Quality of Life Research

, Volume 26, Issue 4, pp 935–943 | Cite as

Neonatal treatment philosophy in Dutch and German NICUs: health-related quality of life in adulthood of VP/VLBW infants

  • Linda D. Breeman
  • Sylvia van der Pal
  • Gijsbert H. W. Verrips
  • Nicole Baumann
  • Peter Bartmann
  • Dieter WolkeEmail author



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.


Prematurity Low birth weight Neonatal treatment Health-related quality of life Longitudinal study Cross-cultural study 



We would like to thank all current and former group members, pediatricians, psychologists, and research nurses of the Dutch Project On Preterm and Small-for-gestational-age infants (POPS) and the Bavarian Longitudinal Study (BLS). Moreover, we would like to thank those who contributed to the study organisation, recruitment, data collection, and management of the adulthood assessments. Special thanks are due to the study participants and their families.


The Dutch POPS study was supported by grant HS-08385 from the Agency for Health Care Policy and Research, USA. The German BLS study was supported by grants PKE24, JUG14, 01EP9504 and 01ER0801 from the German Federal Ministry of Education and Science.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11136_2016_1410_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 kb)
11136_2016_1410_MOESM2_ESM.docx (17 kb)
Supplementary material 2 (DOCX 16 kb)


  1. 1.
    Rüegger, C., Hegglin, M., Adams, M., Bucher, H. U., & for the Swiss Neonatal Network. (2012). Population based trends in mortality, morbidity and treatment for very preterm- and very low birth weight infants over 12 years. BMC Pediatrics, 12(17), 2–12.Google Scholar
  2. 2.
    Veen, S., Ens-Dokkum, M. H., Schreuder, A. M., Verloove-Vanhorick, S. P., Brand, R., & Ruys, J. H. (1991). Impairments, disabilities, and handicaps of very preterm and very-low-birthweight infants at five years of age. The Collaborative Project on Preterm and Small for Gestational Age Infants (POPS) in The Netherlands. The Lancet, 338(6), 33–36.CrossRefGoogle Scholar
  3. 3.
    Msall, M. E., & Tremont, M. R. (2002). Measuring functional outcomes after prematurity: Developmental impact of very low birth weight and extremely low birth weight status on childhood disability. Mental Retardation and Developmental Disabilities Research Reviews, 8(4), 258–272.CrossRefPubMedGoogle Scholar
  4. 4.
    Saigal, S., Stoskopf, B., Pinelli, J., Streiner, D., Hoult, L., Paneth, N., et al. (2006). Self- perceived health-related quality of life of former extremely low birth weight infants at young adulthood. Pediatrics, 118(3), 1140–1148.CrossRefPubMedGoogle Scholar
  5. 5.
    Zwicker, J. G., & Harris, S. R. (2008). Quality of life of formerly preterm and very low birth weight infants from preschool age to adulthood: A systematic review. Pediatrics, 121(2), e366–e376.CrossRefPubMedGoogle Scholar
  6. 6.
    Verrips, E., Vogels, T., Saigal, S., Wolke, D., Meyer, R., Hoult, L., et al. (2008). Health-related quality of life for extremely low birth weight adolescents in Canada, Germany, and The Netherlands. Pediatrics, 122(3), 556–561.CrossRefPubMedGoogle Scholar
  7. 7.
    Van Lunenburg, A., Van der Pal, S., Van Dommelen, P., Van der Pal-de, K., Gravenhorst, J. B., et al. (2013). Changes in quality of life into adulthood after very preterm birth and/or very low birth weight in The Netherlands. Health and Quality of Life Outcomes, 11(51), 2–8.Google Scholar
