The Global Action Report on Preterm Birth 18 Routine

Long-term outcomes Examples: Frequency in survivors: Specific physical effects Visual impairment • BLOCKINBlindness or high myopia after retinopathy of prematurity • BLOCKINIncreased hypermetropia and myopia Around 25% of all extremely preterm affected [a] Also risk in moderately preterm babies especially if poorly monitored oxygen therapy Hearing impairment Up to 5 to 10% of extremely preterm [b] Chronic lung disease of prematurity • BLOCKINFrom reduced exercise tolerance to requirement for home oxygen Up to 40% of extremely preterm [c] Long-term cardiovascular ill-health and non-communicable disease • BLOCKINIncreased blood pressure • BLOCKINReduced lung function • BLOCKINIncreased rates of asthma • BLOCKINGrowth failure in infancy, accelerated weight gain in adolescence Full extent of burden still to be quantified Neuro-developmental/ behavioral effectse Mild Disorders of executive functioning • BLOCKINSpecific learning impairments, dyslexia, reduced academic achievement Moderate to severe Global developmental delay • BLOCKINModerate/severe cognitive impairment • BLOCKINMotor impairment • BLOCKINCerebral palsy Affected by gestational age and quality of care dependent [f] Psychiatric/ behavioral sequelae • BLOCKINAttention deficit hyperactivity disorder • BLOCKINIncreased anxiety and depression Family, economic and societal effects Impact on family Impact on health service Intergenerational • BLOCKINPsychosocial, emotional and economic • BLOCKINCost of care [h] – acute, and ongoing • BLOCKINRisk of preterm birth in offspring Common varying with medical risk factors, disability, socioeconomic status [g] References: a O'Connor et al. (2007). " Ophthalmological problems associated with preterm birth. " Eye (Lond) 21(10): 1254-1260. b Marlow et al. (2005). " Neurologic and developmental disability at six years of age after extremely preterm birth. " N Engl J Med 352(1): 9-19., Doyle et al (2001). " Outcome at 5 years of age of children 23 to 27 weeks' gestation: refining the prognosis. " Pediatrics 108(1): 134-141. c Greenough, A. (2012). " Long term respiratory outcomes of very premature birth (<32 weeks). " Semin Fetal Neonatal Med 17(2): 73-76. d Doyle et al. (2003). " Health and hospitalistions after discharge in extremely low birth weight infants. (2006). " Short-term outcomes of infants born at 35 and 36 weeks gestation: we need to ask more questions. " Semin Perinatol 30(1): 28-33. e Mwaniki et al., Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet, 2012. f Hagberg et al. (2001). " Changing panorama of cerebral palsy in Sweden. VIII. Prevalence and origin in the birth year period 1991-94. " Acta Paediatr 90(3): 271-277. Doyle et al (2001). " Outcome at 5 years …