Perception of quality of life in school-age children born before 32 weeks of gestational age 

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Objective: To assess the impact of BPD on perceived quality of life in preterm infants at school age. Methods : We conducted a prospective observational study of infants less than 32 weeks' gestation admitted to our neonatal unit between January 2012 and December 2014. Quality of life was assessed at school age using the Pediatric Quality of Life (PedsQL) questionnaire, with higher scores indicating poorer quality of life. Results: The study included 102 patients with a mean gestational age of 29.42 weeks (SD 1.87) and a mean birth weight of 1221.36 g (SD 347.25), with an average age of 8.59 years (SD 0.90) at the time of the survey. Patients with BPD 2-3 exhibited a significantly poorer perception of “total quality of life” (p=0.03) and in the “social activities” domain (p=0.02) compared to those without BPD or with BPD 1; even after adjusting for gestational age in a multivariate model. No significant differences were observed for “health & activities” domain (p=0.31), “emotional state” domain (p=0.58), or “school activities” domain (p=0.33). No significant differences were found between patients without a diagnosis of BPD and those with grade 1 BPD. Similarly, no significant differences were observed when comparing patients of less than 28 weeks' gestational age and more than 28 weeks of gestational age. Conclusion : In our study of preterm infants, those diagnosed with grade 2-3 BPD exhibited lower perceived quality of life compared to preterm infants without BPD or with grade 1 BPD. No differences in quality of life were observed between patients without BPD diagnosis and those with grade 1 BPD. No significant differences in QoL were found between infants born before and after 28 weeks' gestation. Bronchopulmonary Dysplasia prematurity quality of life Figures Figure 1 Figure 2 INTRODUCTION While survival rates of extremely preterm infants have significantly increased in recent years, respiratory morbidity remains prevalent among the most immature neonates ( 1 – 3 ). Bronchopulmonary dysplasia (BPD) is the most common respiratory consequence of prematurity. Its prevalence rises with decreasing gestational age, with up to 50% of infants born before 28 weeks' gestation with grade 2–3 BPD ( 4 ). These patients exhibit a heightened risk of asthma and impaired pulmonary function tests ( 5 – 7 ). However, the impact of this condition on their quality of life (QoL) remains elusive and subject to debate. BPD infants have an increased risk to hospital readmission after discharge compared to the general population, particularly in the first two years of life. In addition, their ongoing management requires multidisciplinary follow-up, resulting in frequent hospital visits ( 8 , 9 ). The increased frequency of hospital admissions, emergency department visits, outpatient follow-up appointments, and missed school days can have a significant impact on the quality of life of both caregivers and patients ( 10 ). Some authors suggest that these circumstances may contribute to a decline in the physical and psychological well-being of those affected by BPD, potentially impacting not only their school years but also extending into adulthood ( 11 )( 12 ). However, other authors have found no significant differences in the quality of life of young people with BPD compared with healthy volunteer controls ( 13 , 14 ). Furthermore, with advances in perinatal and neonatal care over the last decades, the pathophysiology and progression of BPD has evolved, leading to uncertainties regarding the impact on the quality of life of individuals affected by the so-called "new bronchopulmonary dysplasia" ( 3 , 8 , 15 ). While some studies suggest a potential improvement in quality of life (QoL) over time, the variability in findings highlights the need for further research to provide a robust basis for guiding interventions and improving QoL in this vulnerable population. Therefore, the aim of this study was to assess the impact of a diagnosis of BPD on perceptions of QoL at school age in our cohort of preterm infants MATERIAL AND METHODS Study Design and Subjects A single-center prospective observational study including all infants of less than 32 weeks’ gestational age admitted to our Neonatal Care Unit between January 2012 and December 2014 was conducted. Data were collected from medical records and follow-up visits. Exclusion criteria included patients who died during the neonatal period or prior to the study commencement, those lost to follow-up or with unavailability for contact, and patients whose family members declined to provide informed consent. The following prenatal data were collected: gestational age, defined in weeks and days since the last menstrual period or, if this was not known, it was estimated from the first trimester ultrasound; birth weight, in g; sex; presence of chorioamnionitis; intrauterine growth restriction (IUGR) and prenatal corticosteroid administration. As postnatal variables, the need for delivery room ventilation, surfactant administration, use of invasive mechanical ventilation (IMV) and high frequency oscillatory ventilation (HFOV), presence and grade of BPD (defined according to the NIH consensus definition (15); supplemental oxygen required for at least 28 days, defined as grade 1 [breathing room air at 36 weeks PMA or discharge], grade 2 (need for <30% oxygen at 36 weeks PMA or discharge), or grade 3 (need for ≥30% oxygen and/or positive pressure at 36 weeks PMA or discharge), periventricular leukomalacia/stage 3 intraventricular hemorrhage or in association with intraparenchymal hemorrhage (PVLM/IVH) according to the modified Papile’s classification (16), necrotizing enterocolitis (NEC), late-onset sepsis (LOS), and patent ductus arteriosus (PDA) were collected. Quality of life analysis The Pediatric Quality of Life Questionnaire (PedsQL) was completed by the children who participated in the study to evaluate their quality of life. This questionnaire was developed by the Children's Hospital and Health Center in San Diego, California. It was designed to assess health-related quality of life (HRQoL) in children and adolescents aged 2 to 18 years. In this study, the scale for children aged 8-12 years was used to assess their perceived quality of life (17). The PedsQL 4.0 questionnaire consists of 23 items covering four domains: 1) “health & activities” (8 items), 2) “emotional state” (5 items), 3) “social activities” (5 items) and 4) “school activities” (5 items). These scales have been carefully developed through focus groups and cognitive interviews (18). The items are scored on a scale from 0 to 4, where 0 indicated never and 4 almost always, with a higher number indicating a poorer perceived quality of life. In order to summarize the results in this study, the items were grouped according to domains (“health & activities”, “emotional state”, “social activities” and “school activities”) and simplified by adding them to a “total quality of life”. Statistical analysis Descriptive analysis was performed using absolute frequencies and percentages for the analysis of qualitative variables and means with standard deviation or medians with interquartile range for quantitative variables, depending on the symmetry of the distributions. Proportions were compared using Pearson's χ2 test and Fisher's exact test, where appropriate, and quantitative variables were compared using Student's t-test for normal distributions and Mann-Whitney U test for non-normal distributions. Multivariate analysis was performed using logistic regression or multiple linear regression, as appropriate. Statistical significance was set at p < 0.05. The Statistical Package for the Social Sciences (SPSS, version 25) was used. RESULTS A total of 102 patients were enrolled in the study (Fig. 1 ), with 60 (58%) being male. Among the participants, 42.3% (44 patients) were diagnosed with BPD (all grades 1, 2 and 3), with 17 (16.6%) patients classified with BPD 2–3. The mean gestational age of the total sample was 29.42 weeks (SD 1.87), with those in the no BPD/BPD 1 group having a mean gestational age of 29.61 weeks (SD 1.80) and those in the BPD 2–3 group having a mean gestational age of 28.48 weeks (SD 2.00) (p = 0.02). Baseline characteristics of the total sample and subgroups based on BPD diagnosis are presented in Table 1 . At the time of the questionnaire, the mean age of the patients was 8.59 years (SD 0.90). No significant differences were observed between patients without and with BPD (all grades 1, 2 and 3) in the total perception of quality of life (p = 0.53) or across the four domains: “health & activities” (p = 0.52), “emotional state” (p = 0.34), “social activities” (p = 0.11), and “school activities” (p = 0.91) (Table 3 ). However, patients with BPD 2–3 exhibited a significantly poorer perception of “total quality of life” (p = 0.03) and in the “social activities” domain (p = 0.02) compared to those without BPD or with BPD 1, with no differences noted in “health & activities” domain (p = 0.31), “emotional state” domain (p = 0.58), or “school activities” domain (p = 0.33) (Fig. 2 , Table 2 ). This effect persisted after adjusting for gestational age in the multivariate model (Table 2 ). No statistically significant differences were found between patients without a diagnosis of BPD and those with grade 1 BPD (Table 3 ). Similarly, there were no statistically significant variations in quality of life between those of less or more than 28 weeks gestational age (Table 4 ). Further analysis of perinatal factors potentially influencing quality of life at school age revealed a poorer perception of quality of life (as indicated by higher scores) with increased hours of mechanical ventilation, adjusted for the degree of BPD. However, no significant associations were observed between other perinatal factors such as gestational age, low birth weight, necrotizing enterocolitis, patent ductus arteriosus, periventricular leukomalacia, stage 3 or higher intraventricular hemorrhage, late-onset sepsis, and quality of life perception at school age, adjusted for the degree of BPD (Table 5 ). DISCUSSION This study highlights the importance of assessing quality of