Unrecognised and unmet physical health problems in a national cohort of very low birthweight young adults and controls
Brian A. Darlow 1 3 , Julia Martin 1 , L. John Horwood 21 Department of Paediatrics, University of Otago PO Box 4345, Christchurch 8140, New Zealand
2 Christchurch Health and Development Study, University of Otago, Christchurch, New Zealand
3 Corresponding author. Email: brian.darlow@otago.ac.nz
Journal of Primary Health Care 11(1) 32-38 https://doi.org/10.1071/HC18044
Published: 3 April 2019
Journal Compilation © Royal New Zealand College of General Practitioners 2019.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Young adults are often reluctant to seek medical attention. Compared with full-term controls, very low birthweight (<1500 g; VLBW) young adults may have more health problems.
AIM: To assess the frequency of unrecognised or unmet physical health needs during a comprehensive health and welfare assessment of a national cohort of VLBW adults born in 1986 compared with full-term controls.
METHODS: The VLBW cohort (n = 229; 71% of those alive) and controls (n = 100) aged 27–29 years were assessed in one University Hospital over 2 days. Physical health assessments included growth, respiratory function, blood pressure, echocardiogram, renal function, blood tests and an interview. Cranial MRI scans were performed on 150 VLBW adults and 50 controls. Significant unrecognised or unmet health needs were defined as including a body mass index (BMI) >30 plus raised fasting insulin >80 pmol/L; any two of moderate respiratory obstruction, or reduced diffusing capacity, or being a regular smoker; cardiovascular: hypertension or abnormal echocardiogram.
RESULTS: Among the VLBW cohort and controls; 61% versus 73% (P < 0.05) rated their overall health as very good or excellent. A general practitioner (GP) referral letter was sent for 44% VLBW adults and 38% controls, concerning metabolic problems in 20% and 17% respectively; respiratory problems in 12% and 4% (P < 0.05) respectively; cardiovascular problems in 14% and 12% respectively; abnormal renal function in 7% in both groups; and anaemia in 3% and 5% respectively.
DISCUSSION: Unrecognised or unmet health needs were frequent in both VLBW young adults and controls. Respiratory problems and hypertension were more frequent in the former. Continuity of care is important for VLBW adults who require a regular GP. GPs should routinely ask about gestation and birthweight and VLBW graduates should volunteer this information.
KEYWORDS: Blood pressure; cardiorespiratory health; obesity; primary health care
References
[1] Aarseth S, Dalen I, Haavet OL. Encouraging adolescents to contact their GP: a community-based trial. Br J Gen Pract. 2014; 64 e262–7.| Encouraging adolescents to contact their GP: a community-based trial.Crossref | GoogleScholarGoogle Scholar | 24771839PubMed |
[2] Ministry of Health. Annual Data Explorer 2016/17: New Zealand Health Survey [Data File]. Wellington: Ministry of Health; 2017 [cited 2018 December 31]. Available from: https://minhealthnz.shinyapps.io/nz-health-survey-2016-17-annual-data-explorer/_w_15542d9e/#!/home.
[3] Denny S, de Silva M, Fleming T, et al. The prevalence of chronic health conditions impacting on daily functioning and the association with emotional well-being among a national sample of high school students. J Adolesc Health. 2014; 54 410–5.
| The prevalence of chronic health conditions impacting on daily functioning and the association with emotional well-being among a national sample of high school students.Crossref | GoogleScholarGoogle Scholar | 24210897PubMed |
[4] Crump C, Sundquist K, Sundquist J, Winkleby MA. Gestational age at birth and mortality in young adulthood. JAMA. 2011; 306 1233–40.
| Gestational age at birth and mortality in young adulthood.Crossref | GoogleScholarGoogle Scholar | 21934056PubMed |
[5] Crump C, Winkleby MA, Sundquist K, Sundquist J. Risk of hypertension among young adults who were born preterm: a Swedish national study of 636,000 births. Am J Epidemiol. 2011; 173 797–803.
| Risk of hypertension among young adults who were born preterm: a Swedish national study of 636,000 births.Crossref | GoogleScholarGoogle Scholar | 21320866PubMed |
[6] Crump C, Winkleby MA, Sundquist J, Sundquist K. Risk of asthma in young adults who were born preterm: a Swedish national cohort study. Pediatrics. 2011; 127 e913–20.
| Risk of asthma in young adults who were born preterm: a Swedish national cohort study.Crossref | GoogleScholarGoogle Scholar | 21422091PubMed |
[7] Raju TNK, Buist AS, Blaisdell CJ, et al. Adults born preterm: a review of general health and system-specific outcomes. Acta Paediatr. 2017; 106 1409–37.
| Adults born preterm: a review of general health and system-specific outcomes.Crossref | GoogleScholarGoogle Scholar | 28419544PubMed |
[8] Darlow BA, Horwood LJ, Woodward LJ, et al. The New Zealand 1986 very low birth weight cohort as young adults: mapping the road ahead. BMC Pediatr. 2015; 15 90
| The New Zealand 1986 very low birth weight cohort as young adults: mapping the road ahead.Crossref | GoogleScholarGoogle Scholar | 26242407PubMed |
[9] Bunin GR, Vardhanabhuti S, Lin A, et al. Practical and analytical aspects of using friend controls in case-control studies: experience from a case-control study of childhood cancer. Paediatr Perinat Epidemiol. 2011; 25 402–12.
| Practical and analytical aspects of using friend controls in case-control studies: experience from a case-control study of childhood cancer.Crossref | GoogleScholarGoogle Scholar | 21819422PubMed |
[10] Ware J Jr, Kosinski M, Gandek B. SF-36 Health Survey: Manual & Interpretation Guide. Lincoln, RI, United States: QualityMetric, Inc.; 2005.
