Prematurity Is a Chronic Disease

Abstract

Few studies have investigated neuroradiographic findings of preterm birth from a clinical perspective into adulthood, or used a sibling comparison to demonstrate these differences. In this volume of The Journal, Kuula et al report deployment of MRI to assess brain abnormalities and volumetric differences in a cohort of adults born preterm at very low birth weight (VLBW), using siblings as controls. At mean age 29 years, the investigators found significantly more structural abnormalities in VLBW subjects than control siblings, 37% vs. 13%, with periventricular leukomalacia the most common finding. The VLBW group had smaller absolute brain volumes and, after adjusting for estimated intracranial volume, also larger ventricles, less gray matter, and smaller thalami, caudate nuclei, right hippocampus, and left pallidum. No differences in total white matter were detected. While other researchers have documented chronic white matter abnormalities in adults following prematurity, the chronic gray matter changes here are intriguing and require further study. Perhaps more notable is the persistence of sequelae far into adult life. Children with cerebral palsy and visual impairments were excluded from this study, but other neurodevelopmental differences in this population may be associated with these abnormalities. Children born premature are already known to be at increased risk of hypertension and chronic cardiovascular disease, chronic pulmonary disease, diabetes mellitus, and even premature death. The findings of Kuula et al underscore that prematurity is a chronic disease also affecting the central nervous system. There are no guidelines for the long-term medical follow-up of people born preterm. Meanwhile there are survivorship guidelines for prevalent yet less common conditions of childhood, such as cancer or liver transplantation. With about 10% of US births categorized as premature and over 1% VLBW, perhaps it is time give more attention to the investigation and management of chronic diseases in adulthood that arise from prematurity. Article page 48