Healthcare professionals, neonatal units, hospitals, follow-up teams, and health services
Statement of standard
Key cardiometabolic risk factors (in particular blood pressure, abdominal obesity and physical inactivity) are monitored from childhood to adult life.
Rationale
Children and adults born very preterm are likely to be at increased risk of common late-life diseases, such as coronary heart disease, high blood pressure, stroke, type 2 diabetes, and impaired glucose regulation which jointly are referred to as “cardiometabolic disease”. (1–5) Some studies also point to increased abdominal fat, although evidence is less certain. (6) Importantly, those born preterm seem to undertake less physical activity (7) and are less fit (8), comprising a potential target for secondary prevention.
In addition to cardiometabolic risk factors, children and adults may have reduced lung function (see separate standard) (9) and reduced bone mineral density. (10) Increasing physical activity and fitness carries benefits also in terms of lung and bone health.
These risks highlight the need of promotion of healthy lifestyle and vigilance in detecting individuals among whom specific risk factors attain levels that may warrant intervention. Promotion of healthy lifestyle is likely to benefit the whole family.
There are no published studies assessing the efficacy of preventive measures specifically in children born preterm. However, there are evidence-based guidelines on healthy lifestyle for the general population and on detection of high-risk individuals and prevention based on individual risk factors. Long-term outcomes in children and adults born preterm are currently under intensive research and have been highlighted as an important research topic by agencies such as the US National Institutes of Health. (11) This research is likely to provide new scientific evidence to support the recommendations.
Many of the health benefits considered in this recommendation are best achieved through “health in all policies” – i.e. measures elsewhere than in the health sector (e.g. day-care, education, food industry, community planning). (12)
Benefits
Short-term benefits
N/AList
Long-term benefits
Early identification of individuals in need of more intensive medical follow-up or intervention (consensus)
Potentially better cognitive development and peer relationships (consensus)
Potentially reduced risk of cardiometabolic disease in later life (consensus)
Potentially reduced risk of other non-communicable diseases (e.g. pulmonary disease) (consensus)
Components of the standard
Component
Grading of evidence
Indicator of meeting the standard
For parents and family
Parents and family as well as children and adults born preterm are informed by healthcare professionals about principles of healthy lifestyle, such as prevailing nutrition and physical activity recommendations, and about cardiometabolic risk factors and their follow-up in the healthcare system. (1–5)
A (High quality) B (High quality)
Patient information sheet1
For healthcare professionals
A guideline on detecting cardiometabolic risk factors is adhered to by all healthcare professionals (follow-up clinics, primary healthcare) encountering children and adults born preterm and appropriate advice and interventions are ensured, including national/European/International population guidelines. (13–16)
A (High quality) B (High quality)
Guideline
Blood pressure is measured every 2 years after 3 years of age for all children and those with high blood pressure are referred to specialist evaluation. (17)
A (Moderate quality) B (High quality)
Guideline
Physical activity, diet and other aspects of healthy lifestyle are assessed and adequate support to promote healthy lifestyle as necessary is provided. (13)
A (Moderate quality) B (High quality)
Guideline
Training on the assessment of cardiometabolic risk factors in preterm born children and adults and on healthy lifestyle is attended by all responsible healthcare professionals.
B (High quality)
Training documentation
For neonatal unit, hospital, and follow-up team
A guideline on the assessment of cardiometabolic risk factors in children and adults born preterm is available and regularly updated.
B (High quality)
Guideline
Information on healthy lifestyle and cardiometabolic risk factors is included in discharge planning and follow-up visits and communicated to primary care providers. (1–5)
A (High quality) B (High quality)
Patient information sheet1
Training on the assessment of cardiometabolic risk factors in preterm born children and adults and on healthy lifestyle is ensured.
B (High quality)
Training documentation
For health service
A national guideline on the assessment of cardiometabolic risk factors including children and adults born preterm is available and regularly updated.
B (High quality)
Guideline
Benchmarking of neonatal units to include long-term measures of cardiometabolic health is ensured. (11,18)
B (Moderate quality)
Audit report2
1The indicator “patient information sheet” is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.
2The indicator “audit report” can also be defined as a benchmarking report.
Where to go
Further development
Grading of evidence
For parents and family
N/A
For healthcare professionals
N/A
For neonatal unit
N/A
For hospital
N/A
For health service
Develop evidence-base for preventive strategies.
A (Low quality)
Getting started
Initial steps
For parents and family
Parents and family, as well as children and adults born preterm are informed by healthcare professionals about principles of healthy lifestyle, such as prevailing nutrition and physical activity recommendations.
For healthcare professionals
Incorporate healthy lifestyle counselling in the training of neonatal follow-up healthcare professionals.
