Psychosocial Outcomes of Young Adults Born Very Low Birth Weight Brian A. Darlow, L. John Horwood, Huia M.

Pere-Bracken and Lianne J. Woodward Pediatrics 2013;132;e1521; originally published online November 18, 2013; DOI: 10.1542/peds.2013-2024

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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2013 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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Woodward. and bChristchurch Health and Development Study. and physical functioning than other VLBW young adults.6 [228. New Zealand. Department of Pediatrics. Christchurch 8140. former VLBW young adults obtained similar scores across many aspects of health and social functioning as their same age peers. FRACP. Darlow.8]). The impact of neurodevelopmental disability at age 7 to 8 years on young adult outcomes was examined. and critically reviewed the manuscript. Ms Pere-Bracken contributed to the study design. and reviewed and revised the manuscript. Dr Woodward contributed to the study design and reviewed and revised the manuscript. had few or no friends (20. Christchurch.a L. December 2013 Downloaded from pediatrics. Those with previous disability had poorer social. PO Box 4345. young adults. long-term outcome.2013-2024 Accepted for publication Sep 19. and social functioning of a national cohort of very low birth weight (VLBW) infants born in 1986 in New Zealand compared with a control group of young adults born the same year.nz PEDIATRICS (ISSN Numbers: Print. MSc. and cDepartment of Pediatrics and Psychology.1 [221.2 to 35. Missouri WHAT’S KNOWN ON THIS SUBJECT: Several studies have suggested that very low birth weight young adults have increased risks of physical and health problems. had lower rates of tertiary education/ training (percentage difference [95% confidence interval]: 213. and all authors approved the final manuscript as submitted.b Huia M. 2013 Address correspondence to Brian A. darlow@otago. Online.0 to 24. in many areas there were no differences between the VLBW cohort and controls.aappublications. and social difficulties. education.org/cgi/doi/10. and VLBW adults rated their overall quality of life and behavioral functioning similarly to their peers. had more often been welfare dependent (23. Pere-Bracken.a and Lianne J. with some differences largely confined to those with previous disability. FRACP.org at Indonesia:AAP Sponsored on December 15. PhDc aDepartment of Pediatrics.2 cm shorter than controls.pediatrics. 2013 e1521 .2013-2024 doi:10. Mr Horwood contributed to the study concept and design. educational underachievement. MD. including quality-of-life scores. John Horwood. with some differences largely confined to those with disability at age 7 to 8 years. very low birth weight.0 to 28. CONCLUSIONS: Despite some evidence of health. St Louis. 1098-4275). questionnaire ABBREVIATIONS SGA—small for gestational age VLBW—very low birth weight VP—very preterm Dr Darlow conceptualized and designed the study and drafted the initial manuscript. However. VLBW young adults were 5.6 kg lighter and 4. and poorer social functioning than their peers. WHAT THIS STUDY ADDS: Former VLBW young adults in this national cohort scored as well as term controls on many measures of health and social functioning.ac.0]). occupational. www.2]). was responsible for all the data collection. RESULTS: We interviewed 230 VLBW young adults (71% of survivors) and 69 controls at age 22 to 23 years. educational status.5 [7.6]). Washington University School of Medicine.1542/peds. educational. KEY WORDS infant.8]) and university degree completion (215. and more often had wheeze in the past year (20. 0031-4005. Pediatrics 2013. carried out the initial analyses. Copyright © 2013 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.6 to 21. E-mail: brian. New Zealand/epidemiology. but there are limited population-based and longitudinal data. METHODS: Participants underwent a comprehensive face-to-face interview that included standardized assessment tools and previously used custom written survey items. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. abstract OBJECTIVE: To assess the early adult health.1 [9. New Zealand. MA. health status. University of Otago Christchurch. MD.ARTICLE Psychosocial Outcomes of Young Adults Born Very Low Birth Weight AUTHORS: Brian A. quality of life.5 [10. FUNDING: All phases of this study were supported by a project grant from the New Zealand Child Health Research Foundation (Cure Kids). Darlow. Number 6.132:e1521–e1528 PEDIATRICS Volume 132. University of Otago Christchurch.2 to 32.1542/peds.

