Long-term follow up of preterms below 33 weeks of gestation at school age

Objectives: Survival rates of preterms have improved dramatically in the last decades while the rate of early brain lesions remained constant. But data on cognitive development are incomplete since systematic follow up started only five years from now. We present our former results of eight to nine year old children.

Patients and methods: 51/65 former preterms, all below 33 weeks of gestation, and treated in the University Hospital Freiburg (n=4 died, n=4 no contact, n=2 excluded because of chromosomal abnormalities, n=3 refused participation, one child move to its home country). Date collection: 1. from medical charts on pregnancy and birth, perinatal risk factors and former neurological examinations.

2. from standardized parents questionnaire on actual neurological findings, school attendance and performance, child's behaviour and socio economic status ot the family.

3. „KINDL“-Questionnaire on quality of life in childhood. (Ravens-Sieberer U und Bullinger M, 1998).

Statistics with Statistical Package for the Social Sciences (SPSS): Chi-square test and logistic regression.

Results: 1. Normal development: 35%. Minor disability: 46%, profound disability: 11%. Significant risk factors for abnormal development were: male gender (OR 9.5), small for gestational age (OR 17.0), low socio economic or migrant status of the family (OR 20.9), pathological cerebral ultrasound (OR 33.4).

2. School attendance: Regular school: 83%, special educational: 11%. Risk factors for poor school performance at 8–9 years were: abnormal neurological findings at 1–3 years (OR 16), low socio economic status (OR 266), ELBW status at birth (OR 514).

3. KINDL-questionnaire: Quality of life was comparable to the normal control group.

Discussion: Our results do not differ from those of other single center studies, and are better than reports of population based studies. Power and validity are impaired by the retrospective data collection and the absence of standardized developmental tests. But recent standardized examinations at two years of age indicate comparable results.