A new patient population for adult clinicians: Preterm born adults.
A new patient population for adult clinicians: Preterm born adults.
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成人临床医生的新患者群体：早产成人。
DOI：
10.1016/j.lana.2022.100188
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Sullivan,MaryC
中科院分区：
文献类型：
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作者：
D'Agata,AmyL;Green,CarolE;Sullivan,MaryC
如果一个单一的事件可以影响健康，运动能力，学习风格，社会交往，甚至个人身份-但个人没有记忆的事件？早产儿是一个被低估的弱势群体。对早产儿的多项研究，包括我们35年的纵向研究，发现了成人医疗保健提供者在评估中应该考虑的重要健康问题。令人担忧的问题包括心血管疾病、代谢综合征、抑郁、焦虑和注意力问题的发病率增加，教育程度降低和恋爱频率降低。1，2北欧一项针对600多万人的研究发现，胎龄与防止早期成人死亡率之间存在线性关系，早产儿的早期死亡率比足月同龄人高出144倍。3与此同时，早产存活率越来越普遍。在过去的几十年里，近九分之一的美国婴儿早产，现在超过95%的婴儿存活。2全球流行率和存活率数据表明，每年有1 500多万早产幸存者长大成人。4这表明有一个新的人群对成人健康提供者有新的医疗保健需求。出生史应该是每个病人病历的一部分。5由于早产的风险和患病率各不相同，所有医疗从业人员都应该意识到长期影响的可能性。每10个30岁的早产儿患者中就有一个早产儿，治疗早产儿长期并发症的临床专家（即神经病学，精神病学，心脏病学）可能会有更多的早产儿患者。认识到早产是一个累积的、终身的风险因素是第一步。作为临床医生和研究人员，我们观察到医学界，就像整个社会一样，倾向于将早产视为一种局限于婴儿期的健康事件--孩子长大后就会消失。具有讽刺意味的是，一些儿科医生报告说，他们对早产儿的健康并发症的培训和理解有限，而且几乎没有证据表明成人医生对这些成人的护理知识。6最近制定了初步的成人初级保健指南，以筛查和管理与早产相关的健康并发症。7.早产带来的健康风险也是对平等和正义的风险。有社会风险因素的妇女更有可能早产。这包括黑人妇女、生活在社会经济萧条地区的妇女以及有两次或两次以上不良童年经历的妇女。8.种族主义和基于种姓的不平等的许多方面可能使已经面临早产风险的人的健康状况复杂化和恶化。还需要引起早产儿研究界的注意。迄今为止，研究的重点是较年轻的年龄组和主要是白色人口。未来的研究需要寻找不同种族的人群，并全面检查早产的潜在生命过程并发症。当考虑社会经济因素如何影响个体的非稳态负荷时，这一点尤其重要。对于许多早产儿来说，早产不仅仅是一个健康问题，这是他们是谁的问题。他们对健康的感知，或健康相关的生活质量（HRQL），是一个关键的结果。迄今为止，这一证据因年龄、早产程度和报告者而异;临床医生和父母倾向于对HRQL的评价比幸存者更负面。早产儿可能没有事件记忆，但早产的影响可能会通过家庭叙述和独特的生活经历产生反响。有些人认为是典型的发达个体...
What if a single event could sway health, exercise capacity, learning style, social interactions, and even personal identities− yet individuals had no memory of the event? Adults born preterm are an under-recognized and vulnerable population. Multiple studies of individuals born prematurely, including our 35-year longitudinal study, have found important health concerns that adult healthcare providers should consider in their assessments. Concerns include increased rates of cardiovascular disease, metabolic syndrome, depression, anxiety and attention problems, lower educational attainment and frequency of romantic relationships. 1, 2 A Nordic study of over six million individuals found a linear relationship between gestational age and protection against early adult mortality, with preterm individuals showing 144 times increased likelihood of early mortality as full-term peers. 3 At the same time, surviving premature birth has become increasingly common. For the last several decades, nearly one in nine US babies is born early, and now more than 95% survive. 2 Global prevalence and survival data indicate more than 15 million preterm birth survivors annually reach adulthood. 4 This suggests a new population of individuals with emerging healthcare needs for adult health providers. Birth history should be part of every patients’ medical record. 5 Due to the varied risks and prevalence of premature birth, all healthcare practitioners should be aware of the potential for long-term effects. With one in ten 30-year-old patients born preterm, clinical specialists who treat long-term complications of prematurity (ie, neurology, psychiatry, cardiology) may have more preterm-born patients. Recognizing preterm birth as a cumulative, lifelong risk factor is the first step. As clinicians and researchers, we have observed the medical community, like society at-large, tends to view prematurity as a health event localized to infancy-something kids outgrow. Ironically, some pediatric providers report limited training and understanding of health complications for children born preterm, and little evidence exists regarding adult practitioners’ knowledge to care for these adults. 6 Preliminary adult primary care guidelines were recently created to screen and manage prematurity-related health complications. 7 Health risks from prematurity are also risks to equality and justice. Women who bear social risk factors are more likely to give birth early. This includes Black women, those living in socio-economically depressed areas, and women with two or more Adverse Childhood Experiences. 8 The many arms of racism and caste-based inequalities can complicate and worsen the health of people already at risk from preterm birth. Attention also needs to be drawn to the prematurity research community. To date, research has focused on younger age groups and predominantly White populations. Future research needs to seek out ethnically diverse populations and comprehensively examine potential lifecourse complications of early birth. This is especially important when considering how socioeconomic factors may influence the allostatic load of individuals. For many born preterm, prematurity is not just a health concern, it’sa matter of who they are. Their perception of health over time, or health related quality of life (HRQL), is a critical outcome. To date, this evidence varies with age, degree of prematurity and reporter; clinicians and parents tend to rate HRQL more negatively than survivors. 9, 10 Preterm-born individuals may not have event memories but, early birth repercussions can reverberate through family narratives and unique life experiences. Some identify as typically developed individuals …