in a limited number of cases. ensuring balance with respect to the gender.4–10 Data are now emerging from a growing body of cohort and crosssectional studies. 126 (31%) were . 58% had received antenatal steroids.Infants born very low birth weight (VLBW. we enrolled all New Zealand VLBW infants admitted for neonatal intensive care in a prospective study of retinopathy of prematurity. the VLBW cohort had higher rates of behavioral problems (conduct disorders. their families. and we assessed 298 children (96% of survivors who resided in New Zealand. learning problems. anxiety/withdrawal) and poorer school achievement. components of the Composite International Diagnostic Interview23 for assessment of mental disorders. A more detailed description of the measures used in the Downloaded from pediatrics. VLBW infants are more likely to experience poor growth. attention problems.9 This cohort is unique in being populationbased. executive deficits.19 In the current study.11–17 In 1986.1000 g and at .28 wk was 64%. version 2. and 15% had mild disability. ethnicity. which was principally an IQ between 1 and 2 SDs below the mean. which lasted ∼2 hours. and employment. health history. and social functioning relative to a comparison group of young adults born at term in the same year.1000 g. social and partner relationships. individual behavior and everyday executive difficulties. family. income.aappublications. especially attention-deficit/hyperactivity disorder. Survival for those born . METHODS Participants The 1986 cohort comprised all 413 VLBW infants who were live born and admitted for NICU care in New Zealand. the Barkley adult self-report scales of attentiondeficit/hyperactivity disorder and oppositional defiant disorder symptoms22. the cohort was traced through their addresses at age 7 to 8 years. income. There were no substantive differences between those recruited by either method in terms of characteristics or outcome.8.8 Compared with the Christchurch Health and Development Study cohort studied at the same age.18 and surviving children were followed up at ages 7 to 8 years. 5% had severe disability. 338 (82%) of whom survived to discharge. 103 (25%) were small for gestational age (SGA). and society is the quality of that survival in the longer term. educational underachievement.20 which allows quality-of-life scores to be derived. educational and e1522 DARLOW et al occupational achievement. grandparents’ addresses. showing that these impairments may persist and in turn impact the preterm survivor’s longer term functioning and life-course opportunities. whereas neurosensory impairments. The interview incorporated a series of standardized assessment tools including the following: the Short Form 36 Health Survey. an additional 12 children had died.1 Although survival rates for these infants now exceed 90%. and quality of life. the Inventory of Parent and Peer Attachments24.28 wk gestation. and the Rosenberg self-esteem scale. . 91% of all survivors). National Health Index codes (a unique person identifier used within the New Zealand health system since 1993) via the electoral rolls and.3 During childhood. and 95 (23%) were born to mothers who identified as Maori. characterized by high rates of antenatal steroid exposure.32 wk gestation) account for 1% to 2% of live births but between 50% and 75% of the workload of NICUs. with up to 40% of school-aged children born VP experiencing cognitive delay.9.1500 g) or very preterm (VP. Even more common are neurobehavioral impairments. general practitioners. Assessment Measures After written informed consent. particularly during adolescence but also early adulthood. The aim of the current study was to retrace the cohort at 23 years and to assess their health. Knowledge of longer term outcomes is also crucial to inform current neonatal care. participants were assessed for height. Of these. In addition. are seen in up to 10%. 2013 . and overall life satisfaction. and body mass index (BMI). employment. weight. by local advertisements. This interview examined individual functioning across a range of domains including the following: current living arrangements. the Behavior Rating Inventory of Executive Function–Adult Version21. There is now clear evidence demonstrating increased rates of health problems among surviving VLBW infants compared with those born at term in their early years.org at Indonesia:AAP Sponsored on December 15. At follow-up at age 7 to 8 years. A comparison group of individuals who were born at term in New Zealand and who were not admitted for NICU care was recruited. 132 (32%) weighed .18 At birth. because of time constraints. and life satisfaction. subsequently also via random sampling from electoral rolls (total of 29). physical and mental health. initially through peer nomination by cohort members (total of 40) and. all participants underwent a face-to-face interview conducted by 1 researcher.25 This information was supplemented by custom written survey items used previously in the Christchurch Health and Development Study26 to assess education. and regional distribution of the sample. including cerebral palsy. . and with comprehensive information on child health and development during middle childhood. and clinically significant emotional and behavioral adjustment problems. education. 5% had moderate disability. self-esteem. Checks were made with Statistics New Zealand to see if any individuals had died since the last follow-up. waist circumference.2 what is most important for the individual. peer. and partner relationships.

