Advances in perinatal care have increased the number of premature babies who survive.
There are concerns, however, about the ability of these children to cope with the
demands of adulthood.
We linked compulsory national registries in Norway to identify children of different
gestational-age categories who were born between 1967 and 1983 and to follow them
through 2003 in order to document medical disabilities and outcomes reflecting social
performance.
The study included 903,402 infants who were born alive and without congenital anomalies
(1822 born at 23 to 27 weeks of gestation, 2805 at 28 to 30 weeks, 7424 at 31 to 33
weeks, 32,945 at 34 to 36 weeks, and 858,406 at 37 weeks or later). The proportions
of infants who survived and were followed to adult life were 17.8%, 57.3%, 85.7%,
94.6%, and 96.5%, respectively. Among the survivors, the prevalence of having cerebral
palsy was 0.1% for those born at term versus 9.1% for those born at 23 to 27 weeks
of gestation (relative risk for birth at 23 to 27 weeks of gestation, 78.9; 95% confidence
interval [CI], 56.5 to 110.0); the prevalence of having mental retardation, 0.4% versus
4.4% (relative risk, 10.3; 95% CI, 6.2 to 17.2); and the prevalence of receiving a
disability pension, 1.7% versus 10.6% (relative risk, 7.5; 95% CI, 5.5 to 10.0). Among
those who did not have medical disabilities, the gestational age at birth was associated
with the education level attained, income, receipt of Social Security benefits, and
the establishment of a family, but not with rates of unemployment or criminal activity.
In this cohort of people in Norway who were born between 1967 and 1983, the risks
of medical and social disabilities in adulthood increased with decreasing gestational
age at birth.
2008 Massachusetts Medical Society