life in preterm patients with BPD, particularly those with grade 2–3, as they have a worse perception of quality of life at school age. Despite recent advancements in the survival rates of extremely preterm infants, the prevalence of respiratory sequel, particularly BPD, remains high ( 1 , 2 ). Prior research indicates that patients diagnosed with BPD are at an increased risk of asthma and pulmonary function abnormalities compared to those without BPD ( 5 , 19 – 22 ). However, there is no established consensus on the impact of this condition on quality of life. The present study used the Pediatric Quality of Life Questionnaire (PedsQL) to evaluate the QoL of preterm infants during school age, focusing on four domains: “health & activities”, “emotional state”, “social activities”, and “school activities”. Patients with BPD 2–3 exhibited a significantly poorer perception of the “total quality of life” (p = 0.03) and in the “social activities” domain (p = 0.02) compared to those without BPD or with BPD 1, even after adjusting for gestational age in a multivariate model. In our sample of patients with BPD, the scores were higher (indicating poorer quality of life) than those reported in the study by W. Varni et al. ( 17 ), where the questionnaire was completed by healthy children. Lee et al. conducted a systematic review in 2023 to analyze the impact of BPD on quality of life from three perspectives: caregivers' quality of life, caregivers' perception of patients' quality of life, and BPD patients' self-reported quality of life. The results highlighted difficulties experienced by patients and carers, including sleep problems and acute care needs, which negatively affected quality of life, particularly in the immediate post-discharge period. In this study, patients with BPD demonstrated physical QoL similar to preterm infants without BPD in late childhood and early adulthood ( 12 ). Additionally, Sudhir Sriram et al. and Wook Kim, S. et al. reported that patients without BPD had better perceived QoL than those with BPD ( 23 , 24 ). In our study population, no significant differences were observed in the "health & activities" domains, suggesting effective control and management of respiratory pathology during follow-up. However, significant disparities were found in the "social activities" domain, potentially related to findings described by Della Longa L et al. ( 25 ), who noted that preterm infants have difficulties recognizing facial emotions, which may impact their social skills. In light of these findings, it may be worth considering referring patients with BPD to psychological services to enhance their social skills, as research suggests that simple interventions can result in clinical improvement ( 26 ). However, other authors have not found differences in quality of life in patients with BPD. Beaudoin et al found similar health-related quality of life and respiratory symptoms when comparing patients with a history of prematurity and bronchopulmonary dysplasia with healthy term controls, despite the fact that the former required greater use of health services and prescription drugs ( 27 ). Other authors also report no significant differences in quality of life between patients with BPD and healthy controls ( 14 ), and even find lower rates of depression, fatigue and pain in the BPD group ( 13 ). In our study, we observed no significant differences in QoL between patients without BPD and those with grade I BPD, nor between those born before and after 28 weeks' gestation. This suggests that the presence of grade 2–3 BPD has a more substantial impact on perceived QoL than gestational age. The association between prematurity and altered QoL remains contentious, with some studies indicating a diminished perception of QoL in preterm infants compared to term infants, ( 28 , 29 ), while others show no such correlation ( 30 – 32 ). Our findings align with previous research by Wook Kim, S. et al., who noted worse QoL perceptions in infants born before 26 weeks' gestational age but found that this effect disappeared when adjusted for BPD and other comorbidities ( 23 ). Zwiker et al. found a decreasing effect of prematurity/very low birth weight on health-related quality of life over time, but the heterogeneous nature of the studies limits definitive conclusions ( 33 ). Additionally, among other perinatal factors considered, only the duration of invasive mechanical ventilation increased the risk of poorer QoL (adjusted for BPD). In line with our sample, other studies using the PedsQL scale have also found no association between low birth weight for gestational age and quality of life ( 34 ). As for other perinatal factors, there is currently no clear evidence that they are associated with changes in perceived quality of life. Several limitations need to be acknowledged in our study. Firstly, we were unable to include a control group of healthy term infants due to challenges in adequately monitoring them. Additionally, as this was a single-center study, the generalizability of our results to other populations may be limited. Another significant limitation is the inability to include all preterm infants born during the study due to the extended follow-up period and loss to follow-up of several patients, which may introduce bias as healthier patients might have been more likely to maintain follow-up. In conclusion, this study highlights the importance of assessing quality of life in preterm patients with BPD, particularly in those with grade BPD 2–3. The findings suggest that the presence of BPD 2–3, significantly impacts their perception of quality of life, particularly in aspects related to “social activities”. These results underscore the necessity for long-term follow-up, not only for the detection and treatment of medical issues but also for intervention in areas affecting quality of life. Moreover, given the lack of consensus in the literature and the variability in results, further research is crucial to guide specific interventions aimed at enhancing the well-being of this vulnerable population throughout their development. CONCLUSION Preterm infants diagnosed with grade 2-3 bronchopulmonary dysplasia have a worse perception of quality of life than preterm infants without BPD or with grade 1 BPD, regardless of gestational age. No differences were observed in the quality of life between patients without a diagnosis of BPD and those with grade 1 BPD. Additionally, there were no significant differences in quality of life between infants born before and after 28 weeks' gestation. Declarations Author Contribution A.M.-H.: conceptualization, data curation, investigation, software, validation,writing original draft, and writing review and editing.A.M.-C.: data curation and writing review and editing.C.R.-N.: data curation and writing review and editing.S.B.-A.: writing—review and editing.JL.R.-C.: writing—review and editing.N.G.-P.: writing—review and editing. M.S.-L.: conceptualization and writing—review and editing. Ethics approval This study was approved by the Ethics Committee of the Gregorio Marañon Hospital (ref. FXPULMPREM) and conducted in accordance with the Declaration of Helsinki. Funding Declaration This research received no external funding. 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Characteristics of the sample No BPD/ 1 (n=85) BPD 2-3 (n=17) Total (n=102) p GA* 29,61 (1,80) 28,48 (2,00) 29,42 (1,87) 0,02 Weight 1276,20 (335,09) 947,18 (275,37) 1221,36 (347,25) <0,01 SGA* 10 (12%) 4 (24%) 14 (14%) 0,19 Sex, % male 51 (60%) 9 (53%) 60 (59%) 0,59 Antenatal corticosteroids 66 (78%) 11 (65%) 77 (75%) 0,25 Chorioamnionitis 18 (21%) 4 (24%) 22 (22%) 0,83 NIPPV/IPPV* at delivery room 45 (53%) 16 (95%) 42 (60%) <0,01 Surfactant administration 37 (44%) 13 (76%) 50 (49%) 0,01 Postnatal corticosteroids 0 (0%) 1 (6%) 1 (1%) 0,03 IMV* 34 (40%) 15 (89%) 49 (48%) <0,01 HFOV* 10 (12%) 7 (42%) 17 (17%) <0,01 IMV Hours* 45,75 (128,22) 299,15 (347,15) 87,98 (204,37) <0,01 NEC* 2 (1%) 1 (6%) 3 (3%) 0,43 PVLM/IVH * 3 (4%) 6 (35%) 9 (9%) <0,01 PDA* 16 (19%) 8 (47%) 24 (24%) 0,01 LOS * 43 (51%) 14 (82%) 57 (56%) 0,02 No BPD/ 1: Patients without BPD and BPD grade 1 BPD 2-3: Patients with BPD grades 2 and 3 *Data are expressed as mean (standard deviation) and n (%) *Comparison of means (Student's test); Comparison of proportions (chi-squared test) *GA: gestational age; SGA: small for gestational age; NIPPV: noninvasive positive pressure ventilation IPPV: invasive positive pressure ventilation; IMV: invasive mechanical ventilation; HFOV: high-frequency oscillatory ventilation; NEC: necrotizing enterocolitis (> Grade 2 Bell); PVLM/IVH: periventricular leukomalacia/stage 3 intraventricular hemorrhage or in association with intraparenchymal hemorrhage; PDA: patent ductus arteriosus; LOS: late-onset sepsis. Table 2. Comparison of quality of life between patients with no BPD/1 and patients with grade 2-3 BPD No BPD/ 1 (n=85) BPD 2-3 (n=17) p B Standard Error p Health & activities 4,14 (4,75) 5,47 (5,88) 0,31 1,37 1,36 0,32 Emotional state 5,98 (3,86) 6,53 (3,22) 0,58 0,97 1,01 0,34 Social activities 2,52 (2,85) 4,41 (3,41) <0,01 1,74 0,80 0,03 School activities 4,86 (3,87) 6,18 (5,15) 0,33 1,34 1,12 0,23 Total QOL* 17,49 (12,31) 24,94 (17,85) 0,03 7,98 3,65 0,03 *Variables are described as mean (standard deviation) *Comparison of means with Student's T *Multiple linear regression (adjusted for BPD) *Total QOL: “total quality of life” Table 3. Comparison of quality of life between patients without BPD and patients with grade 1 BPD No BPD (58) BPD 1 (27) p No DBP (n=58) DBP 1-2-3 (n=44) p Health & activities 4,09 (5,11) 4,26 (3.96) 0,87 4,09 (5,11) 4,73 (4,76) 0,52 Emotional state 6,38 (3,77) 5,11 (3,99) 0,16 6,38 (3,77) 5,66 (3,74) 0,34 Social activities 2,41 (2,59) 2,74 (3,38) 0,62 2,42 (2,59) 3,39 (3,45) 0,11 School activities 5,12 (4,11) 4,30 (3,28) 0,36 5,12 (4,11) 5,02 (4,15) 0,91 Total QOL* 18,00 (12,79) 16,41 (11,36) 0,58 18,00 (12,79) 19,70 (14,64) 0,53 *Variables are described as mean (standard deviation) *Comparison of means with Student's T *Total QOL: “total quality of life” Table 4. Comparison of quality of life between patients with less and more than 28 weeks of gestational age 28 weeks (n=82) p Health & activities 4,25 (5,18) 4,39 (4,92) 0,91 Emotional state 4,60 (3,62) 6,43 (3,72) 0,05 Social activities 3,05 (3,2) 2,78 (2,99) 0,72 School activities 5,10 (4,62) 5,07 (4,01) 0,98 Total QOL* 17,00 (14,94) 19,16 (13,29) 0,53 *Variables are described as mean (standard deviation) *Comparison of means with Student's T Table 5. Multiple linear regression: Perinatal factors influencing “total quality of life” adjusted for BPD F R 2 B Standard Error p GA* 2,40 0,046 0,47 0,73 0,52 Weight 2,34 0,045 0,002 0,01 0,58 SGA* 2,23 0,043 1,20 3,89 0,76 Chorioamnionitis 2,20 0,043 -0,62 3,23 0,85 NIPPV/IPPV* at delivery room 2,18 0,042 0,17 2,85 0,95 Surfactant administration 2,66 0,051 2,61 2,73 0,34 Postnatal corticosteroids 2,26 0,044 -5,25 13,82 0,70 Hours of IMV 4,37 0,081 0,015 0,01 0,04 HFOV* 2,27 0,044 1,51 3,73 0,69 NEC* 2,41 0,046 -5,16 7,87 0,51 PVLM/IVH* 2,39 0,046 -3,27 5,14 0,53 PDA* 2,20 0,043 -0,61 3,23 0,85 LOS* 2,20 0,043 0,53 3,67 0,85 *Multiple linear regression (adjusted for BPD) *GA: gestational age; SGA: small for gestational age; NIPPV: noninvasive positive pressure ventilation IPPV: invasive positive pressure ventilation; IMV: invasive mechanical ventilation; HFOV: high-frequency oscillatory ventilation; NEC: necrotizing enterocolitis (> Grade 2 Bell); PVLM/IVH: periventricular leukomalacia/stage 3 intraventricular hemorrhage or in association with intraparenchymal hemorrhage; PDA: patent ductus arteriosus; LOS: late-onset sepsis. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Nov, 2024 Read the published version in European Journal of Pediatrics → Version 1 posted Editorial decision: Revision requested 28 Oct, 2024 Reviews received at journal 22 Oct, 2024 Reviewers agreed at journal 13 Oct, 2024 Reviewers invited by journal 23 May, 2024 Editor assigned by journal 20 May, 2024 Submission checks completed at journal 20 May, 2024 First submitted to journal 13 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4412567","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":307834674,"identity":"8cc15552-b806-4aa7-a954-773543d1c0c2","order_by":0,"name":"Amaia Merino-Hernández","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYJCCA2CSGYgTKkAM5gYStDw4A2IwEtYCB4wP28AUfi380w4/PPCDYZuceTvvwQeJ82qj+duBWn5UbMOpReJ2msHBHobbxjKH+ZINErcdz51xmLGBsefMbdzW3E4wOMDDcDtxBjOPmUTitmO5DUAtzIxtuLXI307/cPAPw+16iJY5x3LnE9JicDvH4DDQlgQJsJaGmtwNhLQY3s4pOCxjcNsQaIuxQcKxA7kbgVoO4vOL3O30zR/fVNyWl+A/Y/jwR01d7rzzhw8++FGBx/sQ58FZh8HkAQLqUUAdKYpHwSgYBaNghAAAUAJcZ80J6goAAAAASUVORK5CYII=","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":true,"prefix":"","firstName":"Amaia","middleName":"","lastName":"Merino-Hernández","suffix":""},{"id":307834677,"identity":"202863c9-f03e-4df4-97b7-18467e0faa2d","order_by":1,"name":"Agustin Muñoz-Cutillas","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Agustin","middleName":"","lastName":"Muñoz-Cutillas","suffix":""},{"id":307834678,"identity":"2223339d-bafd-4f2b-ac65-2c07e648fb11","order_by":2,"name":"Cristina Ramos-Navarro","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Cristina","middleName":"","lastName":"Ramos-Navarro","suffix":""},{"id":307834680,"identity":"b1b1ed12-58f9-4fc0-84b6-3dc9a2d71fb8","order_by":3,"name":"Sara Bellón-Alonso","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Sara","middleName":"","lastName":"Bellón-Alonso","suffix":""},{"id":307834681,"identity":"451d9c72-bb08-4556-865f-10e97c9baad1","order_by":4,"name":"Juan Luis Rodríguez-Cimadevilla","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Luis","lastName":"Rodríguez-Cimadevilla","suffix":""},{"id":307834682,"identity":"c021f3c2-b1cf-417b-bdac-88bc50c7c750","order_by":5,"name":"Noelia González-Pacheco","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Noelia","middleName":"","lastName":"González-Pacheco","suffix":""},{"id":307834683,"identity":"86e1b159-8d3e-44dd-9587-f466704be9f1","order_by":6,"name":"Manuel Sánchez-Luna","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Manuel","middleName":"","lastName":"Sánchez-Luna","suffix":""}],"badges":[],"createdAt":"2024-05-13 10:21:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4412567/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4412567/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00431-024-05882-z","type":"published","date":"2024-11-28T15:57:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57722545,"identity":"f4831d8b-690b-44e1-a8a4-c6043ae46ba5","added_by":"auto","created_at":"2024-06-04 19:09:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":81947,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chart - Recruitment of preterm infants for follow-up\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4412567/v1/729a55fcf99324eb1478a268.png"},{"id":57722547,"identity":"e674c3d2-8191-4ba2-a039-aa7df273dee1","added_by":"auto","created_at":"2024-06-04 19:09:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":56096,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eQuality of life according to the different ITEMS\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4412567/v1/e8ff16c3807a5219557490fe.png"},{"id":70382629,"identity":"b5717989-58fa-4b56-8b0f-dc8edb70ec08","added_by":"auto","created_at":"2024-12-02 16:28:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":908235,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4412567/v1/b33c9a25-e81b-4329-a548-80ea38558b39.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perception of quality of life in school-age children born before 32 weeks of gestational age ","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eWhile survival rates of extremely preterm infants have significantly increased in recent years, respiratory morbidity remains prevalent among the most immature neonates (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBronchopulmonary dysplasia (BPD) is the most common respiratory consequence of prematurity. Its prevalence rises with decreasing gestational age, with up to 50% of infants born before 28 weeks' gestation with grade 2\u0026ndash;3 BPD (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These patients exhibit a heightened risk of asthma and impaired pulmonary function tests (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, the impact of this condition on their quality of life (QoL) remains elusive and subject to debate.\u003c/p\u003e \u003cp\u003eBPD infants have an increased risk to hospital readmission after discharge compared to the general population, particularly in the first two years of life. In addition, their ongoing management requires multidisciplinary follow-up, resulting in frequent hospital visits (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe increased frequency of hospital admissions, emergency department visits, outpatient follow-up appointments, and missed school days can have a significant impact on the quality of life of both caregivers and patients (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Some authors suggest that these circumstances may contribute to a decline in the physical and psychological well-being of those affected by BPD, potentially impacting not only their school years but also extending into adulthood (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, other authors have found no significant differences in the quality of life of young people with BPD compared with healthy volunteer controls (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, with advances in perinatal and neonatal care over the last decades, the pathophysiology and progression of BPD has evolved, leading to uncertainties regarding the impact on the quality of life of individuals affected by the so-called \"new bronchopulmonary dysplasia\" (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile some studies suggest a potential improvement in quality of life (QoL) over time, the variability in findings highlights the need for further research to provide a robust basis for guiding interventions and improving QoL in this vulnerable population. Therefore, the aim of this study was to assess the impact of a diagnosis of BPD on perceptions of QoL at school age in our cohort of preterm infants\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA single-center prospective observational study including all infants of less than 32 weeks\u0026rsquo; gestational age admitted to our Neonatal Care Unit between January 2012 and December 2014 was conducted. Data were collected from medical records and follow-up visits.\u003c/p\u003e\n\u003cp\u003eExclusion criteria included patients who died during the neonatal period or prior to the study commencement, those lost to follow-up or with unavailability for contact, and patients whose family members declined to provide informed consent. The following prenatal data were collected: gestational age, defined in weeks and days since the last menstrual period or, if this was not known, it was estimated from the first trimester ultrasound; birth weight, in g; sex; presence of chorioamnionitis; intrauterine growth restriction (IUGR) and prenatal corticosteroid administration. As postnatal variables, the need for delivery room ventilation, surfactant administration, use of invasive mechanical ventilation (IMV) and high frequency oscillatory ventilation (HFOV), presence and grade of BPD (defined according to the NIH consensus definition (15); \u0026nbsp;supplemental oxygen required for at least 28 days, defined as grade 1 [breathing room air at 36 weeks PMA or discharge], grade 2 (need for \u0026lt;30% oxygen at 36 weeks PMA or discharge), or grade 3 (need for \u0026ge;30% oxygen and/or positive pressure at 36 weeks PMA or discharge), periventricular leukomalacia/stage 3 intraventricular hemorrhage or in association with intraparenchymal hemorrhage (PVLM/IVH) according to the modified Papile\u0026rsquo;s classification (16), \u0026nbsp;necrotizing enterocolitis (NEC), late-onset sepsis (LOS), and patent ductus arteriosus (PDA) were collected.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuality of life analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Pediatric Quality of Life Questionnaire (PedsQL) was completed by the children who participated in the study to evaluate their quality of life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis questionnaire was developed by the Children\u0026apos;s Hospital and Health Center in San Diego, California. It was designed to assess health-related quality of life (HRQoL) in children and adolescents aged 2 to 18 years. In this study, the scale for children aged 8-12 years was used to assess their perceived quality of life (17).