0 54.8 46. December 2013 cases. There was a clear trend (P . (Further information on outcomes for the VLBW cohort stratified by variation in previous neurosensory disability at age 7–8 years is provided in the Supplemental Information and Supplemental Tables 9–13.001 .2 31.1) 40.3 (222.001). mild.5. university degree). hours worked. or Pacific Islander.. Where the case group is further stratified (eg. There were significant trends for fewer friends and poorer quality peer relationships as assessed by the Inventory of Parent and Peer Attachments scale with increasing disability at age 7 to 8 years (P .ARTICLE present analysis is provided in Supplemental Table 7.8 23. % Maori/Pacific Island ethnicity.28 wk gestation.57 .6 (24. % VLBW Cohort (n = 230) 1145 (238) 45.7) 23.) Family.16 . mean (SD). no qualifications. There was no effect of receipt of antenatal steroids related to any of the outcomes reported below. Table 1 describes the characteristics of the sample. Poisson regression for count outcomes. gender. Education.with 2 known deaths since 7 to 8 years of age (of unknown causes). with half as many gaining a university degree.4 (0.0 to 19.4 45.7) — Mean/Percentage Difference (95% CI) 22462 (22617 to 22307) 22. % Family of professional/ managerial SES.4%.12) — P .001 — CI. and the t test for independent samples or analysis of variance for differences in means of other continuous outcomes. 3. the VLBW group was further stratified to test for variation in outcome by previous neurosensory disability at age 7 to 8 (none. There were no significant differences between the proportion of the 230 survivors assessed and the 94 survivors not assessed who weighed . y Antenatal steroids.4%. 19%. In supplementary analyses. The VLBW cohort reported being closer to their parents/grandparents but had fewer friends. the VLBW cohort was more likely to be still living TABLE 1 Characteristics of Study Participants Characteristic Birth weight.10th percentile) relative to those who were normally grown.3 to 0. In these PEDIATRICS Volume 132. Downloaded from pediatrics. These calculations suggest the study had adequate power to detect small to moderate effect sizes.05 to detect a mean or percentage difference in outcome between groups with effect sizes (Cohen’s d) in the range of d = 0. VLBW graduates were more likely to have ever been welfare dependent.70 . % Age of mother at birth of child.3 to 11. g Male gender. and sexual/partner relationships are shown in Table 3. Number 6. the design has adequate power to detect moderate to large effect sizes (d = 0. together with 69 controls.6 (218. Finally.8 22.org at Indonesia:AAP Sponsored on December 15. to examine whether effect size differences were influenced by between-group differences in participant characteristics (age at assessment.42 to 20. ethnicity. VLBW participants were interviewed at a mean age that was 3 months younger than the controls (P .17 .9) 20. RESULTS Of the national VLBW cohort born in 1986. power is reduced for subgroup analyses..27 (20.8).05). SES.5–0.2 (22.2 (218. and 251 were traced and approached to take part in this study. parental education. moderate/severe). Statistical Analysis Between-group comparisons were tested for statistical significance by using the x2 test of independence for comparison of percentages. and multiple linear regression for other continuous outcomes).7 26. 324 were believed tobe alivein2008.aappublications. Effect size estimates were summarized by the mean or percentage difference in outcome between groups and the associated 95% confidence interval. —. mean (SD). by previous disability).5) 58. were born at . were male. tertiary enrollment. not assessed. employment and income. The VLBW cohort had lower overall educational attainment.1000 g at birth.65 . 71% of the surviving cohort). depending on the nature of the outcome being assessed. peer.6 (6. mean (SD).0) 21. This report concerns the 230 who consented to participate (92% of those approached. .6 (215. the observed outcome comparisons were adjusted by using multiple regression methods (logistic regression for dichotomous outcomes.8 (4. socioeconomic status). Poisson regression for analysis of count outcomes.4) 45.1 22. The trend was most marked for those with previous disability at age 7 to 8 years (34. The study had 80% power at a = 0. Analyses were also conducted to compare outcomes for those in the VLBW cohort who were SGA at birth (birth weight . Maori. and greater welfare dependence with increasing previous disability at age 7 to 8 years.8 to 0.7 (0. socioeconomic status.01) on all measures toward lower income.2 27. high school completion.5) 8. % Father with tertiary qualifications.4) 24.0 50. .9%. 2013 e1523 .4 to 9. % Age at assessment. In terms of current living arrangements. were born SGA. 56. The study was approved by the Multiregion Ethics Committee of the Ministry of Health (New Zealand).2) 29. confidence interval.8 to 10. or who had moderate/severe disability at 7 to 8 years of age (Supplemental Table 8). . or welfare dependence are shown in Table 2. y Mother with tertiary qualifications.18 .3 to 3.3 Term Controls (n = 69) 3607 (651) 47.

