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Researchers examine long-term outcomes of very preterm infants born in The Netherlands nearly 20 years ago

One out of 10 Dutch teenagers, who were born as very preterm infants in 1983, suffers from a severe disability or handicap. Over half of them face serious difficulties in everyday life and have to cope with learning, attention, and social-emotional problems. In fact, it is possible that as many as 40 percent of these Dutch adolescents will not be able to become fully independent adults. These are the sobering conclusions of a long-term study of Dutch preterm infants, which was supported in part by the Agency for Healthcare Research and Quality (HS08385).

Despite advances in neonatal intensive care since the 1980s, it is not certain that long-term consequences for these infants have improved, note researchers at Leiden University Medical Center and the TNO Institute for Prevention and Health in The Netherlands who conducted the study. However, their study suggests that the long-term outcomes of modern neonatal care can be evaluated at a much earlier age than previously thought. For example, they found that a severe handicap (unable to function without help either due to blindness, deafness, mental retardation, or other disability) was easily detected before 2 years of age and did not disappear thereafter. Much of the impairment in this group of children was also identified at 5 years of age but was not considered to be important, since these children had been very small and/or very sick and were expected to outgrow their impairments. However, later followup demonstrated that such impairments were very predictive for later problems at school.

The incidence of disabilities or mild handicaps increased over time. When the growing child was no longer able to meet increasing expectations in school, the drop-out rate increased. This phenomenon also explained the increasing incidence of school problems with advancing age among the Dutch children. These findings are based on perinatal data on 1,338 infants born in 1983 with a gestational age of under 32 weeks and/or birthweight less than 1,500 g. The infants were assessed at 2 years of age by their pediatricians, at 5 years by a team of investigators, and at 9-14 years by questionnaires completed by parents, teachers, and the children themselves.

See "Looking back in time: Outcome of a national cohort of very preterm infants born in The Netherlands in 1983," by Frans J. Walther, A. Lya den Ouden, and S. Pauline Verloove-Vanhorick, in Early Human Development 59, pp. 175-191, 2000.

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