title: Neonatal treatment philosophy in Dutch and German NICUs: health-related quality of life in adulthood of VP/VLBW infants.
abstract: Although survival after very preterm birth (VP)/very low birth weight (VLBW) has improved, a significant number of VP/VLBW individuals develop physical and cognitive problems during their life course that may affect their health-related quality of life (HRQoL). We compared HRQoL in VP/VLBW cohorts from two countries: The Netherlands (n = 314) versus Germany (n = 260) and examined whether different neonatal treatment and rates of disability affect HRQoL in adulthood.
  
  
  
  To analyse whether cohorts differed in adult HRQoL, linear regression analyses were performed for three HRQoL outcomes assessed with the Health Utilities Index 3 (HUI3), the London Handicap Scale (LHS), and the WHO Quality of Life instrument (WHOQOL-BREF). Stepwise hierarchical linear regression was used to test whether neonatal physical health and treatment, social environment, and intelligence (IQ) were related to VP/VLBW adults' HRQoL and cohort differences.
  
  
  
  Dutch VP/VLBW adults reported a significantly higher HRQoL on all three general HRQoL measures than German VP/VLBW adults (HUI3: .86 vs .83, p = .036; LHS: .93 vs. .90, p = .018; WHOQOL-BREF: 82.8 vs. 78.3, p < .001). Main predictor of cohort differences in all three HRQoL measures was adult IQ (p < .001).
  
  
  
  Lower HRQoL in German versus Dutch adults was related to more cognitive impairment in German adults. Due to different policies, German VP/VLBW infants received more intensive treatment that may have affected their cognitive development. Our findings stress the importance of examining effects of different neonatal treatment policies for VP/VLBW adults' life.
authors.affiliation: Department of Psychology, University of Warwick, Coventry, CV4 7AL, UK.|Department of Youth & Family, Utrecht University, Utrecht, The Netherlands.
authors.forename: Linda D
authors.initials: LD
authors.lastname: Breeman
authors.affiliation: TNO, Leiden, The Netherlands.
authors.forename: Sylvia
authors.initials: S
authors.lastname: van der Pal
authors.affiliation: TNO, Leiden, The Netherlands.
authors.forename: Gijsbert H W
authors.initials: GH
authors.lastname: Verrips
authors.affiliation: Department of Psychology, University of Warwick, Coventry, CV4 7AL, UK.
authors.forename: Nicole
authors.initials: N
authors.lastname: Baumann
authors.affiliation: Department of Neonatology, University Hospital Bonn, Bonn, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Bartmann
authors.affiliation: Department of Psychology, University of Warwick, Coventry, CV4 7AL, UK. D.Wolke@warwick.ac.uk.|Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK. D.Wolke@warwick.ac.uk.
authors.forename: Dieter
authors.initials: D
authors.lastname: Wolke
mesh_terms: D000328:Adult; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D005858:Germany; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D009426:Netherlands; D011788:Quality of Life; D012044:Regression Analysis; D017741:Survivors / Q000523:psychology
keywords: Cross-cultural study; Health-related quality of life; Longitudinal study; Low birth weight; Neonatal treatment; Prematurity