9 28.8) 213. there were also higher lifetime incidences of cardiac (P = . .4) 21. and rates of engagement were all substantially lower for those with moderate/severe disability at age 7 to 8 years (P .7) 219.4) P .4 59.02) and wheeze in the past 12 months (36. family socioeconomic status).58 with their parents and less likely to be rooming with their peers (P . Employment.4) 28. .024 .001)..9 (2. There was an overall trend toward lesser engagement by the VLBW cohort in sexual/partner relationships.1 to 1. and Sexual/Partner Relationships Measure Family relationships. and hearing (P = .8 44.005 .6 (20. The VLBW cohort had similar rates of tobacco.13 CI. quality of life.3 to 5.3 to 27.0 (224.9 87.9) 480 (236) 30. confidence interval.1 (219. alcohol.9 to 19.3 (227. % Welfare dependent (past 12 months).7 20.4 76.2 75.21 .8) 211.9) 26.6 kg lighter and 4. e1524 DARLOW et al Substance abuse.2 to 32.7 to 31. There was a consistent trend for those with moderate/ severe disability at age 7 to 8 years to be much less likely to have any involvement with drugs. .5 25. .0 78.7 59. criminality.73 . % No formal educational qualifications High school completiona Enrolled in tertiary education/training Attained a university degree Employment Working in paid employment.8 21.6 (22.0) cm shorter (P .25 . mean (SD) Income/welfare dependence After-tax income. and mental health are shown in Table 4. Control for these factors did not materially affect any of the observed .0 to 6.5 (10. data not shown). but this difference was not significant (P = .2 78.6–9.014 .9 14.6 to 4.1) 216. confidence interval. behavior. In addition. mean (SD). The 2 groups had similar scores on all measures. The average weight/height differentials between the cohort and controls did not vary with gender.1 (221. Finally.0 (210. . University Entrance or an equivalent qualification.6 (228.5 (221. 2013 . % Had sex (ever) Had sex (past 12 months) Had romantic partner (past 12 months) Ever cohabited with partner Ever pregnant/got partner pregnant Became a parent CI.2) 213.2 to 22.7 to 28.7%).2 cm shorter than controls.0 to 24.7 to 7. both legal and illicit (P .6) 242 (2113 to 29) 23.9 26. NZD/wk Welfare dependent (ever). % VLBW Cohort Term Controls (n = 230) (n = 69) 14.7 Mean/Percentage Difference (95% CI) 8.016 . analyses were extended by using regression methods to include control for possible between-group differences in personal and family background characteristics (age at assessment. parental education. and Income/Welfare Dependence Measure Educational attainment. a Completed 5 years of high school education and attained Higher School Certificate.4 (218.1 61.1 (3.8) 23. and overall functioning are shown in Table 6.014 ..29).02).0) 9. 4th edition.7 18. 5. those born SGA were. There was a trend for poorer behavioral regulation composite scores (P = . those with moderate/severe disability were more likely to be living with parents (56% vs 36% of those with no/mild disability vs 25% of controls) or in residential care (22% [5 individuals] vs none in the other groups) (P .4 33. % Close/very close relationship with mother Close/very close relationship with father Close/very close relationship with grandparents Peer relationships.33 .aappublications.1 to 5.2–12. Peer.3%. ethnicity.0 30.8) P no apparent variability in previous disability. Executive