Childhood respiratory and neurodevelopmental outcomes of extreme premature infants – risk and protective factors and impact on the family

Abstract

Background: As survival of extremely preterm infants improves, longer term outcomes become increasingly important. Respiratory and neurodevelopmental morbidities have the most impact for later life. Beyond measuring outcomes for the individual, monitoring effects of premature birth on the family are important to be able to describe the full impact of premature birth.

Methods: Single-centre implementation studies on preventative strategies to avoid lung disease and how to treat it in early childhood are included in this thesis. A summary of changes in early clinical management on a statewide scale is described. A retrospective study on the impact of intraventricular haemorrhage [IVH] on developmental outcomes was conducted. Population data was used for data linkage to describe primary school outcomes of extremely born infants and risk factors for poor performance. A review of current literature on parental mental health and family functioning was conducted.

Results: Less invasive respiratory resuscitation may lead to improved survival. Protocolised monitoring of oxygen requirement for infants with established chronic neonatal lung disease can lead to a decrease in length of stay. Mild IVH does not impact long-term neurodevelopmental outcomes, and most extremely preterm infants sit school exams and perform above national minimum standard. Risk factors for poor school performance include in-hospital morbidity and socioeconomic vulnerability along with parental capacity. Parental mental health after hospital discharge following premature birth is mostly affected in the first few years and improves over time.

Conclusion: The neonatal community continues to explore strategies to improve in-hospital outcomes. Avoiding major complications means most patients will attend school. However, optimal care in hospital does not predict school performance of extremely preterm infants, rather parental education and capacity are the major contributors to longer term outcome.