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Long-term outcomes of preterm infants in the first 6 years of life: a nationwide population-based study in Korea

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Abstract

This study examined the relationship between gestational age and long-term outcomes up to 6 years of age using population-based big data from the National Health Insurance Service in Korea. This retrospective observational cohort study used data from the National Health Information Database (2011–2017). All children born in Korea during 2011 (January 1–December 31) were eligible and were followed up until 2017. Gestational age groups were divided into extremely preterm (< 28 weeks), very preterm (28–31 weeks), moderate-to-late preterm (32–36 weeks), and full-term (37–41 weeks). The survival rate, neurodevelopmental diseases, hearing or visual impairment, and respiratory morbidities were compared for each gestational age group. In total, 370,301 children were included in the analysis. The total survival rate increased with increasing gestational age. Furthermore, the risk of neurodevelopmental diseases (i.e., epilepsy, cerebral palsy, delayed development, mental retardation, language disorder, developmental coordination disorder, autism spectrum disorder), hearing or visual impairment, and asthma-related inhaler prescription increased with decreasing gestational age, despite adjustment for covariates.

Conclusion: Lower gestational age was associated with an increase in a wide spectrum of adverse neurodevelopmental and respiratory outcomes in the first 6 years of life. Although morbidities were highest at the earliest gestational ages, moderate-to-late preterm children were significantly associated with increased adverse outcomes compared with full-term children. Our findings prove this under-recognized group’s long-term follow-up and policy support.

What is Known:

• Infants born preterm are at high risk for neurodevelopmental and various medical health problems.

• Nationwide research on long-term outcomes for moderate-to-late preterm birth is sparse.

What is New:

• In this nationwide cohort study, lower gestational age at birth was inversely associated with increased adverse neurodevelopmental and respiratory outcomes in the first 6 years of life.

• Long-term follow-up and policy support are required for moderate-to-late preterm children who are at risk of increased adverse outcomes compared with full-term births.

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Abbreviations

ADHD:

Attention-deficit hyperactivity disorder

ASD:

Autism spectrum disorder

CP:

Cerebral palsy

CI:

Confidence intervals

DCD:

Developmental coordination disorder

DSM-5:

Diagnostic and Statistical Manual of Mental Disorders 5th edition

ICD-10:

International Classification of Disease, 10th Revision

KCD:

Korean Standard Classification of Disease

NDR:

National Disability Registry

NHIS:

National Health Insurance Service

OR:

Odds ratios

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Funding

This work was supported by the National Health Insurance Ilsan Hospital grant (NHIMC 2019–20-006).

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Authors and Affiliations

  1. Department of Pediatrics, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang, Republic of Korea

    Ju Hyun Jin, Sung Hee Lee & Shin Won Yoon

  2. Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea

    Tae Mi Youk

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Contributions

Ju Hyun Jin, Sung Hee Lee, and Shin Won Yoon contributed to the study’s conception and design. Tae Mi Youk performed the data collection and analysis. Ju Hyun Jin wrote the first draft of the manuscript. Sung Hee Lee and Tae Mi Youk commented on the previous versions of the manuscript. Shin Won Yoon revised the manuscript. All authors contributed to the critical revision of the manuscript and have read and approved the submitted version.

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Correspondence to Shin Won Yoon.

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This study was approved by the Institutional Review Board of the National Health Insurance Service Ilsan Hospital (approval no. NHIMC 2022–03-040).

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The authors declare no competing interests.

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Communicated by Gregorio Milani

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Jin, J.H., Lee, S.H., Youk, T.M. et al. Long-term outcomes of preterm infants in the first 6 years of life: a nationwide population-based study in Korea. Eur J Pediatr 182, 641–650 (2023). https://doi.org/10.1007/s00431-022-04728-w

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  • DOI: https://doi.org/10.1007/s00431-022-04728-w

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