[11] Burney PGJ, Luczynska C, Chinn S, Jarvis D. The European Community Respiratory Health Survey. Eur Respir J. 1994; 7 954–60.
| The European Community Respiratory Health Survey.Crossref | GoogleScholarGoogle Scholar |
[12] Graham BL, Brusasco V, Burgos F, et al. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur Respir J. 2017; 49 1600016
| 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung.Crossref | GoogleScholarGoogle Scholar | 28049168PubMed |
[13] Darlow BA, Martin J, Horwood LJ. Metabolic syndrome in very low birth weight young adults and controls: the NZ 1986 VLBW study. J Pediatr. 2018;
| Metabolic syndrome in very low birth weight young adults and controls: the NZ 1986 VLBW study.Crossref | GoogleScholarGoogle Scholar | 30545563PubMed |
[14] Gibson AM, Doyle LW. Respiratory outcomes for the tiniest or most immature infants. Semin Fetal Neonatal Med. 2014; 19 105–11.
| Respiratory outcomes for the tiniest or most immature infants.Crossref | GoogleScholarGoogle Scholar | 24239022PubMed |
[15] Bolton CE, Bush A, Hurst JR, et al. Are early life factors considered when managing respiratory disease? A British Thoracic Society survey of current practice. Thorax. 2012; 67 1110
| Are early life factors considered when managing respiratory disease? A British Thoracic Society survey of current practice.Crossref | GoogleScholarGoogle Scholar | 22993167PubMed |
[16] Crump C. Medical history taking in adults should include questions about preterm birth. BMJ. 2014; 349 g4860
| Medical history taking in adults should include questions about preterm birth.Crossref | GoogleScholarGoogle Scholar | 25085466PubMed |
[17] Parkinson JRC, Hyde MJ, Gale C, et al. Preterm birth and the metabolic syndrome in adult life: a systematic review and meta-analysis. Pediatrics 2013; 131 e1240–63.
| Preterm birth and the metabolic syndrome in adult life: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[18] Kajantie E, Hovi P. Is very preterm birth a risk factor for adult cardiovascular disease? Semin Fetal Neonatal Med. 2014; 19 112–7.
| Is very preterm birth a risk factor for adult cardiovascular disease?Crossref | GoogleScholarGoogle Scholar | 24332842PubMed |
[19] Nuyt AM, Lavoie JC, Mohamed I, et al. Adult consequences of extremely preterm birth: cardiovascular and metabolic diseases risk factors, mechanisms, and prevention avenues. Clin Perinatol. 2017; 44 315–32.
| Adult consequences of extremely preterm birth: cardiovascular and metabolic diseases risk factors, mechanisms, and prevention avenues.Crossref | GoogleScholarGoogle Scholar | 28477663PubMed |
[20] Maron BJ, Maron MS. Hypertrophic cardiomyopathy. Lancet. 2013; 381 242–55.
| Hypertrophic cardiomyopathy.Crossref | GoogleScholarGoogle Scholar | 22874472PubMed |
[21] Wardlaw JM, Booth TC, Laurie G, et al. Acting on incidental findings in research imaging. BMJ. 2015; 351 h5190
| Acting on incidental findings in research imaging.Crossref | GoogleScholarGoogle Scholar | 26556813PubMed |
[22] Weber F, Knopf H. Incidental findings in magnetic resonance imaging of the brains of healthy young men. J Neurol Sci. 2006; 240 81–4.
| Incidental findings in magnetic resonance imaging of the brains of healthy young men.Crossref | GoogleScholarGoogle Scholar | 16256141PubMed |
[23] Dyet LE, Kennea N, Counsell SJ, et al. Natural history of brain lesions in extremely preterm infants studied with serial magnetic resonance imaging from birth and neurodevelopmental assessment. Pediatrics. 2006; 118 536–48.
| Natural history of brain lesions in extremely preterm infants studied with serial magnetic resonance imaging from birth and neurodevelopmental assessment.Crossref | GoogleScholarGoogle Scholar | 16882805PubMed |
[24] Skiöld B, Horsch S, Hallberg B, et al. White matter changes in extremely preterm infants, a population-based diffusion tensor imaging study. Acta Paediatr. 2010; 99 842–9.
| White matter changes in extremely preterm infants, a population-based diffusion tensor imaging study.Crossref | GoogleScholarGoogle Scholar | 20132144PubMed |
[25] Broström L, Bolk J, Padilla N, et al. Clinical implications of diffuse excessive high signal intensity (DEHSI) on neonatal MRI in school age children born extremely preterm. PLoS One 2016; 11 e0149578
| Clinical implications of diffuse excessive high signal intensity (DEHSI) on neonatal MRI in school age children born extremely preterm.Crossref | GoogleScholarGoogle Scholar | 26886451PubMed |
[26] Denny S, Farrant B, Cosgriff J, et al. Forgone health care among secondary school students in New Zealand. J Prim Health Care. 2013; 5 11–8.
| Forgone health care among secondary school students in New Zealand.Crossref | GoogleScholarGoogle Scholar | 23457690PubMed |
[27] Hargreaves DS, Greaves F, Levay C, et al. Comparison of health care experience and access between young and older adults in 11 high-income countries. J Adolesc Health. 2015; 57 413–20.
| Comparison of health care experience and access between young and older adults in 11 high-income countries.Crossref | GoogleScholarGoogle Scholar | 26205758PubMed |
[28] Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev. 2012; 10 CD009009
| 23076952PubMed |
