Outcomes into Adulthood of Survivors Born Either Extremely Low Birthweight or Extremely Preterm

We need to understand the outcomes into adulthood for survivors born either extremely low birthweight (ELBW; < 1,000 g) or extremely preterm (EP; < 28 weeks' gestational age), particularly their blood pressure and cardiovascular metabolic status,respiratory function, growth, psychological and mental health performance, and functional outcomes. Blood pressure is higher in late adolescence and early adulthood in ELBW/EP survivors compared with controls. In some studies, expreterm survivors have higher insulin and blood lipid concentrations than controls, which may also increase their risk for later cardiovascular disease. ELBW/EP survivors have more expiratory airflow obstruction than do controls. Those who had bronchopulmonary dysplasia (BPD) in the newborn period have even worse lung function than those who did not have BPD. As a group, they are unlikely to achieve their full lung growth potential, which means that more of them are likely to develop chronic obstructive airway disease in later life. Although they are smaller than term born controls, their weight gradually rises and ultimately reaches a mean z-score close to zero in late adolescence, and they ultimately attain a height z-score close to their mid-parental height z-score. On average, ex-preterm survivors have intelligence quotient (IQ) scores and performance on tests of academic achievement approximately 2/3 SD lower than do controls, and they also perform less well on tests of attention and executive function. They have similar high rates of anxiety and depression symptoms in late adolescence as do controls. They are, however, over-represented in population registries for rarer disorders such as schizophrenia and Autism Spectrum Disorder. In cohort studies, ex-preterm survivors mostly report good quality of life and participation in daily activities, and they report good levels of self-esteem. In population studies, they require higher levels of economic assistance, such as disability pensions, they do not achieve education levels as high as controls, fewer are married, and their rates of reproduction are lower, at least in early adulthood. Survivors born ELBW/EP will present more and more to health carers in adulthood, as they survive in larger numbers.

Are we improving long-term outcomes for extremely preterm babies?

Survival rates for extremely preterm or tiny babies have increased dramatically with advances in perinatal and neonatal intensive care. However, the rates of neurological impairments and disabilities are too high in survivors relative to term controls; major neurological disability rates in those < 1000 g or < 28 weeks are four to five times higher than in term controls. There are some recent advances, however, that improve the outcome, both short and long term, for extremely preterm or tiny babies. Magnesium sulphate given to the mother just prior to very preterm birth reduces the rate of cerebral palsy in survivors. Caffeine given to very tiny babies not only reduces several short-term morbidities, such as patent ductus arteriosus and bronchopulmonary dysplasia, but also reduces the rates of death or disability, cerebral palsy and cognitive delay. Docosahexanoic acid, an omega-3 fatty acid important in brain function, given as a supplement to feeds in very preterm babies, improves cognitive function, but mostly in females and in those < 1250 g birthweight. Developmental interventions after discharge home designed to improve baby cognitive and motor development have been shown to increase cognitive development over the preschool years; however, the effect is no longer evident after the patients start school. In summary, several recent interventions look promising in improving long-term outcomes for very preterm infants; however, their effects when implemented into usual clinical practice must be determined