Long-term consequences of prematurity

Transcription

1 Long-term consequences of prematurity implications for follow-up Oslo Kari Anne I. Evensen

2 Prematurity and low birth weight Low birth weight (LBW) <2500 g ~ <37 wks 5.7% Very low birth weight (VLBW) <1500 g ~ <32 wks 0.9% Extremely low birth weight (ELBW) <1000 g ~ <28 wks 0.5% Very preterm birth <32 wks Preterm birth <37 wks Extremely preterm birth <28 wks World Health Organization 2004 Medical Birth Registry of Norway 2017

3 Brain vulnerability Rapid brain growth during later pregnancy More folding as amount of brain tissue increases Structures in rapid development are vulnerable to damage 9 Kolb & Fantie. Handbook of Clinical Child Neuropsychology 2009 Volpe, Lancet Neurol 2009

4 Consequenses of prematurity High risk for mortality and morbidity Advances in peri- and neonatal medicine mortality in children born with very low birth weight 80 % 70 % 60 % 50 % 40 % 30 % 20 % 10 % 0 %? Evensen, Doctoral thesis NTNU 2010

5 NTNU Low Birth Weight in a Lifetime Perspective Study (NTNU LBW Life) A longitudinal follow-up study of VLBW individuals at NTNU Study clinical outcomes and brain correlates across a life span

6 NTNU LBW Life 57 international publications 16 PhD theses International network EU project

7 Study population Three counties in Central Norway Born Nord- and Sør-Trøndelag + some children from Møre and Romsdal Trondheim

8 VLBW Control very low birth weight children born preterm with birth weight below 1500 g (n=55-64) normal birth weight children born at term with birth weight above the 10 th centile (n=81-90)

9 Multidisciplinary research NEURO- PSYCHOLOGIST CHILD PSYCHIATRIST CHILD OPHTHALMO- LOGIST PHYSIO- THERAPIST PEDIATRICIANS

10 Assessments from childhood to adult age 1 yr: 5-6 yrs: 14 yrs: Motor and cognitive skills Motor and cognitive skills Motor and cognitive skills, vision, mental health and quality of life yrs: 23 yrs: yrs: Cognitive and executive skills, mental and physical health, quality of life Motor skills, mental health and quality of life Cognitive skills, mental and physical health and quality of life MRI 16

11 LONG-TERM CONSEQUENCES

12 Motor problems in VLBW children MOTOR 35% 30% 25% 20% p= % VLBW Control 15% 10% 5% 0% 1 yr 5 yrs 14 yrs 23 yrs Evensen et al. Early Hum Dev 2009

13 Motor problems in VLBW children MOTOR 35% 30% 25% 20% p= % VLBW Control 15% 10% 5% 0% 1 yr 5 yrs 14 yrs 23 yrs p<0.01 vs. Control Evensen et al. Early Hum Dev 2009

14 Motor problems in VLBW adolescents MOTOR 35% 30% 25% 20% p= % VLBW Control 15% 10% 5% 0% 1 yr 5 yrs 14 yrs 23 yrs p<0.01 vs. Control Evensen et al. Early Hum Dev 2009

15 Motor problems in VLBW young adults MOTOR 35% 30% 25% VLBW Control 20% 15% p= % 5% 0% 1 yr 5 yrs 14 yrs 23 yrs p<0.01 vs. Control Husby et al. Early Hum Dev 2013

16 Physical health-related quality of life

17 Visual problems in VLBW adolescents VISION 50% VLBW 45% p= % Control 35% 30% p= % 20% 15% 10% p=0.06 5% 0% p<0.05 vs. Kontroll Evensen et al. 2009

18 IQ in VLBW children COGNITION Mean score VLBW Control Full IQ Verbal IQ Performance IQ p<0.05, p<0.01 vs. Control

19 IQ in VLBW adolescents Mean score 120 COGNITION VLBW Control Estimated IQ 2 subscales Estimated IQ 4 subscales Vocabulary Aritmethic Block design Picture arrangement p<0.01 vs. Control

20 IQ in VLBW young adults Mean score 120 COGNITION VLBW 100 Control Full scale IQ Verbal IQ Performance IQ p vs. Control Løhaugen et al. 2010

21 Education in VLBW young adults COGNITION 100% 5 % 80% 21 % 21 % Master s degree or higher 60% 46 % 31 % Bachelor 40% 20% 30 % 0% VLBW p<0.01 vs. Control 41 % 7 % Control High school or eqvivalent level High school not completed Unemployed or disability benefit: 19% VLBW vs. 5% Control Lærum et al. 2017

22 Psychiatric diagnoses in VLBW adolescents MENTAL HEALTH 35% 30% 25% 20% VLBW Control 15% 10% 5% 0% Any Anxiety Depressive ADHD Other p<0.05, p 0.01 vs. Control Indredavik et al. 2004

