g (s.d.=600 g). Median length-of-stay in NICU was 5 days. At 42 months, the NICU group had significantly more problems on the HSCS-PS as compared to the full-term healthy infants in neurosensory, motor and learning/remembering. Moderate/severe health status problems were associated with congenital anomalies (odds ratio (OR), 3.2; confidence interval (CI): 1.3 to 7.8); smoking status (OR, 2.7, CI: 1.1 to 6.6) and SNAP score (OR, 1.04; CI: 1.0 to 1.1).

Conclusion:

Term babies admitted to NICUs may have significant health issues in childhood. Greater attention needs to be paid to long-term outcomes of term NICU graduates. Further study is warranted to address which NICU term survivors warrant secondary and/or tertiary-level neurodevelopmental follow-up.

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References

  1. Aylward GP, Pfeiffer SI, Wright A, Verhulst SJ . Outcome studies of low birth weight infants published in the last decade: a metaanalysis. J Pediatr 1989; 115(4): 515–520.

    Article  CAS  Google Scholar 

  2. Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJ . Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA 2002; 288(6): 728–737.

    Article  Google Scholar 

  3. Escobar GJ, Littenberg B, Petitti DB . Outcome among surviving very low birthweight infants: a meta-analysis. Arch Dis Child 1991; 66(2): 204–211.

    Article  CAS  Google Scholar 

  4. Grunau RE, Whitfield MF, Fay TB . Psychosocial and academic characteristics of extremely low birth weight (< or =800 g) adolescents who are free of major impairment compared with term-born control subjects. Pediatrics 2004; 114(6): e725–e732.

    Article  Google Scholar 

  5. Hack M . Young adult outcomes of very-low-birth-weight children. Semin Fetal Neonatal Med 2006; 11(2): 127–137.

    Article  Google Scholar 

  6. Hack M, Taylor HG, Drotar D, Schluchter M, Cartar L, Andreias L et al. Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s. JAMA 2005; 294(3): 318–325.

    Article  CAS  Google Scholar 

  7. Saigal S . Perception of health status and quality of life of extremely low-birth weight survivors. The consumer, the provider, and the child. Clin Perinatol 2000; 27(2): 403, 19, x.

    Article  CAS  Google Scholar 

  8. Saigal S, den Ouden L, Wolke D, Hoult L, Paneth N, Streiner DL et al. School-age outcomes in children who were extremely low birth weight from four international population-based cohorts. Pediatrics 2003; 112(4): 943–950.

    Article  Google Scholar 

  9. Saigal S, Stoskopf BL, Streiner DL, Burrows E . Physical growth and current health status of infants who were of extremely low birth weight and controls at adolescence. Pediatrics 2001; 108(2): 407–415.

    Article  CAS  Google Scholar 

  10. Stjernqvist K, Svenningsen NW . Ten-year follow-up of children born before 29 gestational weeks: health, cognitive development, behaviour and school achievement. Acta Paediatr 1999; 88(5): 557–562.

    Article  CAS  Google Scholar 

  11. Vohr BR, Wright LL, Poole WK, McDonald SA . Neurodevelopmental outcomes of extremely low birth weight infants <32 weeks' gestation between 1993 and 1998. Pediatrics 2005; 116(3): 635–643.

    Article  Google Scholar 

  12. Marlow N, Wolke D, Bracewell MA, Samara M, EPICure Study Group. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 2005; 352(1): 9–19.

    Article  CAS  Google Scholar 

  13. Mikkola K, Ritari N, Tommiska V, Salokorpi T, Lehtonen L, Tammela O et al. Neurodevelopmental outcome at 5 years of age of a national cohort of extremely low birth weight infants who were born in 1996–1997. Pediatrics 2005; 116(6): 1391–1400.

    Article  Google Scholar 

  14. Theunissen NC, Veen S, Fekkes M, Koopman HM, Zwinderman KA, Brugman E et al. Quality of life in preschool children born preterm. Dev Med Child Neurol 2001; 43(7): 460–465.

    Article  CAS  Google Scholar 

  15. Lindeke LL, Mills MM, Georgieff MK, Tanner ME, Wrbsky PM . Health, growth, and use of community services in NICU graduates at early school age. J Pediatr Health Care 1998; 12(6 Part 1): 299–304.

    Article  CAS  Google Scholar 

  16. Ludman L, Lansdown R, Spitz L . Factors associated with developmental progress of full term neonates who required intensive care. Arch Dis Child 1989; 64(3): 333–337.

