When a study involves a longitudinal cohort of patients enrolled at birth and followed for years or even decades, one can learn a great deal about the long-term consequences of something that has occurred in early infancy. Such is the case with infants born preterm and followed prospectively by various investigators looking at medical and developmental outcomes of these infants born early. This month in Pediatrics, five different studies highlight long-term outcomes of preterm infants at various ages and stages as they get older. We are highlighting them all together because they are all worth knowing about and combined—can provide a myriad of data that will help you better manage these patients and educate their families so as to be aware of complications that may lie up the road as a result of being preterm as well as suggest strategies to prevent these complications from occurring. The five studies include the following:
- A randomized controlled trial that looked at the role of a home-based early intervention program in the first year of life for preterm infants who are then studied at 8 years of age for their cognitive and behavioral functioning as well as to look at parental mental health at the same time. (Spittle et al. (10.1542/peds.2016-1363))
- A study that compares preterm infants with neonatal hypoglycemia with normoglycemic controls in terms of cognitive and behavioral outcome from 3 to 18 years whose results may surprise you. (Goode et al. 10.1542/peds.2016-1424)
- A cohort of infants linked to school developmental test records that identified an interesting association between a planned birth for infants between 32 and 39 weeks gestation and developmental abnormalities seen at school age. (Bentley et al. 10.1542/peds.2016-2002) suggesting that earlier planning for birth before reaching full-term may have more risks than benefits.
- A randomized controlled double-blinded multicenter international clinical trial of preterm infants less than 32 weeks gestation given different fractions of oxygen at birth who were then followed for survival and neurodevelopmental outcomes at 24 months of age (Boronat et la. 10.1542/peds.2016-1405). This one may also surprise you.
- Finally a longitudinal cohort of infants born from early to late preterm as well as early and full-term studied for the relationship between gestational age and their verbal abilities as well as working memory skills at age 11 with some optimistic news about the ability for those who were very preterm and showed the most delay being possibly able to catch-up. (10.1542/peds.2016-0578)
The first three studies noted above also have commentaries that shed even more light on how much we can learn from longitudinal follow-up of high risk infants. One by neonatal epidemiologists Drs. Marie McCormick and Jonathan Litt focus on the importance of early intervention for these preterm infants (10.1542/peds.2016-2207) and comment on the study by Spittle et al. (10.1542/peds.2016-1363)) A second by neonatologists Drs. William Hay and Paul Rozance (10.1542/peds.2016-2881) celebrate how good management of neonatal hypoglycemia (as discussed in the study by Goode et al. (10.1542/peds.2016-1424) can lead to improved developmental outcomes. Finally a third by Drs. Sibhan Dolan and Mary Rosser advocate for doing all we can for delaying planned delivery until at least 39 weeks given the findings in the study by Bentley et al. (10.1542/peds.2016-2002).
It’s never too early to read long-term outcome studies that can influence how we manage our preterm patients starting in infancy and continuing onward—and our delivery of these studies and commentaries are well worth laboring over (but it will be an easy labor).