Premature children have been followed for forty years

A large study is being conducted into the long-term consequences of premature birth

Every year around 7 percent of babies in the Netherlands are born prematurely, worldwide it is even 10 percent. November 17, 2022 was about these children, so it’s World Prematurity Day. TNO has used the POPS survey since 1983 to research the development and health of almost all children born prematurely in the Netherlands that year. Radboudumc participates in this research and looks in particular at the consequences of premature birth on the kidneys. Together with TNO and Care4Neo, pediatric nephrologist Michiel Schreuder emphasizes the importance of continuing to monitor these children and adults.

The POPS cohort includes 1,336 individuals born in 1983 with a gestational age of less than 32 weeks and/or a birth weight of less than 1500 grams. That’s 94% of all babies born very prematurely or with a very low birth weight in the Netherlands in 1983. Over the years, the cohort has provided a lot of information about the short- and long-term consequences for these now almost 40-year-olds. Nowhere in the world has a nationwide cohort of this size been followed and thoroughly studied for such a long period of time.

Continuation of the POPS survey
The last physical examination took place in 2001, when the premature children were 19 years old. Then TNO, together with various academic hospitals, investigated the medical, psychosocial and social functioning of the POPS participants. At the ages of 28 and 35, the group was surveyed online with questionnaires. The results in the areas of quality of life, life course, relationships and pregnancies were examined.

TNO researcher Sylvia van der Pal: ‘We would like to follow this up, ideally with a comprehensive physical examination. The fact that participants in the POPS cohort are now almost 40 years old and are in a new life phase is a good time for a next measurement. Furthermore, the study results from 19, 28 and 35 years after birth indicate that it is important to monitor the long-term consequences of premature birth.’

The importance of long-term tracking
Michiel Schreuder is a professor of pediatric nephrology at the Radboudumc Amalia Children’s Hospital. He says: ‘Premature birth is actually a living experiment. We are saving these young and small children, but it is also important to know what this means for their future and how you can prevent any problems. By age 19, 50% have high blood pressure. It may not lead to problems at that age, but there is a good chance that it will at a later age. You don’t expect kidney damage at the age it takes. You can already see damage in the over 40s, but it may not show until later. The fact is that with an unhealthy disposition of the kidneys, the risk of damage later in life is greater. The same applies, for example, to diabetes and lung damage. It is important to look for grievances that arise in this group throughout life so that we can take action against them. In this way, not only this group, but also children who are now born prematurely, benefit from the knowledge that the POPS cohort provides.’

According to Schreuder, a problem is that premature birth already receives attention in pediatrics, but as soon as the transition to adult care occurs at the age of 18, the impact of premature birth fades into the background. “Now only the most vulnerable premature children are followed up to the age of 8, but puberty has not yet arrived at that time. It would therefore be fantastic if we could use a new POPS study to show what causes premature birth in adults,” says Schreuder.

More knowledge about kidneys, brain and lungs
It is currently being investigated whether and how a follow-up to the POPS survey can be provided. Van der Pal: ‘We are now mapping out what we want to look at. We are also looking for researchers who are interested in this cohort based on their expertise and who want to participate in a new measurement. It would be great if we could examine the preterm adults for a number of additional things compared to the measurement at age 19. The participants from the year are at least enthusiastic, I often get emails asking if there will be another round.’

‘I hope some of the people who didn’t participate online the last two times will now do so when it comes to a physical examination. How wonderful that research is being done in many areas, including: brain development, kidney damage, blood pressure, insulin, heart and blood vessels, body composition, lung problems, pregnancy problems and fertility and psychosocial themes. There is a need for clarity on many aspects, among researchers, doctors, but also premature babies and their parents,” says Schreuder.

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