A large study is being conducted into the long-term consequences of premature birth
Every year about 7 percent of babies in the Netherlands are born prematurely, worldwide that is even 10 percent. November 17, 2022 was all about these children, then it’s World Prematurity Day. TNO has been using the POPS study since 1983 to research the development and health of almost all children born prematurely in the Netherlands that year. Radboudumc is participating in this research and is looking in particular at the consequences of premature birth on the kidneys. Together with TNO and Care4Neo, pediatric nephrologist Michiel Schreuder emphasizes the importance of continuing to monitor these children and adults.
The POPS cohort includes 1,336 people who were born in 1983 with a gestational age of less than 32 weeks and/or a birth weight below 1500 grams. That is 94% of all babies born very prematurely or with a very low birth weight in the Netherlands in 1983. Over the years, the cohort has provided a great deal of information about the short- and long-term consequences for these now almost 40-year-olds. Nowhere in the world has a nationwide cohort of this size been followed and extensively studied for such a long period of time.
Continuation of the POPS study
The last physical examination took place in 2001, when the premature babies were 19 years old. Then TNO, together with various academic hospitals, investigated the medical, psychosocial and social functioning of the POPS participants. At the age of 28 and 35, the group was surveyed online with questionnaires. The outcomes in the areas of quality of life, life course, relationships and pregnancies were examined.
TNO researcher Sylvia van der Pal: ‘We would like to follow up on this, ideally with an extensive physical examination. The fact that participants in the POPS cohort are now almost 40 years old and are in a new phase of life is a good time for a next measurement. In addition, the study results from 19, 28 and 35 years after birth indicate that it is important to monitor the long-term consequences of preterm birth.’
Importance of long-term tracking
Michiel Schreuder is Professor of Pediatric Nephrology at the Radboudumc Amalia Children’s Hospital. He says: ‘Premature birth is actually a living experiment. We do save these young and small children, but it is also important to know what that means for their future and how you can prevent any problems. By the age of 19, 50% have elevated blood pressure. That may not lead to problems at that age, but there is a good chance that it will at a later age. You don’t expect kidney damage at that age, that takes time. You may already see damage in the over-40s, but it may not show up until later. The fact is that with an unhealthy predisposition of the kidneys, the risk of damage later in life is greater. The same applies to diabetes and lung damage, for example. It is important to look for complaints that occur in this group throughout life, so that we can take preventive action against them. In this way, not only this group, but also children who are now born prematurely benefit from the knowledge that the POPS cohort provides.’
According to Schreuder, one problem is that premature birth is already receiving attention in paediatrics, but as soon as the transition to adult care is made at the age of 18, the impact of premature birth fades into the background. “Now only the most vulnerable preterm children are followed up to the age of 8, but puberty has yet to come at that point. It would therefore be great if we could use a new POPS study to show what causes preterm birth in adults,” says Schreuder.
More knowledge about kidneys, brain and lungs
It is currently being examined whether and how a follow-up to the POPS study can be given. Van der Pal: ‘We are now mapping out what we want to look at. We are also looking for researchers who are interested in this cohort based on their expertise and who want to participate in a new measurement. It would be great if we could examine the preterm adults for a number of additional things compared to the measurement at 19 years. In any case, the participants from the cohort are enthusiastic, I often receive emails asking whether there will be another round.’
‘I am hopeful that some of the people who have not participated online the last two times will now want to do so when it comes to a physical examination. How wonderful it is that research is being done in many areas, including: brain development, kidney damage, blood pressure, insulin, heart and blood vessels, body composition, lung problems, pregnancy problems and fertility and psychosocial themes. There is a need for clarity on many aspects, among scientists, doctors, but also premature children and their parents,” thinks Schreuder.
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