Health-related quality of life in children and adolescents born very preterm and its correlates: a cross-sectional study

Abstract

AbstractObjectiveWe aimed to assess health-related quality of life (HRQOL) in a cohort of very preterm born children and adolescents (aged 5-16), and to compare it with their fullterm born siblings and the general population. We also explored correlates of HRQOL among the very preterm born.DesignCross-sectional surveyPatientsChildren born <32 weeks gestation (N = 442) as well as their fullterm born siblings (N = 145)Main outcome measuresPrimary outcome was KINDL total score (0 worst - 100 best), a validated multidimensional measure of HRQOL in children and adolescents.MethodsLinear mixed models accounted for family unit. Secondary analysis compared very preterm born children to another cohort of healthy children from the same time period. A classification tree analysis explored potential correlates of HRQOL.ResultsOn average, preterm children, both <28 and 28-31 weeks gestational age, had similar KINDL total score to fullterm sibling controls (-2.3, 95% CI -3.6 to -0.6), and to population controls (+1.4, 95% CI 0.2 to 2.5). Chronic non-respiratory health conditions (such as attention deficit hyperactivity disorder (ADHD) or heart conditions, but not including cerebral palsy), age, and respiratory symptoms affecting daily life were key correlates of HRQOL among very preterm born children.ConclusionsVery preterm birth in children and adolescents was not associated with a relevant reduction in HRQOL compared to their fullterm born peers. However, lower HRQOL was explained by other factors, such as older age, and the presence of chronic non-respiratory health conditions, but also by possibly modifiable current respiratory symptoms. The influence of respiratory symptom amelioration and its potential influence on HRQOL needs to be investigated further.What is already known on this topicAs infants born very preterm become more likely to survive, the importance of health-related quality of life (HRQOL) increases. Research on HRQOL in very preterm born children and adolescents often focuses on non-modifiable risk factors without potential interventions.What this study addsHRQOL in very preterm born children and adolescents is similar to that of their siblings and to the general population. Age, respiratory symptoms, and chronic health conditions were associated with HRQOL. Better control of respiratory symptoms could improve HRQOL in very preterm born children and adolescents.How this study might affect research, practice or policyA better understanding of the complex picture of pulmonary disease following prematurity throughout life and interventions to treat respiratory symptoms may be leveraged to improve HRQOL as very preterm born children and adolescents grow.