    Article  CAS  Google Scholar 

  17. Philips III JB, Dickman HM, Resnick MB, Nelson Jr RM, Eitzman DV . Characteristics, mortality, and outcome of higher-birth weight infants who require intensive care. Am J Obstet Gynecol 1984; 149(8): 875–879.

    Article  Google Scholar 

  18. Gray JE, McCormick MC, Richardson DK, Ringer S . Normal birth weight intensive care unit survivors: outcome assessment. Pediatrics 1996; 97(6 Part 1): 832–838.

    CAS  PubMed  Google Scholar 

  19. Lian WB, Yeo CL, Ho LY . Two-year outcome of normal-birth-weight infants admitted to a Singapore neonatal intensive care unit. Ann Acad Med Singapore 2002; 31(2): 199–205.

    CAS  PubMed  Google Scholar 

  20. Lupton BA, Hill A, Roland EH, Whitfield MF, Flodmark O . Brain swelling in the asphyxiated term newborn: pathogenesis and outcome. Pediatrics 1988; 82(2): 139–146.

    CAS  PubMed  Google Scholar 

  21. Hageman JR, Dusik J, Keuler H, Bregman J, Gardner TH . Outcome of persistent pulmonary hypertension in relation to severity of presentation. Am J Dis Child 1988; 142(3): 293–296.

    CAS  PubMed  Google Scholar 

  22. Hintz SR, Benitz WE, Colby CE, Sheehan AM, Rycus P, Van Meurs KP et al. Utilization and outcomes of neonatal cardiac extracorporeal life support: 1996–2000. Pediatr Crit Care Med 2005; 6(1): 33–38.

    Article  Google Scholar 

  23. Ichiba H, Matsunami S, Itoh F, Ueda T, Ohsasa Y, Yamano T . Three-year follow up of term and near-term infants treated with inhaled nitric oxide. Pediatr Int 2003; 45(3): 290–293.

    Article  CAS  Google Scholar 

  24. Brown KL, Miles F, Sullivan ID, Hoskote A, Verhulst L, Ridout DA et al. Outcome in neonates with congenital heart disease referred for respiratory extracorporeal membrane oxygenation. Acta Paediatr 2005; 94(9): 1280–1284.

    Article  Google Scholar 

  25. Lipkin PH, Davidson D, Spivak L, Straube R, Rhines J, Chang CT . Neurodevelopmental and medical outcomes of persistent pulmonary hypertension in term newborns treated with nitric oxide. J Pediatr 2002; 140(3): 306–310.

    Article  CAS  Google Scholar 

  26. Rosenberg AA . Outcome in term infants treated with inhaled nitric oxide. J Pediatr 2002; 140(3): 284–287.

    Article  Google Scholar 

  27. Connolly MA, Johnson JA . Measuring quality of life in paediatric patients. Pharmacoeconomics 1999; 16(6): 605–625.

    Article  CAS  Google Scholar 

  28. Hack M . Consideration of the use of health status, functional outcome, and quality-of-life to monitor neonatal intensive care practice. Pediatrics 1999; 103(1 Suppl E): 319–328.

    CAS  PubMed  Google Scholar 

  29. Schmidt LJ, Garratt AM, Fitzpatrick R . Child/parent-assessed population health outcome measures: a structured review. Child Care Health Dev 2002; 28(3): 227–237.

    Article  CAS  Google Scholar 

  30. Saigal S, Rosenbaum P, Stoskopf B, Hoult L, Furlong W, Feeny D et al. Development, reliability and validity of a new measure of overall health for pre-school children. Qual Life Res 2005; 14(1): 243–257.

    Article  CAS  Google Scholar 

  31. Klassen AF, Landgraf JM, Lee SK, Barer M, Raina P, Chan HW et al. Health related quality of life in 3 and 4 year old children and their parents: preliminary findings about a new questionnaire. Health Qual Life Outcomes 2003; 1(1): 81.

    Article  Google Scholar 

  32. Varni JW, Seid M, Kurtin PS . PedsQL 4.0: reliability and validity of the pediatric quality of life inventory version 4.0 generic core scales in healthy and patient populations. Med Care 2001; 39(8): 800–812.

    Article  CAS  Google Scholar 

  33. Fekkes M, Theunissen NC, Brugman E, Veen S, Verrips EG, Koopman HM et al. Development and psychometric evaluation of the TAPQOL: a health-related quality of life instrument for 1–5-year-old children. Qual Life Res 2000; 9(8): 961–972.

