Gabriela Prado Peralta

OBJECTIVE: We aimed to assess physical activity and screen time in a cohort of very preterm-born children and adolescents (aged 5–16 years), in comparison with their full-term siblings. We also aimed to identify potential correlates of these lifestyle factors among the very preterm-born. DESIGN: Cross-sectional survey in the greater Zurich area of Switzerland. PATIENTS: Children born 1 hour per day) and screen time (hours per day or <2 hours per day). METHODS: Linear/logistic regression accounted for age group, sex and family unit. A classification tree analysis explored potential correlates of physical activity and screen time among the very preterm-born. RESULTS: Physical activity of very preterm-born children was similar to that of their full-term siblings, but only one-third of participants met physical activity requirements (i.e. at least 1 hour per day). Screen time was similar in both groups, but much higher among adolescents regardless of preterm birth status. Chronic conditions and respiratory symptoms were not associated with insufficient physical activity. No correlates were identified for physical activity, while age group and socioeconomic status were associated with screen time. CONCLUSIONS: No differences in physical activity and screen time were observed between very preterm-born children and their full-term siblings, but only one-third of participants met physical activity recommendations. Both groups were observed to be less active than the general population. Neither respiratory symptoms nor chronic conditions explained variation in these lifestyle outcomes. Both very preterm-born children and adolescents and their full-term siblings could benefit from better adherence to international physical activity and screen time guidelines.

Objective: The existence of catch-up lung function growth and its predictors is uncertain. We aimed to identify lung function trajectories and their predictors in a population-based birth cohort.Methods: We applied group-based trajectory modelling to z-scores of forced expiratory volume in 1 second (zFEV₁) and z-scores of forced vital capacity (zFVC) from 1151 children assessed at around 4, 7, 9, 10, 11, 14 and 18 years. Multinomial logistic regression models were used to test whether potential prenatal and postnatal predictors were associated with lung function trajectories.Results: We identified four lung function trajectories: a low (19% and 19% of the sample for zFEV₁and zFVC, respectively), normal (62% and 63%), and high trajectory (16% and 13%) running in parallel, and a catch-up trajectory (2% and 5%) with catch-up occurring between 4 and 10 years. Fewer child allergic diseases and higher body mass index z-score (zBMI) at 4 years were associated with the high and normal compared with the low trajectories, both for zFEV₁and zFVC. Increased children’s physical activity during early childhood and higher zBMI at 4 years were associated with the catch-up compared with the low zFEV₁trajectory (relative risk ratios: 1.59 per physical activity category (1.03–2.46) and 1.47 per zBMI (0.97–2.23), respectively). No predictors were identified for zFVC catch-up growth.Conclusion: We found three parallel-running and one catch-up zFEV₁and zFVC trajectories, and identified physical activity and body mass at 4 years as predictors of zFEV₁but not zFVC catch-up growth.

Objectives We aimed to assess health-related quality of life (HRQOL) in a cohort of very preterm born children and adolescents (aged 5-16), and to compare it with their fullterm born siblings and the general population. We also explored correlates of HRQOL among the very preterm born. Methods Cross-sectional survey. Primary outcome was KINDL total score (0 worst - 100 best). Linear mixed models accounted for family unit. Secondary analysis compared very preterm born children to another cohort of healthy children from the same time period. A classification tree analysis explored potential correlates of HRQOL. Results On average, preterm children had a 2.1 point lower KINDL total score than fullterm sibling controls (95% CI -3.6 to -0.6). Compared to population controls, very preterm born children had a 1.4 point higher KINDL score (0.2 to 2.5). Chronic health conditions, age, and respiratory symptoms affecting daily life were key correlates of HRQOL among very preterm born children. Conclusions Very preterm birth in children and adolescents was not associated with a relevant reduction in HRQOL compared to their fullterm born peers. However, lower HRQOL was likely explained by other factors, such as older age, the presence of chronic health conditions, but also by current respiratory symptoms that may be modifiable. A comprehensive assessment of the pulmonary sequelae provoking symptoms and interventions targeting medical management, physical activity and exercise capacity of preterm born children and adolescents may help to reduce respiratory symptoms and its potential influence on HRQOL needs to be investigated further.