  8. 8.
    Roberts, G., Burnett, A. C., Lee, K. J., Cheong, J., Wood, S. J., Anderson, P. J., et al. (2013). Quality of life at age 18 years after extremely preterm birth in the post-surfactant era. The Journal of Pediatrics, 163(4), 1008–1013.CrossRefPubMedGoogle Scholar
  9. 9.
    Hack, M., Flannery, D. J., Schluchter, M., Cartar, L., Borawski, E., & Klein, N. (2002). Outcomes in young adulthood for very-low-birth-weight infants. New England Journal of Medicine, 346(3), 149–157.CrossRefPubMedGoogle Scholar
  10. 10.
    Mathiasen, R., Hansen, B. M., Nybo Anderson, A. M., & Greisen, G. (2009). Socio-economic achievements of individuals born very preterm at the age of 27 to 29 years: a nationwide cohort study. Developmental Medicine and Child Neurology, 51(11), 901–908.CrossRefPubMedGoogle Scholar
  11. 11.
    Baumann, N., Bartmann, P., & Wolke, D. (2016). Health-related quality of life into adulthood after very preterm birth. Pediatrics, 137(4), 1–10.CrossRefGoogle Scholar
  12. 12.
    Göpel, W., Kribs, A., Ziegler, A., Laux, R., Hoehn, T., Wieg, C., et al. (2011). Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): An open-label, randomised, controlled trial. The Lancet, 378(9803), 1627–1634.CrossRefGoogle Scholar
  13. 13.
    Verloove-Vanhorick, S., Verwey, R., Brand, R., Gravenhorst, J. B., Keirse, M., & Ruys, J. (1986). Neonatal mortality risk in relation to gestational age and birth weight Results of a national survey of preterm and very-low-birth weight infants in The Netherlands. Lancet, 1(8472), 55–57.CrossRefPubMedGoogle Scholar
  14. 14.
    Riegel, K., Ohrt, B., Wolke, D., & Österlund, K. (1995). Die Entwicklung gefährdet geborener kinder bis zum fünften lebensjahr. [The development of children born at risk until their fifth year of life]. Stuttgart: Ferdinand Enke VerlagGoogle Scholar
  15. 15.
    Verrips, G. H. W., Stuifbergen, M. C., Den Ouden, A. L., Bonsel, G. J., Gemke, R., Paneth, N., et al. (2001). Measuring health status using the Health Utilities Index: agreement between raters and between modalities of administration. Journal of Clinical Epidemiology, 54(5), 475–481.CrossRefPubMedGoogle Scholar
  16. 16.
    Eryigit Madzwamuse, S., Baumann, N., Jaekel, J., Bartmann, P., & Wolke, D. (2014). Neuro-cognitive performance of very preterm or very low birth weight adults at 26 years. Journal of Child Psychology and Psychiatry, 56(8), 857–864.CrossRefPubMedGoogle Scholar
  17. 17.
    Feeny, D., Furlong, W., & Barr, R. D. (1998). Multiattribute approach to the assessment of health-related quality of life: Health Utilities Index. Medical and Pediatric Oncology, 30(S1), 54–59.CrossRefGoogle Scholar
  18. 18.
    Horsman, J., Furlong, W., Feeny, D., & Torrance, G. (2003). The Health Utilities Index (HUI): Concepts, measurement properties and applications. Health and Quality of Life Outcomes, 1(54), 1–13.Google Scholar
  19. 19.
    Harwood, R., Rogers, A., Dickinson, E., & Ebrahim, S. (1994). Measuring handicap: The London Handicap Scale, a new outcome measure for chronic disease. Quality in Health Care, 3(1), 11–16.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    The WHOQOL group. (1996). WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment. Geneva: World Health Organization.Google Scholar
  21. 21.
    Breeman, L. D., Jaekel, J., Baumann, N., Bartmann, P., & Wolke, D. (2015). Preterm cognitive function into adulthood. Pediatrics, 36(3), 415–423.CrossRefGoogle Scholar