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe PedsQL 4.0 questionnaire consists of 23 items covering four domains: 1) \u0026ldquo;health \u0026amp; activities\u0026rdquo; (8 items), 2) \u0026ldquo;emotional state\u0026rdquo; (5 items), 3) \u0026ldquo;social activities\u0026rdquo; (5 items) and 4) \u0026ldquo;school activities\u0026rdquo; (5 items). These scales have been carefully developed through focus groups and cognitive interviews \u0026nbsp;(18). The items are scored on a scale from 0 to 4, where 0 indicated never and 4 almost always, with a higher number indicating a poorer perceived quality of life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn order to summarize the results in this study, the items were grouped according to domains (\u0026ldquo;health \u0026amp; activities\u0026rdquo;, \u0026ldquo;emotional state\u0026rdquo;, \u0026ldquo;social activities\u0026rdquo; and \u0026ldquo;school activities\u0026rdquo;) and simplified by adding them to a \u0026ldquo;total quality of life\u0026rdquo;.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive analysis was performed using absolute frequencies and percentages for the analysis of qualitative variables and means with standard deviation or medians with interquartile range for quantitative variables, depending on the symmetry of the distributions.\u003c/p\u003e\n\u003cp\u003eProportions were compared using Pearson\u0026apos;s \u0026chi;2 test and Fisher\u0026apos;s exact test, where appropriate, and quantitative variables were compared using Student\u0026apos;s t-test for normal distributions and Mann-Whitney U test for non-normal distributions. Multivariate analysis was performed using logistic regression or multiple linear regression, as appropriate. Statistical significance was set at p \u0026lt; 0.05. The Statistical Package for the Social Sciences (SPSS, version 25) was used.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 102 patients were enrolled in the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), with 60 (58%) being male. Among the participants, 42.3% (44 patients) were diagnosed with BPD (all grades 1, 2 and 3), with 17 (16.6%) patients classified with BPD 2\u0026ndash;3. The mean gestational age of the total sample was 29.42 weeks (SD 1.87), with those in the no BPD/BPD 1 group having a mean gestational age of 29.61 weeks (SD 1.80) and those in the BPD 2\u0026ndash;3 group having a mean gestational age of 28.48 weeks (SD 2.00) (p\u0026thinsp;=\u0026thinsp;0.02). Baseline characteristics of the total sample and subgroups based on BPD diagnosis are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAt the time of the questionnaire, the mean age of the patients was 8.59 years (SD 0.90). No significant differences were observed between patients without and with BPD (all grades 1, 2 and 3) in the total perception of quality of life (p\u0026thinsp;=\u0026thinsp;0.53) or across the four domains: \u0026ldquo;health \u0026amp; activities\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.52), \u0026ldquo;emotional state\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.34), \u0026ldquo;social activities\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.11), and \u0026ldquo;school activities\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.91) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, patients with BPD 2\u0026ndash;3 exhibited a significantly poorer perception of \u0026ldquo;total quality of life\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.03) and in the \u0026ldquo;social activities\u0026rdquo; domain (p\u0026thinsp;=\u0026thinsp;0.02) compared to those without BPD or with BPD 1, with no differences noted in \u0026ldquo;health \u0026amp; activities\u0026rdquo; domain (p\u0026thinsp;=\u0026thinsp;0.31), \u0026ldquo;emotional state\u0026rdquo; domain (p\u0026thinsp;=\u0026thinsp;0.58), or \u0026ldquo;school activities\u0026rdquo; domain (p\u0026thinsp;=\u0026thinsp;0.33) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This effect persisted after adjusting for gestational age in the multivariate model (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNo statistically significant differences were found between patients without a diagnosis of BPD and those with grade 1 BPD (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Similarly, there were no statistically significant variations in quality of life between those of less or more than 28 weeks gestational age (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurther analysis of perinatal factors potentially influencing quality of life at school age revealed a poorer perception of quality of life (as indicated by higher scores) with increased hours of mechanical ventilation, adjusted for the degree of BPD. However, no significant associations were observed between other perinatal factors such as gestational age, low birth weight, necrotizing enterocolitis, patent ductus arteriosus, periventricular leukomalacia, stage 3 or higher intraventricular hemorrhage, late-onset sepsis, and quality of life perception at school age, adjusted for the degree of BPD (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study highlights the importance of assessing quality of life in preterm patients with BPD, particularly those with grade 2\u0026ndash;3, as they have a worse perception of quality of life at school age.\u003c/p\u003e \u003cp\u003eDespite recent advancements in the survival rates of extremely preterm infants, the prevalence of respiratory sequel, particularly BPD, remains high (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Prior research indicates that patients diagnosed with BPD are at an increased risk of asthma and pulmonary function abnormalities compared to those without BPD (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). However, there is no established consensus on the impact of this condition on quality of life.\u003c/p\u003e \u003cp\u003eThe present study used the Pediatric Quality of Life Questionnaire (PedsQL) to evaluate the QoL of preterm infants during school age, focusing on four domains: \u0026ldquo;health \u0026amp; activities\u0026rdquo;, \u0026ldquo;emotional state\u0026rdquo;, \u0026ldquo;social activities\u0026rdquo;, and \u0026ldquo;school activities\u0026rdquo;. Patients with BPD 2\u0026ndash;3 exhibited a significantly poorer perception of the \u0026ldquo;total quality of life\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.03) and in the \u0026ldquo;social activities\u0026rdquo; domain (p\u0026thinsp;=\u0026thinsp;0.02) compared to those without BPD or with BPD 1, even after adjusting for gestational age in a multivariate model. In our sample of patients with BPD, the scores were higher (indicating poorer quality of life) than those reported in the study by W. Varni et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), where the questionnaire was completed by healthy children.\u003c/p\u003e \u003cp\u003eLee et al. conducted a systematic review in 2023 to analyze the impact of BPD on quality of life from three perspectives: caregivers' quality of life, caregivers' perception of patients' quality of life, and BPD patients' self-reported quality of life. The results highlighted difficulties experienced by patients and carers, including sleep problems and acute care needs, which negatively affected quality of life, particularly in the immediate post-discharge period. In this study, patients with BPD demonstrated physical QoL similar to preterm infants without BPD in late childhood and early adulthood (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Additionally, Sudhir Sriram et al. and Wook Kim, S. et al. reported that patients without BPD had better perceived QoL than those with BPD (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study population, no significant differences were observed in the \"health \u0026amp; activities\" domains, suggesting effective control and management of respiratory pathology during follow-up. However, significant disparities were found in the \"social activities\" domain, potentially related to findings described by Della Longa L et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), who noted that preterm infants have difficulties recognizing facial emotions, which may impact their social skills. In light of these findings, it may be worth considering referring patients with BPD to psychological services to enhance their social skills, as research suggests that simple interventions can result in clinical improvement (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, other authors have not found differences in quality of life in patients with BPD. Beaudoin et al found similar health-related quality of life and respiratory symptoms when comparing patients with a history of prematurity and bronchopulmonary dysplasia with healthy term controls, despite the fact that the former required greater use of health services and prescription drugs (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Other authors also report no significant differences in quality of life between patients with BPD and healthy controls (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), and even find lower rates of depression, fatigue and pain in the BPD group (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, we observed no significant differences in QoL between patients without BPD and those with grade I BPD, nor between those born before and after 28 weeks' gestation. This suggests that the presence of grade 2\u0026ndash;3 BPD has a more substantial impact on perceived QoL than gestational age. The association between prematurity and altered QoL remains contentious, with some studies indicating a diminished perception of QoL in preterm infants compared to term infants, (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), while others show no such correlation (\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Our findings align with previous research by Wook Kim, S. et al., who noted worse QoL perceptions in infants born before 26 weeks' gestational age but found that this effect disappeared when adjusted for BPD and other comorbidities (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Zwiker et al. found a decreasing effect of prematurity/very low birth weight on health-related quality of life over time, but the heterogeneous nature of the studies limits definitive conclusions (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, among other perinatal factors considered, only the duration of invasive mechanical ventilation increased the risk of poorer QoL (adjusted for BPD). In line with our sample, other studies using the PedsQL scale have also found no association between low birth weight for gestational age and quality of life (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). As for other perinatal factors, there is currently no clear evidence that they are associated with changes in perceived quality of life.