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Longterm prognosis of premature birth. René Mathiasen Bo Mølholm-Hansen Gorm Greisen Anne-Marie Nybo Andersen. Copenhagen University Hospital Rigshospitalet Department of Neonatology. University of Southern Denmark. Background. Risk of developmental problems increases by
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Longterm prognosis of premature birth René Mathiasen Bo Mølholm-Hansen Gorm Greisen Anne-Marie Nybo Andersen Copenhagen University Hospital Rigshospitalet Department of Neonatology University of Southern Denmark Neonatal Symposium
Background Risk of developmental problems increases by decreasing gestational age 0-2 years • Cerebral Palsy: • Visual impairment (incl. blind) • Hearing loss 4-6 years • Cognitive deficits • Minor motor deficits • Major behavioural problems School age / teenage years • School difficulties • Social and emotional problems • Psychiatric problems (anxiety, depression) ca. 10 % ca.50 % Neonatal Symposium (Hansen et al. Dev.Med.Child.Neurol 2002. Walther.F.J. E.Hum.Dev. 2000.)
Aim Is premature birth associated with: • long-term socio economic integration at the age of 30 years? • risk of not completing basic school? • psychiatric disease at adult age? Neonatal Symposium
Methods • Nationalt board of Health • The Causes of death registry • Fertility Databases STATISTIC DENMARK By ID-Number Register of Emigration Ministry of Education • The Danish Ministry of Taxation • The Registry of Income Central Psychiatric Research Register Neonatal Symposium
How is the social integration at the age of 30 years of individuals born before 33 weeks of gestation? Neonatal Symposium
Results: The Cohorte Neonatal Symposium
Results: The Cohorte Neonatal Symposium
Results 1: Education N=193.655 Neonatal Symposium
Results 1: Net Income N=193.655 Neonatal Symposium
Results 1: Transfer Payment GA < 33 weeks GA> 36 weeks (N=1.356) (N=183.193) 5.3% 10.8% 89.2% 94.7% Neonatal Symposium
Results 2: Left Parents Home? N=193.655 NO Yes Neonatal Symposium
Results 2: No. of Children % N=193.655 Neonatal Symposium
Conclusion: • A consistent but small social disadvantage was identified in the very preterm group • Individuals born before 33 weeks of age seem well integrated Neonatal Symposium
Gestational Age and Basic School Achievements Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Results Percentage of survived indiviuals not completing basic school born in 1988-89 Neonatal Symposium
Results Percentage of survived indiviuals not completing basic school born in 1988-89 Neonatal Symposium
Results OR of not completing basic school for surviving individuals in 1988-89 according to gestational age (ref. Term) Neonatal Symposium
Results OR of not completing basic school for surviving individuals in 1988-89 according to gestational age (ref. Term) Gender, CP, SGA, parent’s SES Adjusted model Neonatal Symposium
Z-score of mean grade for survived individuals born in 1988-89 by gestational age-groups Results Neonatal Symposium
Conclusion: • GA 32-36 is associated with school difficulties persisting through basic school. • The risk of not completing basic school increased with decreasing gestational age. • The absolute increase was minimal > GA 32 but GA < 32 it has practical importance. • Difficulties are only explained partly by cerebral palsy. Neonatal Symposium
Psychiatric diseases within of individuals born premature born in Denmark 1974-1996 Neonatal Symposium
Results: Population Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Results Neonatal Symposium
Conclusion: • The association between prematurity and psychiatric disease was statistically very strong. • The absolute risk differences points to a significant problem, particularly in the very preterm group Neonatal Symposium
Thank you for your attention! • Acknowledgement: • Sarah and Ludvig Elsass Foundation • Dagmar Marshall Foundation • Hartmanns Foundation • A.P. Møller and Chastine Mc-Kinney Møllers Foundation • Ronald Mcdonald Foundation • H:S administrationen • Aase og Ejnar Danielsens Fond • Lundbeck Foundation Neonatal Symposium