functioning.1 50.1 to 4.5 (229. There were no differences in the rates of Diagnostic and Statistical Manual of Mental Disorders.03) on the Behavior Rating Inventory of Executive Function–Adult Version with increasing disability at age 7 to 8 years. gender.2 Term Controls (n = 69) 88.05.001 . There was also no significant between-group variability in mean BMI or waist circumference by gender. disorders or suicidal behaviors between the cohort and controls.53 . NZD. TABLE 3 Family.05).04).7 31.9 73.06 .001 .0) 17.4 21.4 (19.9 81. vision (P = .8) kg lighter and 6.8) .5 (7.9 31.9% vs 29.2% vs 30.9 89. Physical health and growth variables are shown in Table 5. % Has few/no friends Sexual/partner relationships.2 63.0 to 23.011 52. New Zealand dollars.TABLE 2 Education.10 . % Hours worked per week. Lifetime hospital admissions and severe or chronic illness was greatest for those with moderate/severe disability at age 7 to 8 years. on average.5 61. 8.001).org at Indonesia:AAP Sponsored on December 15.8) 215. They were also more likely to have a lifetime diagnosis of asthma (46. and cannabis use compared with controls but lesser involvement with other illicit drugs.2 to 35.5) 14.2) 438 (270) 53.1 to 14. on average.8) 27.003 .3 (95% CI: 3. The cohort was. Compared with others in the VLBW cohort.1 Mean/Percentage Difference (95% CI) 23. P = .4 (21.6 to 21.3 5.26 .0 (26. and there was Downloaded from pediatrics.4 34.8 66.4 73.0 (215.05). As well as an overall higher incidence of hospital attendance in the past year and lifetime chronic illness and wheeze among the VLBW cohort.5 (95% CI: 3. VLBW Cohort (n = 230) 85.4 (221.03) problems (data not shown).

mean (SD) Asthma (lifetime).8 37.6) 25.9) Mean/Percentage Difference (95% CI) 1.9 to 21.6) 1.6) 2. P = .7 (210.8 30. There are a number of studies that have reported respiratory outcomes in former VLBW/VP late-adolescents.01 . cm BMI.12. welfare dependency.5) 20. in many areas.47) 8.2 19. mean (SD) Lifetime number of severe/chronic illnesses.44 differences in outcome between VLBW and controls.6 to 4.9 to 2.04 to 0.5) P .6 (210.9 31.ARTICLE TABLE 4 Substance Use.7 .28.3 37. and decreased diffusing capacity.7 72. the evidence suggests that VLBW/VP survivors. and fewer graduate from high school or enter tertiary education.9 (20.4 (5.2) 2.17 past year.0 (29.015 .8 (218. 2013 .3 (213.1) 1. and VLBW graduates rated their overall quality of life and behavioral functioning in a similar way to their term peers.30–33 In general.7 (14.7 to 9.54 (0.18 .6 (230. mean (SD) Weight. to have poorer social.3 (28.3) 217.1) 1. % Daily smoker Weekly alcohol use Cannabis use (ever) Cannabis use (past 12 months) Other illicit drug use (ever) Other illicit drug use (past 12 months) Criminality.1 18.7) 0.9) 20. mean (SD) Number of hospital attendances (past 12 months) .7 to 1.2 (24.9 (216.1 (9.62 . Similarly.0) 20.9 (12.1 (17.27 We did not formally measure IQ in this study.aappublications.54 .8 26.5) 89. and social engagement compared with controls.02).72 . kg/m2 CI.4 (9.8 to 2.07 to 1.7) 88. have reduced forced expiratory volume in 1 second.07 .12 .7 to 11.96 .0 15.9 (5. and physical functioning. there were clear trends for those with previous disability. occupational.0) 25.22 (20.8 8.01) 20. VLBW Cohort (n = 230) 3.18 .3 (211.76 1.4) 0.59 .6 (22.9 (18.7 68.5) 21.1 37.0 to 28. They were less