ABSTRACT
BACKGROUND: The purpose was, first, to evaluate changes in health-related quality of life (HRQL) in a cohort of very low birth weight (VLBW; <1500 g.) or very preterm (< 32 weeks of gestation) children between ages 14 and 19, and second, to identify correlates of HRQL at age 19. METHODS: HRQL was assessed using the Health Utilities Index Mark 3 (HUI3). In order to explore correlates of HRQL, we performed a hierarchical regression analysis. RESULTS: Surviving VLBW children (n = 959) from a 1983 Dutch nation-wide cohort were eligible; 630 participated both at age 14 and 19; 54 at age 19 only. The mean HRQL score decreased from 0.87 to 0.86. The HRQL of 45% was stable, 25% were better and 30% were worse. A regression model showed internalizing problems were related most strongly to HRQL. CONCLUSIONS: In the transition from adolescence to young adulthood, HRQL in Dutch VLBW children was stable at the group level but varied at the individual level. HRQL was negatively associated with internalizing problems and also with physical handicaps. Long-term follow-up studies on the impact of VLBW on HRQL are all the more called for, given the growing number of vulnerable infants surviving the neonatal period.
Subject(s)
Health Status Indicators , Infant, Low Birth Weight , Life Change Events , Premature Birth , Quality of Life , Adolescent , Adult , Age Distribution , Cohort Studies , Disabled Persons/psychology , Disabled Persons/statistics & numerical data , Follow-Up Studies , Gestational Age , Health Surveys/methods , Humans , Infant, Newborn , Longitudinal Studies , Netherlands , Regression Analysis , Self Concept , Sickness Impact Profile , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To evaluate changes in obstetrical and neonatal care for very preterm and extremely preterm infants between 1983 and 1995 in The Netherlands and to evaluate the effect of those changes. STUDY DESIGN: Data on all very preterm or VLBW infants from the linked national obstetrical and neonatal databases of 1995 (N=2066) were compared to data on similar infants from a nation-wide study of very preterm infants born in 1983 (N=1338). RESULTS: Obstetrical and neonatal management changed over time, with an increased number of deliveries in tertiary centres (35.7-60.7%), an increase in C-sections (43.7-56.8%) and prolonged artificial ventilation (3.4-9.5%). Survival until discharge increased from 75 to 90% and neonatal morbidity decreased in relative terms. CONCLUSIONS: The short-term outcome for these very preterm and extremely preterm infants has improved. Long-term follow-up through to school age and adulthood of preterm infants is needed to investigate the changes in the sequelae of intensive obstetrical and neonatal care.
Subject(s)
Cause of Death , Infant Mortality/trends , Infant, Premature , Infant, Very Low Birth Weight , Perinatal Care/standards , Apgar Score , Female , Humans , Incidence , Infant, Newborn , Intensive Care Units, Neonatal , Logistic Models , Male , Multivariate Analysis , Netherlands/epidemiology , Perinatal Care/trends , Pregnancy , Probability , Registries , Retrospective Studies , Risk Assessment , Survival AnalysisABSTRACT
BACKGROUND: To determine: 1) whether substandard factors were present in cases of perinatal death, and to what extent another course of action might have resulted in a better outcome, and 2) whether there were differences in the frequency of substandard factors by level of care, particularly between midwives and gynecologists/obstetricians and between home and hospital births. METHODS: Population-based perinatal audit, with explicit evidence-based audit criteria. SETTING: The northern part of the province of South-Holland in The Netherlands. All levels of perinatal care (primary, secondary and tertiary care, and home and hospital births) were included. CASES: Three hundred and forty-two cases of perinatal mortality (24 weeks of pregnancy--28 days after birth). MAIN OUTCOME MEASURES: Scores by a Dutch and a European audit panel. Score 0: no substandard factors identified; score 1, 2 or 3: one or more substandard factors identified, which were unlikely (1), possibly (2) or probably (3) related to the perinatal death. RESULTS: In 25% of the perinatal deaths (95% Confidence Interval: 20-30%) a substandard factor was identified that according to the Dutch panel was possibly or probably related to the perinatal death. These were mainly maternal/social factors (10% of all perinatal deaths; most frequent substandard factor: smoking during pregnancy), and antenatal care factors (10% of all perinatal deaths; most frequent substandard factor: detection of intra-uterine growth retardation). We did not find statistically significant differences in scores between midwives and gynecologists/obstetricians or between home and hospital births. The European panel identified more substandard factors, but these were again equally distributed by level of care. CONCLUSIONS: Perinatal deaths might be partly preventable in The Netherlands. There is no evidence that the frequency of substandard factors is related to specific aspects of the perinatal care system in The Netherlands.
