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René Mathiasen Bo Mølholm-Hansen Gorm Greisen Anne-Marie Nybo Andersen

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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René Mathiasen Bo Mølholm-Hansen Gorm Greisen Anne-Marie Nybo Andersen

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  1. 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

  2. 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.)

  3. 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

  4. 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

  5. How is the social integration at the age of 30 years of individuals born before 33 weeks of gestation? Neonatal Symposium

  6. Results: The Cohorte Neonatal Symposium

  7. Results: The Cohorte Neonatal Symposium

  8. Results 1: Education N=193.655 Neonatal Symposium

  9. Results 1: Net Income N=193.655 Neonatal Symposium

  10. 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

  11. Results 2: Left Parents Home? N=193.655 NO Yes Neonatal Symposium

  12. Results 2: No. of Children % N=193.655 Neonatal Symposium

  13. 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

  14. Gestational Age and Basic School Achievements Neonatal Symposium

  15. Results Neonatal Symposium

  16. Results Neonatal Symposium

  17. Results Percentage of survived indiviuals not completing basic school born in 1988-89 Neonatal Symposium

  18. Results Percentage of survived indiviuals not completing basic school born in 1988-89 Neonatal Symposium

  19. Results OR of not completing basic school for surviving individuals in 1988-89 according to gestational age (ref. Term) Neonatal Symposium

  20. 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

  21. Z-score of mean grade for survived individuals born in 1988-89 by gestational age-groups Results Neonatal Symposium

  22. 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

  23. Psychiatric diseases within of individuals born premature born in Denmark 1974-1996 Neonatal Symposium

  24. Results: Population Neonatal Symposium

  25. Results Neonatal Symposium

  26. Results Neonatal Symposium

  27. Results Neonatal Symposium

  28. Results Neonatal Symposium

  29. Results Neonatal Symposium

  30. Results Neonatal Symposium

  31. Results Neonatal Symposium

  32. Results Neonatal Symposium

  33. Results Neonatal Symposium

  34. Results Neonatal Symposium

  35. Results Neonatal Symposium

  36. Results Neonatal Symposium

  37. Results Neonatal Symposium

  38. Results Neonatal Symposium

  39. 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

  40. 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

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