New research: Short- and long-term recommendations for babies born preterm
Research findings published online Feb. 23 in the Journal of Pediatric Health Care show that being born preterm can have long-term consequences, including impaired school performance, behavioral and mental health issues, heart and lung problems, and motor delays. Michelle M. Kelly, Ph.D., CRNP, CNE, associate professor at Villanova University’s M. Louise Fitzpatrick College of Nursing, is the lead author of the article “Addressing Preterm Birth History With Clinical Practice Recommendations Across the Life Course.” The publication includes recommendations, which acknowledge the need for early identification, intervention, and family support for not just the most vulnerable infants but for all who were born before the completion of 37 weeks of gestation.
Coauthors of the article are Jane Tobias, assistant professor, Jefferson College of Nursing at Thomas Jefferson University, and Patricia B. Griffith, a Ph.D. student at Villanova’s College of Nursing, and an advanced senior lecturer in the Adult Gerontology Acute Care Nurse Practitioner Program at the University of Pennsylvania School of Nursing.
This set of preterm birth history recommendations is the first comprehensive document to advocate for universal recognition and appreciation of life course health risks related to an individual’s preterm birth history.
Through an in-depth review of literature and validation from health care experts in pediatric and adult care, the researchers developed their recommendations for primary care providers as a way to enhance the identification of those born prematurely, empower health care providers to employ familiar screening strategies, and advocate for mitigation strategies with anticipatory guidance and health promotion. These recommendations advocate a proactive intervention rather than the reactive practice of waiting for children to fail to meet specific milestones or begin to show comorbid tendencies.
“With these recommendations we aim to change the prevailing belief that being born preterm stops mattering to a child’s future health once the child catches up to their peers,” says Kelly. “Most infants born preterm catch up developmentally and physically to their term peers around age two, which is also when we stop correcting for gestational age, which is the process of subtracting the weeks a child was born early to arrive at an adjusted age. For example, an 18-month old who was three months early is considered 15 months developmentally. It is so important that families and health care providers understand that being born preterm is an important part of someone’s health history throughout their lifetime.”
In addition to the risk factors above, preterm birth can increase an individual’s risk for impaired school performance in math, spelling, reading, receptive language, cognitive flexibility, working memory, and verbal fluency; behavioral and mental concerns such as depression, anxiety, and ADHD; and cardiovascular and pulmonary disease, motor delays and coordination impairment.
The authors note that with any new set of recommendations there may be unanticipated risks, such as increased provider attention to potential risk could result in perceptions of vulnerability in the patient or family. To balance this risk, the researchers support healthcare providers addressing preterm birth history in the same manner a family history of heart disease is addressed. “Recognize it as a risk, advocate for lifestyle modifications that mitigate the risk, and intervene as necessary,” the authors advise.
The recommendations advocate for early identification, intervention and support, of all those born preterm. A first step in reducing the potential for chronic health issues is incorporating the question, “Were you born preterm?” into all patient health histories and appreciating the implications of a positive response.