likely to be living independently.4 10.05) of greater risk of asthma with decreasing gestation.89) 0. % Arrested/convicted (ever) Mental health. GP. % Asthma (past 12 months).71 .29 although few in young adults. VLBW Cohort (n = 230) 28.34 At 23 years the VLBW young adults were almost 3 times more likely than the controls to have experienced wheeze in the past 12 months (32% vs 12%.71 .1 to 0. and to exhibit poorer behavioral regulation than other VLBW young adults.7 20.4 to 9.1) 25. particularly if they had chronic neonatal lung disease.5 to 12.org at Indonesia:AAP Sponsored on December 15. % Major depression (past 12 months) Anxiety disorder (ever) Anxiety disorder (past 12 months) Suicidal ideation/attempt (ever) Suicidal ideation/attempt (past 12 months) CI. and one-third of both groups used alcohol weekly and had used cannabis in the past year.2 to 21.2 cm shorter than controls.0) 24.6 11.001 . but fewer VLBW graduates had ever used other illicit drugs or been arrested.1) 25. Number 6.7 18. general practice.1 11.1 (1.005 .. although this difference was now not significant.4 (219.1) 2. and Mental Health Measure Substance use.3 (211.36 .0) 166.0 to 24.20 to 0.7 to 3. The VLBW young adults less often had a university degree and were more likely to have either no qualifications or high school qualifications only. Approximately onequarter of the VLBW cohort and controls were daily smokers. cm Waist circumference.5 to 13.2) 34.8) 0.9 Mean/Percentage Difference (95% CI) 2.9 to 12.9) 3. there were no differences between the VLBW young adults and controls.7 (16. lower forced vital capacity.2) 27. confidence interval. Criminality.5) 1.3) 0. educational achievement.6 (10. However.7 (24.2 (26.8 35.96 .9 to 12.5 (4.6 77. mean (SD) GP visits (past 12 months) .4) 22.4 to 9.8 to 6.4 (0.9) 26. .4 67.016 .9) 26. we found that 32% had a diagnosis of asthma at the time of follow-up. kg Height.0 (3.5) 0. % Growth.1 27. but differences in educational outcomes between the VLBW young adults and controls were more marked in those with previous disability at 7 to 8 years.7 26.018 .0 (3. Several reports have shown that former VLBW/VP young adults do have lower median IQ scores than their peers.1 to 9.8 13.0) 20. even after excluding those with neurosensory impairments and controlling for confounding factors.9 (0. and particularly those with moderate or severe disability at age 7 to 8. December 2013 Downloaded from pediatrics.1 36.96 .1 8.9) P .2 58. they had a higher lifetime number of severe or chronic illnesses and were almost 3 times more likely to have been admitted to a hospital in the PEDIATRICS Volume 132. on average.0 (26.5 (215.0 Term Controls (n = 69) 26.4 40.3 (21. DISCUSSION New Zealand VLBW young adults show clear differences in health. % Any wheeze (past 12 months). In our cohort at 7 to 8 years of age.1) 0.54 (0. mean (SD) Number of severe/chronic illnesses (past 12 months).4 (1.2 (210.4) 170. with a greater proportion having a lifetime diagnosis of asthma. An important finding for the VLBW young adults themselves was that relative to e1525 18.12.2) 3. 5.7 (5.7) Term Controls (n = 69) 2.11. In addition.6 kg lighter and 4. confidence interval.0 (1.00 TABLE 5 Physical Health and Growth Measure Physical health Lifetime number of hospital admissions.1 to 19. with a significant trend (P . VLBW young adults were.