\u003c/p\u003e \u003cp\u003eSeveral limitations need to be acknowledged in our study. Firstly, we were unable to include a control group of healthy term infants due to challenges in adequately monitoring them. Additionally, as this was a single-center study, the generalizability of our results to other populations may be limited. Another significant limitation is the inability to include all preterm infants born during the study due to the extended follow-up period and loss to follow-up of several patients, which may introduce bias as healthier patients might have been more likely to maintain follow-up.\u003c/p\u003e \u003cp\u003eIn conclusion, this study highlights the importance of assessing quality of life in preterm patients with BPD, particularly in those with grade BPD 2\u0026ndash;3. The findings suggest that the presence of BPD 2\u0026ndash;3, significantly impacts their perception of quality of life, particularly in aspects related to \u0026ldquo;social activities\u0026rdquo;. These results underscore the necessity for long-term follow-up, not only for the detection and treatment of medical issues but also for intervention in areas affecting quality of life. Moreover, given the lack of consensus in the literature and the variability in results, further research is crucial to guide specific interventions aimed at enhancing the well-being of this vulnerable population throughout their development.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003ePreterm infants diagnosed with grade 2-3 bronchopulmonary dysplasia have a worse perception of quality of life than preterm infants without BPD or with grade 1 BPD, regardless of gestational age. No differences were observed in the quality of life between patients without a diagnosis of BPD and those with grade 1 BPD. Additionally, there were no significant differences in quality of life between infants born before and after 28 weeks\u0026apos; gestation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.M.-H.: conceptualization, data curation, investigation, software, validation,writing original draft, and writing review and editing.A.M.-C.: data curation and writing review and editing.C.R.-N.: data curation and writing review and editing.S.B.-A.: writing\u0026mdash;review and editing.JL.R.-C.: writing\u0026mdash;review and editing.N.G.-P.: writing\u0026mdash;review and editing. M.S.-L.: conceptualization and writing\u0026mdash;review and editing.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Gregorio Mara\u0026ntilde;on Hospital (ref. FXPULMPREM) and conducted in accordance with the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSaigal S, Doyle LW (2008) An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet Lond Engl 19 de enero de 371(9608):261\u0026ndash;269\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eField DJ, Dorling JS, Manktelow BN, Draper ES Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994-9 compared with 2000-5. BMJ. 31 de mayo de 2008;336(7655):1221\u0026ndash;1223\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaju TNK, Pemberton VL, Saigal S, Blaisdell CJ, Moxey-Mims M, Buist S et al (2017) Long-Term Healthcare Outcomes of Preterm Birth: An Executive Summary of a Conference Sponsored by the National Institutes of Health. J Pediatr. febrero de. ;181:309\u0026ndash;318.e1\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S et al Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993\u0026ndash;2012. JAMA. 8 de septiembre de 2015;314(10):1039\u0026ndash;1051\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKotecha SJ, Edwards MO, Watkins WJ, Henderson AJ, Paranjothy S, Dunstan FD et al (2013) Effect of preterm birth on later FEV1: a systematic review and meta-analysis. Thorax agosto de 68(8):760\u0026ndash;766\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFawke J, Lum S, Kirkby J, Hennessy E, Marlow N, Rowell V et al Lung function and respiratory symptoms at 11 years in children born extremely preterm: the EPICure study. Am J Respir Crit Care Med. 15 de julio de 2010;182(2):237\u0026ndash;245\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVolls\u0026aelig;ter M, R\u0026oslash;ksund OD, Eide GE, Markestad T, Halvorsen T (2013) Lung function after preterm birth: development from mid-childhood to adulthood. Thorax agosto de 68(8):767\u0026ndash;776\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaggie S, Robinson P, Selvadurai H, Fitzgerald DA (2020) Bronchopulmonary dysplasia: A review of the pulmonary sequelae in the post-surfactant era. J Paediatr Child Health mayo de 56(5):680\u0026ndash;689\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYou JY, Shu C, Gong CH, Liu S, Fu Z (2017) [Readmission of children with bronchopulmonary dysplasia in the first 2 years of life: a clinical analysis of 121 cases]. Zhongguo Dang Dai Er Ke Za Zhi Chin J Contemp Pediatr octubre de 19(10):1056\u0026ndash;1060\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGrath-Morrow SA, Ryan T, Riekert K, Lefton-Greif MA, Eakin M, Collaco JM (2013) The impact of bronchopulmonary dysplasia on caregiver health related quality of life during the first 2 years of life. Pediatr Pulmonol junio de 48(6):579\u0026ndash;586\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoman TD, Nayak RP (2021) Short- and Long-Term Complications of Bronchopulmonary Dysplasia. Respir Care 1 de octubre de 66(10):1618\u0026ndash;1629\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee DMX, Tan AKS, Ng YPM, Amin Z (2023) Quality of life of patients and caregivers affected by bronchopulmonary dysplasia: a systematic review. Qual Life Res Int J Qual Life Asp Treat Care Rehabil julio de 32(7):1859\u0026ndash;1869\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSierra G, Liu JP, Ith I, Gudur D, Cunningham D, Dahlberg SE et al (2023) Health-Related Qualities of Life in School-Aged Children with Bronchopulmonary Dysplasia. J Pediatr octubre de 261:113548\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBozzetto S, Carraro S, Tomasi L, Berardi M, Zanconato S, Baraldi E (2016) Health-related quality of life in adolescent survivors of bronchopulmonary dysplasia. Respirol Carlton Vic agosto de 21(6):1113\u0026ndash;1117\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJobe AH, Bancalari E (2001) Bronchopulmonary dysplasia. Am J Respir Crit Care Med junio de 163(7):1723\u0026ndash;1729\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapile LA, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr abril de 92(4):529\u0026ndash;534\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVarni JW, Burwinkle TM, Seid M, Skarr D (2003) The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr Off J Ambul Pediatr Assoc 3(6):329\u0026ndash;341\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVarni JW, Sherman SA, Burwinkle TM, Dickinson PE, Dixon P (2004) The PedsQL\u0026trade; Family Impact Module: Preliminary reliability and validity. Health Qual Life Outcomes 27 de septiembre de 2(1):55\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRonkainen E, Dunder T, Peltoniemi O, Kaukola T, Marttila R, Hallman M (2015) New BPD predicts lung function at school age: Follow-up study and meta-analysis. Pediatr Pulmonol noviembre de 50(11):1090\u0026ndash;1098\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVom Hove M, Prenzel F, Uhlig HH, Robel-Tillig E (2014) Pulmonary outcome in former preterm, very low birth weight children with bronchopulmonary dysplasia: a case-control follow-up at school age. J Pediatr enero de 164(1):40\u0026ndash;45e4\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGibbons JTD, Course CW, Evans EE, Kotecha S, Kotecha SJ, Simpson SJ (2023) Increasing airway obstruction through life following bronchopulmonary dysplasia: a meta-analysis. ERJ Open Res mayo de 9(3):00046\u0026ndash;2023\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun T, Yu HY, Yang M, Song YF, Fu JH (2023) Risk of asthma in preterm infants with bronchopulmonary dysplasia: a systematic review and meta-analysis. World J Pediatr WJP junio de 19(6):549\u0026ndash;556\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim SW, Andronis L, Sepp\u0026auml;nen AV, Aubert AM, Barros H, Draper ES et al (2023) Health-related quality of life of children born very preterm: a multinational European cohort study. Qual Life Res enero de 32(1):47\u0026ndash;58\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSriram S, Schreiber MD, Msall ME, Kuban KCK, Joseph RM, O\u0026rsquo; Shea TM et al (2018) Cognitive Development and Quality of Life Associated With BPD in 10-Year-Olds Born Preterm. Pediatr 1 de junio de 141(6):e20172719\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDella Longa L, Nosarti C, Farroni T Emotion Recognition in Preterm and Full-Term School-Age Children. Int J Environ Res Public Health. 