Development and behaviour of 5-year-old very low birthweight infants

Department of Pediatrics, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, Finland.
European Child & Adolescent Psychiatry (Impact Factor: 3.34). 03/2010; 19(8):669-77. DOI: 10.1007/s00787-010-0104-x
Source: PubMed


The place and time of birth influence the mortality of premature infants. We studied the effect of prematurity, time of birth, birth hospital level and district on the development and behaviour in a national cohort of 5-year-old Finnish very low birthweight infants (VLBWI). All surviving VLBWI (gestational age <32 weeks or birthweight <or=1,500 g) born in 2001-2002 in level II or III hospitals in Finland and full-term controls were included. The parents of 588 (64%) VLBWI and 176 (46%) controls returned the Five to Fifteen questionnaire (FTF) on the development and behaviour of their 5-year-old children. The questionnaire scores were linked to data from the National Medical Birth Register, the Hospital Discharge Register, the Register of Congenital Malformations and the Cause of Death Register. VLBWI had lower developmental and behavioural scores compared to the controls in all FTF domains. In VLBWI, the scores were less optimal, the lower the gestational age was. The time of birth, birth hospital level and district were not associated with the developmental and behavioural scores in VLBWI. In conclusion, short duration of pregnancy adversely influences development and behaviour in VLBWI. Despite differences previously demonstrated in mortality related to time and place of birth, there were no differences in developmental and behavioural scores in VLBWI according to the time of birth, birth hospital level or district. Thus, the survival advantage in level III hospitals seems not to be gained at the expense of behavioural or developmental problems.

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Available from: Emmi Helle (Korvenranta)
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    ABSTRACT: This article summarizes the main findings of the preterm infant sub-study of the Performance, Effectiveness and Costs of Treatment episodes (PERFECT) study. We studied effects of birth hospital level and time of birth on mortality and morbidity and cost-effectiveness of care of very low gestational age (VLGA)/very low birth weight (VLBW) infants. The study included all infants born below 32 weeks or 1501 g in Finland in 2000-2007. Different cohorts were used depending on the time point. The one-year mortality of live-born VLBW/VLGA infants was higher if born in level II versus level III hospitals, or if born during out-of-office hours in level II versus office hours in level III hospitals. Two out of three VLGA/VLBW subjects did not have any of the prematurity-related morbidities studied. The average cost of quality-adjusted life years was €19,245 by four years of age; the cost was higher in VLGA/VLBW infants with long-term morbidities. Birth in a level III hospital improved survival of VLGA/VLBW infants. Results suggest inadequate overnight competence in small hospitals. Despite high initial costs, care of VLGA/VLBW infants was already cost-effective by four years of age. Cost-effectiveness can be improved by reducing long-term morbidities.
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