  22. 22.
    Bleichrodt, N., & Berg, R. H. (2000). Multicultural Capacity Test: Intermediate Level (MCT-M). User manual. NOA: Amsterdam.Google Scholar
  23. 23.
    Von Aster, M., Neubauer, A., & Horn, R. (2006). Wechsler Intelligenztest für Erwachsene (WIE) [Wechsler Adult Intelligence Scale (WAIS III)]. Frankfurt/Main: Harcourt Test Services.Google Scholar
  24. 24.
    Wechsler, D. (1997). Wechsler Adult Intelligence Scale—Third Edition (WAIS III): Administration and scoring manual. San Antonio, TX: The Psychological Corporation.Google Scholar
  25. 25.
    Wolke, D., Chernova, J., Eryigit-Madzwamuse, S., Samara, M., Zwierzynska, K., & Petrou, S. (2013). Self and parent perspectives on health-related quality of life of adolescents born very preterm. Journal of Pediatrics, 163(4), 1020–1026.CrossRefPubMedGoogle Scholar
  26. 26.
    Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.Google Scholar
  27. 27.
    Deary, J. J. (2010). Cognitive epidemiology: Its rise, its current issues, and its challenges. Personality and Individual Differences, 49(4), 337–343.CrossRefGoogle Scholar
  28. 28.
    Bäuml, J. G., Daamen, M., Meng, C., Neitzel, J., Scheef, L., Jaekel, J., et al. (2015). Correspondence between aberrant intrinsic network connectivity and gray-matter volume in the ventral brain of preterm born adults. Cerebral Cortex, 25(11), 4135–4145.CrossRefPubMedGoogle Scholar
  29. 29.
    Meng, C., Bauml, J. G., Daamen, M., Jaekel, J., Neitzel, J., Scheef, L., et al. (2015). Extensive and interrelated subcortical white and gray matter alterations in preterm-born adults. Brain Structure and Functioning, 221(4), 2109–2121.CrossRefGoogle Scholar
  30. 30.
    Jaekel, J., Bartmann, P., Schneider, W., & Wolke, D. (2014). Neurodevelopmental pathways to preterm children’s specific and general mathematic abilities. Early Human Development, 90(10), 639–644.CrossRefPubMedGoogle Scholar
  31. 31.
    Deary, I. J., Whiteman, M. C., Starr, J. M., Whalley, L. J., & Fox, H. C. (2004). The impact of childhood intelligence on later life: Following up the scottish mental surveys of 1932 and 1947. Journal of Personality and Social Psychology, 86(1), 130–147.CrossRefPubMedGoogle Scholar
  32. 32.
    McGurn, B., Deary, I. J., & Starr, J. M. (2008). Childhood cognitive ability and risk of late-onset Alzheimer and vascular dementia. Neurology, 71(14), 1051–1056.CrossRefPubMedGoogle Scholar
  33. 33.
    Hille, E. T. M., Elbertse, L., Gravenhorst, J. B., Brand, R., & Verloove-Vanhorick, S. P. (2005). Nonresponse bias in a follow-up study of 19-year-old adolescents born as preterm infants. Pediatrics, 116(5), e662–e666.CrossRefPubMedGoogle Scholar
  34. 34.
    Flynn, J. R. (1987). Massive IQ gains in 14 nations: What IQ tests really measure. Psychological Bulletin, 101(2), 171–191.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Linda D. Breeman
    • 1
    • 2
  • Sylvia van der Pal
    • 3
  • Gijsbert H. W. Verrips
    • 3
  • Nicole Baumann
    • 1
  • Peter Bartmann
    • 4
  • Dieter Wolke
    • 1
    • 5
    Email author
  1. 1.Department of PsychologyUniversity of WarwickCoventryUK
  2. 2.Department of Youth & FamilyUtrecht UniversityUtrechtThe Netherlands
  3. 3.TNOLeidenThe Netherlands
  4. 4.Department of NeonatologyUniversity Hospital BonnBonnGermany
  5. 5.Division of Mental Health and Wellbeing, Warwick Medical SchoolUniversity of WarwickCoventryUK

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