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J Pediatr. 2013 Dec;163(6):1578-1584.e4. doi: 10.1016/j.jpeds.2013.07.004. Epub 2013 Aug 20.

Associations of preterm births with child health and development: Japanese population-based study.

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  • 1Department of Public Health and Public Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. Electronic address:



To examine associations between the duration of gestation and health and development outcomes at 2.5 years and 5.5 years using a Japanese population-based longitudinal survey (n = 47 015).


Hospitalization was used as an indicator of physical health, and responses to questions about age-appropriate behaviors were used as an indicator of behavioral development. We conducted logistic regression analyses controlling for a set of neonatal and family factors. We also estimated population-attributable fractions.


We observed a steady increase toward shorter duration of gestation in the risk of hospitalizations at age 2.5 years and 5.5 years and developmental delays at 2.5 years (Plinear trend < .001 for all outcomes). We found associations only between extremely preterm birth and delayed behavioral development at age 5.5 years.


There is a linear relationship between shorter duration of gestation and increased risk of later health and developmental problems. In line with Rose's "population paradox," the population-attributable risks for these problems are greater for moderately preterm infants compared with extremely preterm infants.

Copyright © 2013 Mosby, Inc. All rights reserved.


MHLW; Ministry of Health, Labour, and Welfare; PAF; Population-attributable fraction

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