    Article  CAS  Google Scholar 

  34. Saigal S, Stoskopf B, Streiner D, Boyle M, Pinelli J, Paneth N et al. Transition of extremely low-birth-weight infants from adolescence to young adulthood: comparison with normal birth-weight controls. JAMA 2006; 295(6): 667–675.

    Article  CAS  Google Scholar 

  35. Saigal S, Rosenbaum PL, Feeny D, Burrows E, Furlong W, Stoskopf BL et al. Parental perspectives of the health status and health-related quality of life of teen-aged children who were extremely low birth weight and term controls. Pediatrics 2000; 105(3 Part 1): 569–574.

    Article  CAS  Google Scholar 

  36. Theunissen NC, den-Ouden AL, Meulman JJ, Koopman HM, Verloove-Vanhorick SP, Wit JM . Health status development in a cohort of preterm children. J Pediatr 2000; 137(4): 534–539.

    Article  CAS  Google Scholar 

  37. Tideman E, Ley D, Bjerre I, Forslund M . Longitudinal follow-up of children born preterm: somatic and mental health, self-esteem and quality of life at age 19. Early Hum Dev 2001; 61(2): 97–110.

    Article  CAS  Google Scholar 

  38. Klassen AF, Lee SK, Raina P, Chan HW, Matthew D, Brabyn D . Health status and health-related quality of life in a population-based sample of neonatal intensive care unit graduates. Pediatrics 2004; 113(3 Part 1): 594–600.

    Article  Google Scholar 

  39. Lee SK, McMillan DD, Ohlsson A, Pendray M, Synnes A, Whyte R et al. Variations in practice and outcomes in the Canadian NICU network: 1996–1997. Pediatrics 2000; 106(5): 1070–1079.

    Article  CAS  Google Scholar 

  40. Richardson DK, McCormick MC, Gray JE, Goldmann DA . CRIB and SNAP. Lancet 1994; 344(8915): 124–125.

    Article  CAS  Google Scholar 

  41. Gray JE, Richardson DK, McCormick MC, Workman-Daniels K, Goldmann DA . Neonatal therapeutic intervention scoring system: a therapy-based severity-of-illness index. Pediatrics 1992; 90(4): 561–567.

    CAS  PubMed  Google Scholar 

  42. Chamberlayne R, Green B, Barer ML, Hertzman C, Lawrence WJ, Sheps SB . Creating a population-based linked health database: a new resource for health services research. Can J Public Health 1998; 89(4): 270–273.

    CAS  PubMed  Google Scholar 

  43. Becerra JE, Fry YW, Rowley DL . Morbidity estimates of conditions originating in the perinatal period: United States, 1986 through 1987. Pediatrics 1991; 88(3): 553–559.

    CAS  PubMed  Google Scholar 

  44. Rohininath T, O'Connell LA, Sheehan K, Corcoran D, Matthews TG, Clarke TA . Workload and short-term outcome of babies weighing 2,500 grams or more at birth admitted to the paediatric unit of the Rotunda Hospital. J Matern Fetal Neonatal Med 2005; 17(2): 139–143.

    CAS  PubMed  Google Scholar 

  45. Eisen M, Ware Jr JE, Donald CA, Brook RH . Measuring components of children's health status. Med Care 1979; 17(9): 902–921.

    Article  CAS  Google Scholar 

  46. Asch DA, Jedrziewski MK, Christakis NA . Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997; 50(10): 1129–1136.

    Article  CAS  Google Scholar 

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Acknowledgements

The Hospital for Sick Children Foundation (Toronto) provided an operating grant for this study. Veronica Schiariti was the recipient of a trainee award from the Neonatal-Perinatal Interdisciplinary Capacity Enhancement (NICE) Team, which was funded by Canadian Institutes of Health Research (CIHR). From British Columbia Research Institute, Veronica Schiariti holds a Graduate Studentship. Anne Klassen holds a New Investigator Award from CIHR and a Scholar Award from Michael Smith Foundation for Research. We thank the Canadian Neonatal Network.

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Schiariti, V., Klassen, A., Houbé, J. et al. Perinatal characteristics and parents' perspective of health status of NICU graduates born at term. J Perinatol 28, 368–376 (2008). https://doi.org/10.1038/jp.2008.9

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