Outcomes 50 Years After Preterm Birth: A Golden Opportunity to Reflect on Pathways Toward Thriving
Year: 2024
Type: editorial
Abstract: Since the outset of the field decades ago, neonatology has been criticized for advancing survival rates at the cost of comorbid illness and quality of life.The work of Walters et al published in this issue of Pediatrics shows that those fears may have been misplaced.1 This study describes that compared with term-born controls, surviving preterm-born participants were less likely to have significant cardiovascular events despite having a higher risk for hypertension and similar risk of diabetes, prediabetes, and dyslipidemia.The 2 groups also had similar self-reported general health ratings and functional abilities in middle age. 1 The authors are to be commended for bringing data to bear in understanding the long-term health implications of preterm birth on infants in the post-steroid era of neonatal medicine.These positive findings are surprising given the heightened risk for later-life morbidity described in other large, population-based cohort studies of adults born preterm.The high and stable rates of early morbidities in, for example, bronchopulmonary dysplasia, 2 retinopathy of prematurity, 3 and neurosensory impairment 4 over the past decades reinforce the notion of developmental vulnerability imparted by preterm birth.Perhaps these unexpectedly positive results stem from the relatively mild degree of prematurity in the study cohort.Regardless, we must interpret them in the context of accumulating evidence from developmental biology, epigenetics, and epidemiology that supports the significant role of preterm birth and associated morbidity on life course health development.5 This paper illustrates several of the methodological challenges of conducting longitudinal follow-up that threaten study validity.Participant attrition and censoring due to mortality pose significant challenges to interpreting these results.It is widely understood that people electing to participate in longitudinal studies differ in many ways from those lost to follow-up, 6 often on socioeconomic factors 7 inextricably linked with health outcomes.Many such characteristics vary with time, often because of prematurity-related morbidity.Preterm birth itself is associated with lower annual income, lower upward mobility, and higher downward mobility in adulthood compared with term-born peers.8 That participants and nonparticipants in this study share a similar profile on a limited list of baseline factors tells us little about how the groups compare on key health-related social drivers over the span of 50 years.The role of mortality is of particular concern in longitudinal studies following cohorts into adulthood.Individuals with poorer health have higher mortality risk at any given time, a risk that increases with advancing age.In this cohort, the survival advantage of the term-born control group abated after infancy, with a higher all-cause mortality rate compared with that of the group born preterm.Survivors in either group are definitionally healthier than those lost due to nonsurvival.This effect may be amplified among those born preterm because their health may be monitored more closely by caregivers in childhood and by themselves
Source: PEDIATRICS
Authors: Jonathan S. Litt, Henning Tiemeier
Institutions: Stanford Medicine, Stanford University, Harvard University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4405447900