An overview of adult health outcomes after preterm birth
An overview of adult health outcomes after preterm birth
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DOI：
10.1016/j.earlhumdev.2020.105187
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发表时间：
2020-11-01
影响因子：
2.5
通讯作者：
Crump, Casey
中科院分区：
文献类型：
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作者：
Crump, Casey
过去 20 年来，大多数国家的早产（胎龄 < 37 周）患病率有所增加，目前影响到全世界新生儿的近 11%。由于 20 世纪 70 年代至 80 年代治疗方法的进步，接受现代新生儿和儿科护理的早产儿中，95% 以上现在都能存活到成年。最早受益于这些进步的出生群体现在已经是四五十岁了。越来越多的大型队列研究调查了成年期的长期健康后遗症。证据一致表明，早产的成年幸存者罹患涉及各种器官系统的慢性疾病的风险增加，包括心血管、内分泌/代谢、呼吸、肾脏、神经发育和精神疾病，这些疾病要么从儿童期持续到成年期，要么有时在成年期首次出现。与足月出生的人相比，这些疾病还会导致早产儿到成年早期的死亡风险中度增加（30%至50%），而最早胎龄出生的人的死亡风险甚至更高。然而，大多数早产儿出现这些结果的绝对风险较低，并且自我报告的成年后生活质量良好。未来研究的重点包括评估种族和经济多样化人群中早产的长期健康后遗症、对现有队列到老年的额外随访、按早产亚型（例如不同的根本原因）阐明结果以改善风险分层，以及识别支持早产成人长期健康轨迹和福祉的保护因素。
Preterm birth (gestational age < 37 completed weeks) has increased in prevalence in most countries in the past 20 years and now affects nearly 11% of all births worldwide. Because of treatment advances introduced in the 1970s-1980s, > 95% of preterm infants who receive modern neonatal and pediatric care now survive into adulthood. The earliest birth cohorts to benefit from those advances are now in their 4th and 5th decades of life. A growing number of large cohort studies have investigated the long-term health sequelae in adulthood. Evidence has consistently shown that adult survivors of preterm birth have increased risks of chronic disorders involving various organ systems, including cardiovascular, endocrine/metabolic, respiratory, renal, neurodevelopmental, and psychiatric disorders, which either persist from childhood into adulthood or sometimes first manifest in adulthood. These disorders also lead to moderately (30% to 50%) increased mortality risks during early to mid-adulthood among persons born preterm compared with full-term, and even higher risks among those born at the earliest gestational ages. However, the majority of persons born preterm have low absolute risks of these outcomes and good self-reported quality of life in adulthood. Priorities for future research include the assessment of long-term health sequelae of preterm birth in racially and economically diverse populations, additional follow-up of existing cohorts into older adulthood, elucidation of outcomes by preterm birth subtype (e.g., different underlying causes) to improve risk stratification, and identification of protective factors that will support the long-term health trajectory and well-being of preterm-born adults.