Preterm infant HRQOL: Long-term impacts and determinants

A recent study was highlighted at the 2023 American Academy of Pediatrics National Conference & Exhibition that shed light on the long-term impact of very preterm birth on the health-related quality of life (HRQOL) of infants, as well as identified key determinants.

Health-related quality of life (HRQOL) is a comprehensive measure that encompasses various aspects of an individual's well-being, including physical, emotional, and social functioning, as well as perceived health. Little has been known about the HRQOL of very preterm infants after they are discharged from the Neonatal Intensive Care Unit (NICU), or the factors that influence it, according to the authors. To shed light on these issues, a longitudinal study was conducted to describe the HRQOL of very preterm infants at 4 months and 12 months of corrected age, and to identify the maternal and infant characteristics that affect HRQOL.

The study was carried out using data from the NourishStudy, a single-center NICU diet intervention trial. At the 2 time points mentioned, the Infant Toddler Quality of Life (ITQOL) survey was administered to parents. This survey, grounded in the World Health Organization's holistic view of health, assesses HRQOL across six infant-focused domains and two parent-focused domains. Higher scores on the ITQOL indicate better outcomes. The scores were analyzed both as continuous variables and in terms of percentiles based on United States norms. The results provided valuable insights into the HRQOL of very preterm infants and the factors affecting it.

The study's findings demonstrated that very preterm birth had a lasting negative impact on the HRQOL of infants up to a year after their discharge from the NICU. The HRQOL scores at 4 months and 12 months of age were found to be statistically similar, suggesting that the challenges faced by these infants persist over time.

When comparing the study participants with the reference population, investigators observed that certain domains of HRQOL were significantly affected. The domains of Physical Abilities, Growth and Development, General Health, and Parent Impact-Emotional showed scores below the 25th percentile. This means that a higher proportion of very preterm infants were experiencing difficulties in these areas compared to the general population, according to the authors.

The study also looked at the association between maternal and infant characteristics and ITQOL scores. Maternal age was a notable factor, as mothers under 30 years appeared to experience greater emotional impact and time limitations. On the infant's side, low birth weight (less than 1000 g) and very premature birth (gestational age less than 28 weeks) were associated with limitations in physical abilities. Additionally, infants with bronchopulmonary dysplasia had worse General Health scores.

In conclusion, the study sheds light on the long-term impact of very preterm birth on the HRQOL of infants and identifies key determinants. The authors noted additional emotional support may be beneficial for mothers under 30 years. Also, the medical vulnerability of infants in the NICU, as indicated by low birth weight, extreme prematurity, and the presence of bronchopulmonary dysplasia, significantly influences their HRQOL after discharge.

These findings underscore the importance of providing comprehensive care and support to very preterm infants and their parents not only during their stay in the NICU but also well beyond discharge, as the effects of early challenges can continue to influence their quality of life.

Reference:

Belfort M, Cherkerzian S, Foster L, Hermez M. P2C200: Very Preterm Birth and Health-related Quality of Life of Infants and Parents. Poster. Presented at: ­­2023 American Academy of Pediatrics National Conference & Exhibition.