physical component score . consistent with national data.2) Term Controls (n = 69) 51.52 31. Behavior.8 (5.2) 2. Short Form 36 Health Survey.1 (25.9 to 0. Young adulthood is a time of high mobility.5) 52.0) 50. included 74% of survivors. most cohorts were born in the 1970s or early 1980s when few infants received antenatal steroids and so may be less representative of modern neonatal intensive care than our study.9 (21. There were.5 (28.5 (21.8 to 3. from New Zealand to document outcomes for former VLBW infants in young adulthood.5 to 1.org at Indonesia:AAP Sponsored on December 15.49 . there were no significant differences on the Short Form 36 physical or mental component scores or on measures of perceived overall functioning.9 (12. it will be important to objectively assess health and neuropsychological functioning in the cohort. However the number of Maori participants in the control group was too small to draw useful conclusions regarding the size of VLBW/control differences for Maori and non-Maori participants. their term peers.52 ADHD. to our knowledge.4 (6. in New Zealand few infants of #23 wk gestation were offered NICU care in 1986.6) 2.7 (9. attention-deficit/hyperactivity disorder.4) 8.45. were overrepresented in the cohort with 23% of mothers recording Maori ethnicity compared with 13% of all births in 1986.40 . no differences in the basic demographic characteristics of those who did and did not participate in our study.1) 20.9) P . and we are currently undertaking a battery of medical and neuropsychological investigations at age 26 to 27 years.1) . higher welfare dependence. Maori participants had poorer educational qualifications.6) 1.46 As in our study.45 . found that VLBW survivors had greater difficulty establishing social contacts but did not have elevated risks of psychopathology compared with their term-born peers. mean (SD) Behavioral regulation index T score Metacognition index T score Global executive composite T score ADHD/ODD symptoms. most are regional or rely on constrained national registry data. % . Our follow-up included 71% of those known to be alive at 23 years.5% of the cohort identified themselves as Maori and 5. and Overall Functioning Measure BRIEF-A index.11.7 (5. even when scores obtained from parents or other observers have been lower than those for controls.7% as of Pacific Island descent.12 However.3) 50.41–44 The study that is most similar to ours is the Netherlands Project on Preterm and Small for Gestational Age Infants study in VLBW/VP infants born in 1983.1) 0. however. which largely remains the case with contemporary care.3) 2. daily smoking. cannabis use.4 . In addition. Data from other countries are now revealing a range of functional and health-related challenges faced by former VLBW infants in late adolescence and early adulthood.1 (8.1 SD below mean.9 to 7. 15.7 (2. Similar findings have been reported previously for self-reported quality-of-life scores. such trips still being a “right of passage” for many young New Zealanders.1) 41. mean (SD) ADHD score ODD score SF-36 component scores (relative to 18–24-year norms). Behavior Rating Inventory of Executive Function–Adult Version. in the highly informative Helsinki Study32. and higher BMI scores.29 Despite the relatively positive findings. 26.1 (5. At follow-up. 2013 .16.0 (10.6) 42.1 SD below mean. oppositional defiant disorder. A limitation of our study is that we assessed both the VLBW cohort and controls by face-to-face interview only.8) Mean/Percentage Difference (95% CI) 1.3) 20.45 and studies of pulmonary function in late adolescence in VP infants from Melbourne.2 4.6 (5.0 to 4. Those of Maori descent.1 (3. e1526 DARLOW et al Strengths of our study include that it is a national cohort.TABLE 6 Executive Functioning. arrest/conviction. and 166 did so (50% overall).40 it is interesting that in this study receipt of antenatal steroids had no effect on any long-term outcomes. self-esteem. higher suicidal ideation/attempt.2) 7. Whereas antenatal steroids reduce mortality by ∼40%.3) 0. 95% survivors were traced. ODD.7 to 4. Of the few population-based studies.55 .88 . Knowledge of the range of health issues faced by VLBW young adults will inform future neonatal care in general and in New Zealand and will guide multidisciplinary intervention and provision of medical care and social support in childhood and adolescence. Many studies in other countries have been hospital based and so may be subject to a degree of bias.2 (22.4 (20.1 to 10.7) 3. more than half of whom received antenatal steroids. SF-36. Overall. and many members of our cohort are known to be overseas. For example.35–39 Our report is the first. 335 were discharged alive.1 (21. Quality of Life.2 (21.62 .7 6. mean (SD) Self-esteem Life satisfaction VLBW Cohort (n = 230) 52.45 POPS study cohort at age 19 years.5 13.2) 31.0 (11. Hille et al. mental component score Overall functioning. The Netherlands POPS study at 19 years achieved 62% follow-up.6 (21. and that an assessment had been made in middle childhood.4 to 1. Australia.8 (4.47–49 there were 474 consecutive VLBW admissions to the regional NICU from January 1978 to December 1985. Our follow-up rate is comparable to that reported in most international studies. 255 residing in the Helsinki area were invited to participate.5) 51. higher rates of pregnancy/parenthood. the indigenous population in New Zealand.aappublications.1 to 2. or life satisfaction. version 2.8 (8. BRIEF-A.4) 0.46 reporting from the Downloaded from pediatrics.

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