26 de mayo de 2022;19(11):6507\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDell\u0026rsquo;Aversana V, Tofani M, Valente D (2023) Emotional Regulation Interventions on Developmental Course for Preterm Children: A Systematic Review of Randomized Control Trials. Child Basel Switz 22 de marzo de 10(3):603\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeaudoin S, Tremblay GM, Croitoru D, Benedetti A, Landry JS (2013) Healthcare utilization and health-related quality of life of adult survivors of preterm birth complicated by bronchopulmonary dysplasia. Acta Paediatr Oslo Nor 1992 junio de 102(6):607\u0026ndash;612\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTheunissen NC, Veen S, Fekkes M, Koopman HM, Zwinderman KA, Brugman E et al (2001) Quality of life in preschool children born preterm. Dev Med Child Neurol julio de 43(7):460\u0026ndash;465\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGirard-Bock C, Flahault A, Bernard \u0026Eacute;, Bourque CJ, Fallaha C, Cloutier A et al (2021) Health perception by young adults born very preterm. Acta Paediatr Oslo Nor 1992 noviembre de 110(11):3021\u0026ndash;3029\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaumgardt M, Bucher HU, Mieth RA, Fauch\u0026egrave;re JC (2012) Health-related quality of life of former very preterm infants in adulthood. Acta Paediatr Oslo Nor 1992 febrero de 101(2):e59\u0026ndash;63\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCooke RWI (2004) Health, lifestyle, and quality of life for young adults born very preterm. Arch Dis Child marzo de 89(3):201\u0026ndash;206\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonohue PK (2002) Health-related quality of life of preterm children and their caregivers. Ment Retard Dev Disabil Res Rev 8(4):293\u0026ndash;297\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZwicker JG, Harris SR (2008) Quality of life of formerly preterm and very low birth weight infants from preschool age to adulthood: a systematic review. Pediatr febrero de 121(2):e366\u0026ndash;376\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalta M, Sadek-Badawi M (2008) PedsQL relates to function and behavior in very low and normal birth weight 2- and 3-year-olds from a regional cohort. Qual Life Res 1 de junio de 17(5):691\u0026ndash;700\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Characteristics of the sample\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"664\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo BPD/ 1 (n=85)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBPD \u0026nbsp;2-3\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(n=17)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n=102)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGA*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e29,61 (1,80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e28,48 (2,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e29,42 (1,87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e0,02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e1276,20 (335,09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e947,18 (275,37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e1221,36 (347,25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSGA*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e10 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e4 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e14 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e0,19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex, % male\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e51 (60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e9 (53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e60 (59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e0,59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntenatal\u0026nbsp;corticosteroids\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e66 (78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e11 (65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e77 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e0,25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChorioamnionitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e18 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e4 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e22 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e0,83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNIPPV/IPPV* at delivery room\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e45 (53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e16 (95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e42 (60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurfactant administration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e37 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e13 (76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e50 (49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostnatal corticosteroids\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e1 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e0,03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIMV*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e34 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e15 (89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e49 (48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHFOV*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e10 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e7 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e17 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIMV Hours*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e45,75 (128,22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e299,15 (347,15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e87,98 (204,37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNEC*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e1 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e3 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e0,43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePVLM/IVH *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e3 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e6 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e9 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePDA*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e16 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e8 (47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e24 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.96987951807229%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLOS *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.632530120481928%\" valign=\"top\"\u003e\n \u003cp\u003e43 (51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.427710843373493%\" valign=\"top\"\u003e\n \u003cp\u003e14 (82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52409638554217%\" valign=\"top\"\u003e\n \u003cp\u003e57 (56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.44578313253012%\" valign=\"top\"\u003e\n \u003cp\u003e0,02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNo BPD/ 1: Patients without BPD and BPD grade 1\u003c/p\u003e\n\u003cp\u003eBPD \u0026nbsp;2-3: Patients with BPD grades 2 and 3\u003c/p\u003e\n\u003cp\u003e*Data are expressed as mean (standard deviation) and n (%)\u003c/p\u003e\n\u003cp\u003e*Comparison of means (Student\u0026apos;s test); Comparison of proportions (chi-squared test)\u003c/p\u003e\n\u003cp\u003e*GA: gestational age; SGA: small for gestational age; NIPPV: noninvasive positive pressure ventilation IPPV: invasive positive pressure ventilation; IMV: invasive mechanical ventilation; HFOV: high-frequency oscillatory ventilation; NEC: necrotizing enterocolitis (\u0026gt; Grade 2 Bell); PVLM/IVH: periventricular leukomalacia/stage 3 intraventricular hemorrhage or in association with intraparenchymal hemorrhage; PDA: patent ductus arteriosus; LOS: late-onset sepsis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Comparison of quality of life between patients with no BPD/1 and patients with grade 2-3 BPD\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"603\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.066334991708125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.402985074626866%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo BPD/ 1\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=85)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.407960199004975%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBPD 2-3\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=17)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.462686567164179%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.78441127694859%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.930348258706468%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eError\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.945273631840797%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.066334991708125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth \u0026amp; activities\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.402985074626866%\" valign=\"top\"\u003e\n \u003cp\u003e4,14 (4,75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.407960199004975%\" valign=\"top\"\u003e\n \u003cp\u003e5,47 (5,88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.462686567164179%\" valign=\"top\"\u003e\n \u003cp\u003e0,31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.78441127694859%\" valign=\"top\"\u003e\n \u003cp\u003e1,37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.930348258706468%\" valign=\"top\"\u003e\n \u003cp\u003e1,36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.945273631840797%\" valign=\"top\"\u003e\n \u003cp\u003e0,32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.066334991708125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotional state\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.402985074626866%\" valign=\"top\"\u003e\n \u003cp\u003e5,98 (3,86)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.407960199004975%\" valign=\"top\"\u003e\n \u003cp\u003e6,53 (3,22)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.462686567164179%\" valign=\"top\"\u003e\n \u003cp\u003e0,58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.78441127694859%\" valign=\"top\"\u003e\n \u003cp\u003e0,97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.930348258706468%\" valign=\"top\"\u003e\n \u003cp\u003e1,01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.945273631840797%\" valign=\"top\"\u003e\n \u003cp\u003e0,34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.066334991708125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial activities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.402985074626866%\" valign=\"top\"\u003e\n \u003cp\u003e2,52 (2,85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.407960199004975%\" valign=\"top\"\u003e\n \u003cp\u003e4,41 (3,41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.462686567164179%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.78441127694859%\" valign=\"top\"\u003e\n \u003cp\u003e1,74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.930348258706468%\" valign=\"top\"\u003e\n \u003cp\u003e0,80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.945273631840797%\" valign=\"top\"\u003e\n \u003cp\u003e0,03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.066334991708125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool activities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.402985074626866%\" valign=\"top\"\u003e\n \u003cp\u003e4,86 (3,87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.407960199004975%\" valign=\"top\"\u003e\n \u003cp\u003e6,18 (5,15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.462686567164179%\" valign=\"top\"\u003e\n \u003cp\u003e0,33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.78441127694859%\" valign=\"top\"\u003e\n \u003cp\u003e1,34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.930348258706468%\" valign=\"top\"\u003e\n \u003cp\u003e1,12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.945273631840797%\" valign=\"top\"\u003e\n \u003cp\u003e0,23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.066334991708125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal QOL*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.402985074626866%\" valign=\"top\"\u003e\n \u003cp\u003e17,49 (12,31)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.407960199004975%\" valign=\"top\"\u003e\n \u003cp\u003e24,94 (17,85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.462686567164179%\" valign=\"top\"\u003e\n \u003cp\u003e0,03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.78441127694859%\" valign=\"top\"\u003e\n \u003cp\u003e7,98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.930348258706468%\" valign=\"top\"\u003e\n \u003cp\u003e3,65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.945273631840797%\" valign=\"top\"\u003e\n \u003cp\u003e0,03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Variables are described as mean (standard deviation)\u003c/p\u003e\n\u003cp\u003e*Comparison of means with Student\u0026apos;s T\u003c/p\u003e\n\u003cp\u003e*Multiple linear regression (adjusted for BPD)\u003c/p\u003e\n\u003cp\u003e*Total QOL: \u0026ldquo;total quality of life\u0026rdquo; \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Comparison of quality of life between patients without BPD and patients with grade 1 BPD\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"652\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.83614088820827%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.548238897396631%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo BPD (58)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.926493108728943%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBPD 1 (27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.728943338437979%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.926493108728943%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo DBP (n=58)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.304747320061256%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDBP 1-2-3 (n=44)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.728943338437979%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.83614088820827%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth \u0026amp; activities\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.548238897396631%\" valign=\"top\"\u003e\n \u003cp\u003e4,09 (5,11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.926493108728943%\" valign=\"top\"\u003e\n \u003cp\u003e4,26 (3.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.728943338437979%\" valign=\"top\"\u003e\n \u003cp\u003e0,87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.926493108728943%\" valign=\"top\"\u003e\n \u003cp\u003e4,09 (5,11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.304747320061256%\" valign=\"top\"\u003e\n \u003cp\u003e4,73 (4,76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.728943338437979%\" valign=\"top\"\u003e\n \u003cp\u003e0,52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.83614088820827%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotional state\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.548238897396631%\" valign=\"top\"\u003e\n \u003cp\u003e6,38 (3,77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.926493108728943%\" valign=\"top\"\u003e\n \u003cp\u003e5,11 (3,99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.728943338437979%\" valign=\"top\"\u003e\n \u003cp\u003e0,16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.926493108728943%\" valign=\"top\"\u003e\n \u003cp\u003e6,38 (3,77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.304747320061256%\" valign=\"top\"\u003e\n \u003cp\u003e5,66 (3,74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.728943338437979%\" valign=\"top\"\u003e\n \u003cp\u003e0,34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.83614088820827%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial activities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.548238897396631%\" valign=\"top\"\u003e\n \u003cp\u003e2,41 (2,59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.926493108728943%\" valign=\"top\"\u003e\n \u003cp\u003e2,74 (3,38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.728943338437979%\" valign=\"top\"\u003e\n \u003cp\u003e0,62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.926493108728943%\" valign=\"top\"\u003e\n \u003cp\u003e2,42 (2,59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.304747320061256%\" valign=\"top\"\u003e\n \u003cp\u003e3,39 (3,45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.728943338437979%\" valign=\"top\"\u003e\n \u003cp\u003e0,11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.83614088820827%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool activities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.548238897396631%\" valign=\"top\"\u003e\n \u003cp\u003e5,12 (4,11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.926493108728943%\" valign=\"top\"\u003e\n \u003cp\u003e4,30 (3,28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.728943338437979%\" valign=\"top\"\u003e\n \u003cp\u003e0,36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.926493108728943%\" valign=\"top\"\u003e\n \u003cp\u003e5,12 (4,11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.304747320061256%\" valign=\"top\"\u003e\n \u003cp\u003e5,02 (4,15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.728943338437979%\" valign=\"top\"\u003e\n \u003cp\u003e0,91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.83614088820827%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal QOL*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.548238897396631%\" valign=\"top\"\u003e\n \u003cp\u003e18,00 (12,79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.926493108728943%\" valign=\"top\"\u003e\n \u003cp\u003e16,41 (11,36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.728943338437979%\" valign=\"top\"\u003e\n \u003cp\u003e0,58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.926493108728943%\" valign=\"top\"\u003e\n \u003cp\u003e18,00 (12,79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.304747320061256%\" valign=\"top\"\u003e\n \u003cp\u003e19,70 (14,64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.728943338437979%\" valign=\"top\"\u003e\n \u003cp\u003e0,53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Variables are described as mean (standard deviation)\u003c/p\u003e\n\u003cp\u003e*Comparison of means with Student\u0026apos;s T\u003c/p\u003e\n\u003cp\u003e*Total QOL: \u0026ldquo;total quality of life\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Comparison of quality of life between patients with less and more than 28 weeks of gestational age\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"491\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.716904276985744%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.920570264765786%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;28 weeks (n=20)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.75356415478615%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;28 weeks (n=82)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.608961303462321%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.716904276985744%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth \u0026amp; activities\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.920570264765786%\" valign=\"top\"\u003e\n \u003cp\u003e4,25 (5,18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.75356415478615%\" valign=\"top\"\u003e\n \u003cp\u003e4,39 (4,92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.608961303462321%\" valign=\"top\"\u003e\n \u003cp\u003e0,91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.716904276985744%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotional state\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.920570264765786%\" valign=\"top\"\u003e\n \u003cp\u003e4,60 (3,62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.75356415478615%\" valign=\"top\"\u003e\n \u003cp\u003e6,43 (3,72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.608961303462321%\" valign=\"top\"\u003e\n \u003cp\u003e0,05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.716904276985744%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial activities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.920570264765786%\" valign=\"top\"\u003e\n \u003cp\u003e3,05 (3,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.75356415478615%\" valign=\"top\"\u003e\n \u003cp\u003e2,78 (2,99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.608961303462321%\" valign=\"top\"\u003e\n \u003cp\u003e0,72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.716904276985744%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool activities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.920570264765786%\" valign=\"top\"\u003e\n \u003cp\u003e5,10 (4,62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.75356415478615%\" valign=\"top\"\u003e\n \u003cp\u003e5,07 (4,01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.608961303462321%\" valign=\"top\"\u003e\n \u003cp\u003e0,98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.716904276985744%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal QOL*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.920570264765786%\" valign=\"top\"\u003e\n \u003cp\u003e17,00 (14,94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.75356415478615%\" valign=\"top\"\u003e\n \u003cp\u003e19,16 (13,29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.608961303462321%\" valign=\"top\"\u003e\n \u003cp\u003e0,53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Variables are described as mean (standard deviation)\u003c/p\u003e\n\u003cp\u003e*Comparison of means with Student\u0026apos;s T\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Multiple linear regression: Perinatal factors influencing \u0026ldquo;total quality of life\u0026rdquo; adjusted for BPD\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"653\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eR \u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Error\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGA*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e2,40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e0,046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e0,47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e0,73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e0,52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e2,34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e0,045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e0,002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e0,58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSGA*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e2,23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e0,043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e1,20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e3,89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e0,76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChorioamnionitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e2,20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e0,043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e-0,62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e3,23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e0,85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNIPPV/IPPV* at delivery room\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e2,18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e0,042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e0,17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e2,85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e0,95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurfactant administration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e2,66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e0,051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e2,61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e2,73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e0,34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostnatal corticosteroids\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e2,26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e0,044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e-5,25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e13,82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e0,70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHours of IMV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e4,37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e0,081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e0,015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHFOV*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e2,27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e0,044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e1,51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e3,73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e0,69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNEC*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e2,41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e0,046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e-5,16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e7,87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e0,51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePVLM/IVH*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e2,39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e0,046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e-3,27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e5,14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e0,53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePDA*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e2,20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e0,043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e-0,61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e3,23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e0,85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.828220858895705%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLOS*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.196319018404909%\" valign=\"top\"\u003e\n \u003cp\u003e2,20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.496932515337424%\" valign=\"top\"\u003e\n \u003cp\u003e0,043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.809815950920246%\" valign=\"top\"\u003e\n \u003cp\u003e0,53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.94478527607362%\" valign=\"top\"\u003e\n \u003cp\u003e3,67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.723926380368098%\" valign=\"top\"\u003e\n \u003cp\u003e0,85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Multiple linear regression (adjusted for BPD)\u003c/p\u003e\n\u003cp\u003e*GA: gestational age; SGA: small for gestational age; NIPPV: noninvasive positive pressure ventilation IPPV: invasive positive pressure ventilation; IMV: invasive mechanical ventilation; HFOV: high-frequency oscillatory ventilation; NEC: necrotizing enterocolitis (\u0026gt; Grade 2 Bell); PVLM/IVH: periventricular leukomalacia/stage 3 intraventricular hemorrhage or in association with intraparenchymal hemorrhage; PDA: patent ductus arteriosus; LOS: late-onset sepsis.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Bronchopulmonary Dysplasia, prematurity, quality of life","lastPublishedDoi":"10.21203/rs.3.rs-4412567/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4412567/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Preterm infants with bronchopulmonary dysplasia (BPD) are at increased risk of disruptions in their quality of life (QoL) at school age, often associated with respiratory morbidity and the need for ongoing hospital care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To assess the impact of BPD on perceived quality of life in preterm infants at school age.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: We conducted a prospective observational study of infants less than 32 weeks' gestation admitted to our neonatal unit between January 2012 and December 2014. Quality of life was assessed at school age using the Pediatric Quality of Life (PedsQL) questionnaire, with higher scores indicating poorer quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe study included 102 patients with a mean gestational age of 29.42 weeks (SD 1.87) and a mean birth weight of 1221.36 g (SD 347.25), with an average age of 8.59 years (SD 0.90) at the time of the survey. Patients with BPD 2-3 exhibited a significantly poorer perception of “total quality of life” (p=0.03) and in the “social activities” domain (p=0.02) compared to those without BPD or with BPD 1; even after adjusting for gestational age in a multivariate model. No significant differences were observed for “health \u0026amp; activities” domain (p=0.31), “emotional state” domain (p=0.58), or “school activities” domain (p=0.33). No significant differences were found between patients without a diagnosis of BPD and those with grade 1 BPD. Similarly, no significant differences were observed when comparing patients of less than 28 weeks' gestational age and more than 28 weeks of gestational age.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: In our study of preterm infants, those diagnosed with grade 2-3 BPD exhibited lower perceived quality of life compared to preterm infants without BPD or with grade 1 BPD. No differences in quality of life were observed between patients without BPD diagnosis and those with grade 1 BPD. No significant differences in QoL were found between infants born before and after 28 weeks' gestation.\u003c/p\u003e","manuscriptTitle":"Perception of quality of life in school-age children born before 32 weeks of gestational age ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-04 19:09:11","doi":"10.21203/rs.3.rs-4412567/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-28T08:46:50+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-22T20:57:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337247136785710303182048518303594411316","date":"2024-10-13T15:10:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-23T15:35:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-20T07:04:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-20T07:03:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Pediatrics","date":"2024-05-13T10:20:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"907d0b03-2026-484b-9148-b571a5db9060","owner":[],"postedDate":"June 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-02T16:01:32+00:00","versionOfRecord":{"articleIdentity":"rs-4412567","link":"https://doi.org/10.1007/s00431-024-05882-z","journal":{"identity":"european-journal-of-pediatrics","isVorOnly":false,"title":"European Journal of Pediatrics"},"publishedOn":"2024-11-28 15:57:30","publishedOnDateReadable":"November 28th, 2024"},"versionCreatedAt":"2024-06-04 19:09:11","video":"","vorDoi":"10.1007/s00431-024-05882-z","vorDoiUrl":"https://doi.org/10.1007/s00431-024-05882-z","workflowStages":[]},"version":"v1","identity":"rs-4412567","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4412567","identity":"rs-4412567","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}