23 Psychiatric diagnoses in VLBW young adults MENTAL HEALTH 35% 30% 25% VLBW Control 20% 15% 10% 5% 0% Any Anxiety Depressive ADHD Other p<0.01, p vs. Control Lund et al. 2011

24 Mental health-related quality of life

25 Preterm children have increased risk of motor, visual, cognitive and psychiatric problems lasting into adulthood

26 IMPLICATIONS FOR FOLLOW-UP

27 Comorbidity in VLBW adolescents COGNITIVE PROBLEMS n=10 19% PSYCHIATRIC DIAGNOSIS n=14 25% VISUAL PROBLEMS n=22 43% MOTOR PROBLEMS n=13 26% CEREBRAL PALSY n=7 13% Evensen, Doctoral thesis NTNU 2010

28 Comorbidity in VLBW adolescents Motor problems 13 Evensen, Doctoral thesis NTNU 2010

29 Comorbidity in VLBW adolescents CP 4 Motor problems 9 9 adolescents without CP Evensen, Doctoral thesis NTNU 2010

30 Comorbidity in VLBW adolescents CP Cognitive problems Motor problems adolescents without CP or cognitive problems Evensen, Doctoral thesis NTNU 2010

31 Comorbidity in VLBW adolescents CP Cognitive problems 1 2 Motor problems Visual problems 2 3 adolescents without CP or cognitive or visual problems Evensen, Doctoral thesis NTNU 2010

32 Comorbidity in VLBW adolescents CP Cognitive problems 1 Motor problems Visual problems 2 Psychiatric diagnosis 2 1 adolescent without other problems Evensen, Doctoral thesis NTNU 2010

33 Comorbidity in VLBW adolescents COGNITION MENTAL HEALTH VISION MOTOR

34 When do problems appear? Attention deficit, anxiety, social problems, emerging psychiatric diagnoses Learning difficulties, emotional/behavioural problems Minor motor problems Severe brain damage: Cerebral palsy, mental retardation Developmental problems are seen with increasing age 1 yr 6 yr 10 yr 14 yr 20 yr Aylward 2005, de Kleine et al. 2003

35 Prediction of problems Motor examination Cognitive function MRI around term age can to some extent predict CP and motor function, but not other long-term outcomes such as neurocognitive and behavioural impairments van t Hooft et al. Syst Rev 2015 Cognitive function Assessment of infant movements Behavioural difficulties Preterm Term 3 mo 12 mo 4 yr 7 yr 10 yr 11 yr Burns et al. 2004, Butcher et al. 2009, Bruggink et al. 2010, Fjørtoft et al. 2013, Fjørtoft et al. 2015

36 Motor, visual, cognitive and psychiatric problems occur together and motor problems may be an early marker

37 Follow-up in Trondheim Municipality Collaboration between public health nurses, doctors and physiotherapists in Trondheim Municipality and St. Olavs Hospital All children born before week 32 and/or with birth weight below 1500g Based on national clinical guidelines for follow-up of preterm children (Helsedirektoratet 2007) Systematic reviews and meta-analyses last 10 years

38 Follow-up in Trondheim Municipality Multidisciplinary Family-centered and home-based Standardised screening tools as recommended in national and international guidelines and literature: Early and continuous motor evaluations Continuous screening of general and socio-emotional development Screening of language at 2-3 and 4 years of age

39 Summary Preterm children have increased risk for neurodevelopmental problems lasting into adulthood There are associations between motor, visual, cognitive and psychiatric problems as well as brain findings and early motor problems may be a marker Follow-up should be multidisciplinary as well as home-based, family-centered and standardised

40 Thank you for your attention! Center for early brain development and co-workers NTNU: Kari Anne I. Evensen, Siri Weider, Marit S. Indredavik, Ann-Mari Brubakk, Siri Weider, Tora Sund Morken, Stian Lydersen, Marit Martinussen, Jon Skranes, Asta Håberg, Live Eikenes, Lars Morten Rimol, Marius Widerøe, Torstein Vik, Geir Wenberg Jacobsen, Unni Syversen, Eero Kajantie Current PhD students: Former PhD students: Synne Aanes, Haakon August Rosnes Ramberg, Gardinija Mukilvannan Gro Løhaugen, Line Knutsen Lund, Heidi Furre Østgård, Anne Elisabeth Sølsnes, Knut Jørgen Bjuland, Ingrid Marie Husby Hollund, Johanne Marie Iversen, Hester Berger, Kam Sripada, Violeta Lozano Botellero, Chandima N. D. Balasuriya, Astrid M. Winsnes Lærum