Abstract
Numerous studies have identified the effects of prematurity on the neonate’s physical health, however few studies have explored the effects of prematurity on both the physical and mental health of the child as they develop. Secondary analysis of data from the Millennium Cohort Study, a longitudinal study of infants (n = 18 818, born 2000–2002 in the United Kingdom) was performed. Effects of gestational age at birth on health outcomes at 5 years were measured using parental rating of their children’s general health and severity of behavior problems. The association between parent’s general health ratings and behavior problem ratings was low: 86% of those reporting serious behavior problems (5% of the sample, n = 764) rated their child as being in excellent, very good, or good health. Still, a gradient of increasing risk of poorer outcome with decreasing gestational age was observed for a composite health measure (poor/fair health and/or serious behavior problems), suggesting an association with prematurity for this composite assessment of health status. The greatest contribution to the childhood composite health measure at 5 years was for children born at 32–36 weeks gestation: population attributable fractions for having poor outcomes was 3.4% (Bonferroni-adjusted 95% confidence interval 1.1%–6.2%), compared to 1% (0.2–2.3) for birth at less than 32 weeks. Results suggest that preterm children, by school entry, are not only at high risk of physical health problems, but also of behavioral health problems. The recognition of, and response to comprehensive health and well-being outcomes related to prematurity are important in order to correctly plan and deliver adequate paediatric health services and policies.
Highlights
A relatively strong association between gestational age and health at age 5 years was recently described using the large population-based United Kingdom (UK) Millennium Cohort Study (MCS) [1]
Using the United Kingdom (UK)-based register of social payment of child benefit as eligibility criterion, all children born in England and Wales between 1 September 2000 and 31 August 2001, and in Scotland and Northern Ireland between 24 November 2000 and 11 January 2002 were included in the MCS if they were alive and living in the jurisdiction at the time of the first survey (MCS1)
With reference to the first aim of the study, the results clearly show that most parents do not consider serious behavioral problems when rating their child’s general health at age 5 years: while a clear gradient of increasing risk of poorer outcome with decreasing age for both general health rating and behavior problems rating suggests a trend effect of prematurity for each outcome, 86% of the parents who reported that their child had behavior problems of clinically relevant levels rated the same child as being in excellent, very good, or good health
Summary
A relatively strong association between gestational age and health at age 5 years was recently described using the large population-based UK Millennium Cohort Study (MCS) [1]. While the Boyle et al, study [1] assessed numerous aspects of physical health (e.g. hospital admissions at 9 months and at 5 years, longstanding illnesses, asthma etc.) it did not assess any dimension of mental health, except possibly through a measure of general health with parental ratings This is not an unusual omission for population health surveys [2], but it is an important omission for a number of reasons: first, it has become clear that the origins of lifelong mental health problems can be assessed during early childhood [3,4,5]; second, mental ill-health has been identified as the single largest cause of disability in the UK, accounting for 22.8% of the total burden of disability and costing £105.2 billion each year [6]; third, childhood behavior problems such as emotional problems and conduct disorder are the most common and costliest of childhood health problems [7], with many physical and mental health issues being interrelated [8]; and the need to integrate behavioral health services into mainstream paediatric primary care has recently been recognised as a matter of ‘national priority’ in some countries such as the US [9, 10], with the aim of diminishing the ‘body-mind’ separation This is not an unusual omission for population health surveys [2], but it is an important omission for a number of reasons: first, it has become clear that the origins of lifelong mental health problems can be assessed during early childhood [3,4,5]; second, mental ill-health has been identified as the single largest cause of disability in the UK, accounting for 22.8% of the total burden of disability and costing £105.2 billion each year [6]; third, childhood behavior problems such as emotional problems and conduct disorder are the most common and costliest of childhood health problems [7], with many physical and mental health issues being interrelated [8]; and the need to integrate behavioral health services into mainstream paediatric primary care has recently been recognised as a matter of ‘national priority’ in some countries such as the US [9, 10], with the aim of diminishing the ‘body-mind’ separation (illness of the body v. illness of the mind) for children and promoting a model for optimal health care for the individual [11].
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