[Long-term outcome of preterm neonates: the message behind the statistics].
In view of the current progress in neonatal intensive care, the present outcome of former preterm neonates does not necessarily reflect the future outcome of today's preterm neonates. In spite of this statistical uncertainty, long-term follow-up studies performed in the past few years point to the fact that the sequelae of prematurity may appear well beyond infancy and may be revealed in varying manners with increasing age. Therefore, a chronological account of the consequences of prematurity is given in this paper, ranging from perinatal mortality/morbidity to the problems to be observed during early childhood, preschool age, and adolescence right up to the long-term sequelae arising in later adulthood. Within this context, a two-fold paradigm shift in neonatology becomes apparent in that, first, the outcome of preterm neonates is not a result of immaturity per se, yet is significantly influenced by the factors leading to preterm birth (inflammation, intrauterine growth restriction), and, second, the sequelae of prematurity do not end with the end of neonatal intensive care, but are greatly modulated by familial conditions in their further course. Even though the statistical data are still subject to changes, these insights form the basis of a structured long-term follow-up of preterm neonates which, after the progressive establishment of acute treatment strategies, will become an increasingly important challenge to neonatology within the framework of paediatrics.
Singer
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Kinderklinik der Bayerischen Julius-Maximilians-Universität Würzburg. d.singer@mail.uni-wuerzburg.de
D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D007236:Infant, Small for Gestational Age; D019102:Infant, Very Low Birth Weight; D007333:Insulin Resistance / Q000502:physiology; D015931:Intensive Care, Neonatal; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D012307:Risk Factors; D016019:Survival Analysis