Attend training on the assessment of cardiometabolic risk factors in preterm born children and adults and on healthy lifestyle.
For neonatal unit, hospital, and follow-up team
Develop written information material on cardiometabolic risk factors and healthy lifestyle for parents and children and adults born preterm.
Develop and implement a guideline on the assessment of cardiometabolic risk factors in children and adults born preterm.
Support healthcare professionals to participate in training on the assessment of cardiometabolic risk factors in preterm born children and adults and on healthy lifestyle.
For health service
Develop and implement a national guideline on the assessment of cardiometabolic risk factors in children and adults, including those born preterm.
Hovi P, Vohr B, Ment LR, Doyle LW, McGarvey L, Morrison KM, et al. Blood Pressure in Young Adults Born at Very Low Birth Weight: Adults Born Preterm International Collaboration. Hypertens Dallas Tex 1979. 2016;68(4):880–7.
de Jong F, Monuteaux MC, van Elburg RM, Gillman MW, Belfort MB. Systematic review and meta-analysis of preterm birth and later systolic blood pressure. Hypertens Dallas Tex 1979. 2012 Feb;59(2):226–34.
Parkinson JRC, Hyde MJ, Gale C, Santhakumaran S, Modi N. Preterm birth and the metabolic syndrome in adult life: a systematic review and meta-analysis. Pediatrics. 2013 Apr;131(4):e1240-1263.
Hovi P, Andersson S, Eriksson JG, Järvenpää A-L, Strang-Karlsson S, Mäkitie O, et al. Glucose Regulation in Young Adults with Very Low Birth Weight. N Engl J Med. 2007 May 17;356(20):2053–63.
Morrison KM, Ramsingh L, Gunn E, Streiner D, Lieshout RV, Boyle M, et al. Cardiometabolic Health in Adults Born Premature With Extremely Low Birth Weight. Pediatrics. 2016 Sep 2;e20160515.
Crane JD, Yellin SA, Ong FJ, Singh NP, Konyer N, Noseworthy MD, et al. ELBW survivors in early adulthood have higher hepatic, pancreatic and subcutaneous fat. Sci Rep. 2016 17;6:31560.
Kaseva N, Wehkalampi K, Strang-Karlsson S, Salonen M, Pesonen A-K, Räikkönen K, et al. Lower conditioning leisure-time physical activity in young adults born preterm at very low birth weight. PloS One. 2012;7(2):e32430.
Svedenkrans J, Henckel E, Kowalski J, Norman M, Bohlin K. Long-Term Impact of Preterm Birth on Exercise Capacity in Healthy Young Men: A National Population-Based Cohort Study. PLOS ONE. 2013 Jun 12;8(12):e80869.
Gibson A-M, Doyle LW. Respiratory outcomes for the tiniest or most immature infants. Semin Fetal Neonatal Med. 2014 Apr;19(2):105–11.
Hovi P, Andersson S, Järvenpää A-L, Eriksson JG, Strang-Karlsson S, Kajantie E, et al. Decreased bone mineral density in adults born with very low birth weight: a cohort study. PLoS Med. 2009 Aug;6(8):e1000135.
Raju TNK, Pemberton VL, Saigal S, Blaisdell CJ, Moxey-Mims M, Buist S, et al. Long-Term Healthcare Outcomes of Preterm Birth: An Executive Summary of a Conference Sponsored by the National Institutes of Health. J Pediatr. 2017 Feb;181:309–318.e1.
World Health Organization. Ottawa Charter for Health Promotion, 1986. 1986;
World Health Organization. Global recommendations on physical activity for health. [Internet]. 2010 [cited 2018 Jun 7]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK305057/
Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008 [Internet]. Washington, DC: U.S. Department of Health and Human Services; 2008 [cited 2018 Jun 7]. Available from: https://ealth.gov/sites/default/files/2019-10/CommitteeReport_7.pdf
NHS Foundation Trust. Physical activity guidelines for children (under 5 years) [Internet]. https://www.nhs.uk/live-well/exercise/physical-activity-guidelines-children-under-five-years/. [cited 2018 Jun 22]. Available from: https://www.nhs.uk/Livewell/fitness/Documents/children-under-5-years.pdf
Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34(10):1887–920.
Raju TNK, Buist AS, Blaisdell CJ, Moxey‐Mims M, Saigal S. Adults born preterm: a review of general health and system-specific outcomes. Acta Paediatr. 106(9):1409–37.
November 2018 / 1st edition / next revision: 2023
Recommended citation
EFCNI, Kajantie E, van Wassenaer-Leemhuis A et al., European Standards of Care for Newborn Health: Healthy lifestyle and cardiovascular risk factors. 2018.
