Severe neonatal complications and long-term health-related quality of life in very preterm and/or very low birth weight survivors: evidence from the Dutch Project on preterm and small for gestational age cohort

Background: Understanding the impact of severe neonatal complications such as Bronchopulmonary Dysplasia (BPD), Intraventricular Hemorrhage (IVH), or Necrotizing Enterocolitis (NEC) on adult health-related quality of life (HRQoL) beyond the effect of prematurity itself is significant for health economic evaluation and policy. Objective: Analyze the independent associations of BPD, IVH, NEC and multiple birth status with preference-based HRQoL utility scores in adulthood for survivors in the Dutch Project on Preterm and Small-for-gestational-age infants (POPS) a national cohort born in 1983. Methods: Exposures were documented neonatal BPD, severe IVH (grades 3–4), NEC, and multiple birth status. HRQoL data were available for n = 644 (19 y), n = 314 (28 y), and n = 370 (35 y). Using multivariable linear regression adjusted for confounders, we assessed the association between each exposure and HRQoL utility scores and optimal functioning. Analyses incorporated inverse probability weighting to adjust for potential attrition bias. We conducted comprehensive sensitivity analyses including best-case/worst-case imputation scenarios, comparison of IPW-weighted versus unweighted estimates, and post-hoc power calculations. Results: After adjustment for confounders, severe IVH (grade 3/4) was the only neonatal complication independently associated with significant and persistent decrements in overall preference-based HRQoL, with utility score reductions at 19 years (HUI3: β = − 0.08, p = 0.05), 28 years (HUI3: β = − 0.13, p = 0.01), and 35 years (SF-6D: β = − 0.07, p = 0.04). These findings were robust to IPW adjustment for attrition (all |∆β| < 0.02) and fell within plausible bounds established by best-case/worst-case sensitivity analyses. Conclusion: Severe IVH was associated with significant and clinically meaningful utility decrements that persisted into the fourth decade of life.