Long-term complications of the preterm infant
- George T Mandy, MD
George T Mandy, MD
- Associate Professor of Pediatrics
- Baylor College of Medicine
Prematurity is defined as a birth that occurs before 37 completed weeks (less than 259 days) of gestation. It is associated with about one-third of all infant deaths in the United States and accounts for approximately 45 percent of children with cerebral palsy (CP), 35 percent of children with vision impairment, and 25 percent of children with cognitive or hearing impairment.
Complications of prematurity are the underlying reasons for the higher rate of infant mortality and morbidity in preterm infants compared with full-term infants. The risk of complications increases with increasing immaturity. Thus, infants who are extremely preterm (EPT), born at or before 25 weeks gestation, have the highest mortality rate (about 50 percent) and if they survive, are at the greatest risk for long-term morbidity.
In preterm survivors, there is a high rate of long-term neurodevelopment impairment (NDI) and chronic health problems. These chronic medical and neurodevelopmental complications often require additional healthcare and educational services, which add to the overall economic cost of caring for the preterm infant.
The long-term complications of prematurity and the long-term healthcare needs of preterm survivors will be reviewed here. The short-term complications of the preterm infant are discussed separately. (See "Short-term complications of the preterm infant".)
Different degrees of prematurity are defined by gestational age (GA) or birth weight (BW).To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Boyle EM, Poulsen G, Field DJ, et al. Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study. BMJ 2012; 344:e896.
- Stephens AS, Lain SJ, Roberts CL, et al. Survival, Hospitalization, and Acute-Care Costs of Very and Moderate Preterm Infants in the First 6 Years of Life: A Population-Based Study. J Pediatr 2016; 169:61.
- Hack M, Schluchter M, Andreias L, et al. Change in prevalence of chronic conditions between childhood and adolescence among extremely low-birth-weight children. JAMA 2011; 306:394.
- Holsti A, Adamsson M, Hägglöf B, et al. Chronic Conditions and Health Care Needs of Adolescents Born at 23 to 25 Weeks' Gestation. Pediatrics 2017; 139.
- Carmody JB, Charlton JR. Short-term gestation, long-term risk: prematurity and chronic kidney disease. Pediatrics 2013; 131:1168.
- Rodriguez MM, Gomez A, Abitbol C, et al. Comparative renal histomorphometry: a case study of oligonephropathy of prematurity. Pediatr Nephrol 2005; 20:945.
- Abitbol CL, Bauer CR, Montané B, et al. Long-term follow-up of extremely low birth weight infants with neonatal renal failure. Pediatr Nephrol 2003; 18:887.
- Bacchetta J, Harambat J, Dubourg L, et al. Both extrauterine and intrauterine growth restriction impair renal function in children born very preterm. Kidney Int 2009; 76:445.
- Keijzer-Veen MG, Devos AS, Meradji M, et al. Reduced renal length and volume 20 years after very preterm birth. Pediatr Nephrol 2010; 25:499.
- Bracewell MA, Hennessy EM, Wolke D, Marlow N. The EPICure study: growth and blood pressure at 6 years of age following extremely preterm birth. Arch Dis Child Fetal Neonatal Ed 2008; 93:F108.
- Bocca-Tjeertes IF, Kerstjens JM, Reijneveld SA, et al. Growth and predictors of growth restraint in moderately preterm children aged 0 to 4 years. Pediatrics 2011; 128:e1187.
- Scharf RJ, Stroustrup A, Conaway MR, DeBoer MD. Growth and development in children born very low birthweight. Arch Dis Child Fetal Neonatal Ed 2016; 101:F433.
- Smith LJ, van Asperen PP, McKay KO, et al. Reduced exercise capacity in children born very preterm. Pediatrics 2008; 122:e287.
- Fawke J, Lum S, Kirkby J, et al. Lung function and respiratory symptoms at 11 years in children born extremely preterm: the EPICure study. Am J Respir Crit Care Med 2010; 182:237.
- Kotecha SJ, Watkins WJ, Paranjothy S, et al. Effect of late preterm birth on longitudinal lung spirometry in school age children and adolescents. Thorax 2012; 67:54.
- Bolton CE, Stocks J, Hennessy E, et al. The EPICure study: association between hemodynamics and lung function at 11 years after extremely preterm birth. J Pediatr 2012; 161:595.
- Choukroun ML, Feghali H, Vautrat S, et al. Pulmonary outcome and its correlates in school-aged children born with a gestational age ≤ 32 weeks. Respir Med 2013; 107:1966.
- Saarenpää HK, Tikanmäki M, Sipola-Leppänen M, et al. Lung Function in Very Low Birth Weight Adults. Pediatrics 2015; 136:642.
- Hovi P, Andersson S, Eriksson JG, et al. Glucose regulation in young adults with very low birth weight. N Engl J Med 2007; 356:2053.
- Rotteveel J, van Weissenbruch MM, Twisk JW, Delemarre-Van de Waal HA. Infant and childhood growth patterns, insulin sensitivity, and blood pressure in prematurely born young adults. Pediatrics 2008; 122:313.
- Morrison KM, Ramsingh L, Gunn E, et al. Cardiometabolic Health in Adults Born Premature With Extremely Low Birth Weight. Pediatrics 2016; 138.
- Odberg MD, Sommerfelt K, Markestad T, Elgen IB. Growth and somatic health until adulthood of low birthweight children. Arch Dis Child Fetal Neonatal Ed 2010; 95:F201.
- Kerkhof GF, Breukhoven PE, Leunissen RW, et al. Does preterm birth influence cardiovascular risk in early adulthood? J Pediatr 2012; 161:390.
- Sipola-Leppänen M, Karvonen R, Tikanmäki M, et al. Ambulatory blood pressure and its variability in adults born preterm. Hypertension 2015; 65:615.
- Lewandowski AJ, Davis EF, Yu G, et al. Elevated blood pressure in preterm-born offspring associates with a distinct antiangiogenic state and microvascular abnormalities in adult life. Hypertension 2015; 65:607.
- Swamy GK, Ostbye T, Skjaerven R. Association of preterm birth with long-term survival, reproduction, and next-generation preterm birth. JAMA 2008; 299:1429.
- Hack M, Taylor HG, Drotar D, 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; 294:318.
- Stein RE, Siegel MJ, Bauman LJ. Are children of moderately low birth weight at increased risk for poor health? A new look at an old question. Pediatrics 2006; 118:217.
- Petrou S, Eddama O, Mangham L. A structured review of the recent literature on the economic consequences of preterm birth. Arch Dis Child Fetal Neonatal Ed 2011; 96:F225.
- Lindström K, Winbladh B, Haglund B, Hjern A. Preterm infants as young adults: a Swedish national cohort study. Pediatrics 2007; 120:70.
- Moster D, Lie RT, Markestad T. Long-term medical and social consequences of preterm birth. N Engl J Med 2008; 359:262.
- Russell RB, Green NS, Steiner CA, et al. Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics 2007; 120:e1.
- Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Societal costs of preterm birth. In: Preterm Birth: Causes, Consequences, and Prevention, Behrman RE, Butler AS (Eds), National Academies Press, Washington, DC 2006. p.398.
- Mangham LJ, Petrou S, Doyle LW, et al. The cost of preterm birth throughout childhood in England and Wales. Pediatrics 2009; 123:e312.
- Rautava L, Eskelinen J, Häkkinen U, et al. 5-year morbidity among very preterm infants in relation to level of hospital care. JAMA Pediatr 2013; 167:40.