Understanding health-related quality of life (HRQOL) in children and adolescents, during a pandemic and afterwards, aids in understanding how circumstances in their lives impact their well-being. We aimed to identify determinants of HRQOL from a broad range of biological, psychological, and social factors in a large longitudinal population-based sample. Data was taken from a longitudinal sample (n = 1843) of children and adolescents enrolled in the prospective school-based cohort study Ciao Corona in Switzerland. The primary outcome was HRQOL, assessed using the KINDL total score and its subscales (each from 0, worst, to 100, best). Potential determinants, including biological (physical activity, screen time, sleep, etc.), psychological (sadness, anxiousness, stress), and social (nationality, parents’ education, etc.) factors, were assessed in 2020 and 2021 and HRQOL in 2022. Determinants were identified in a data-driven manner using recursive partitioning to define homogeneous subgroups, stratified by school level. Median KINDL total score in the empirically identified subgroups ranged from 68 to 83 in primary school children and from 69 to 82 in adolescents in secondary school. The psychological factors sadness, anxiousness, and stress in 2021 were identified as the most important determinants of HRQOL in both primary and secondary school children. Other factors, such as physical activity, screen time, chronic health conditions, or nationality, were determinants only in individual subscales.Conclusion: Recent mental health, more than biological, physical, or social factors, played a key role in determining HRQOL in children and adolescents during pandemic times. Public health strategies to improve mental health may therefore be effective in improving HRQOL in this age group. What is Known:• Assessing health-related quality of life (HRQOL) in children and adolescents aids in understanding how life circumstances impact their well-being.• HRQOL is a complex construct, involving biological, psychological, and social factors. Factors driving HRQOL in children and adolescents are not often studied in longitudinal population-based samples. What is New:• Mental health (stress, anxiousness, sadness) played a key role in determining HRQOL during the coronavirus pandemic, more than biological or social factors.• Public health strategies to improve mental health may be effective in improving HRQOL in children.

Purpose: Understanding health-related quality of life (HRQOL) in children and adolescents, during a pandemic and afterwards, aids in understanding how circumstances in their lives impact their well-being. We aimed to identify determinants of HRQOL from a broad range of biological, psychological and social factors in a large longitudinal population-based sample. Methods: Data was taken from a longitudinal sample (n = 1843) of children and adolescents enrolled in the prospective school-based cohort study Ciao Corona in Switzerland. The primary outcome was HRQOL, assessed using the KINDL total score and its subscales (each from 0, worst, to 100, best). Potential determinants, including biological (physical activity, screen time, sleep, etc), psychological (sadness, anxiousness, stress) and social (nationality, parents’ education, etc) factors, were assessed in 2020 and 2021, and HRQOL in 2022. Determinants were identified in a data-driven manner using recursive partitioning to define homogeneous subgroups, stratified by school level. Results: Median KINDL total score in the empirically identified subgroups ranged from 68 to 83 in primary school children and from 69 to 82 in adolescents in secondary school. The psychological factors sadness, anxiousness and stress in 2021 were identified as the most important determinants of HRQOL in both primary and secondary school children. Other factors, such as physical activity, screen time, chronic health conditions or nationality, were determinants only in individual subscales. Conclusion: Recent mental health, more than biological, physical or social factors, played a key role in determining HRQOL in children and adolescents during pandemic times. Public health strategies to improve mental health may therefore be effective in improving HRQOL in this age group. What is known: Assessing health-related quality of life (HRQOL) in children and adolescents aids in under- standing how life circumstances impact their well-being. HRQOL is a complex construct, involving biological, psychological and social factors. Factors driving HRQOL in children and adolescents are not often studied in longitudinal population-based samples. What is new: Mental health (stress, anxiousness, sadness) played a key role in determining HRQOL during the coronavirus pandemic, more than biological or social factors. Public health strategies to improve mental health may be effective in improving HRQOL in children.

Objectives Both lifestyle and health-related quality of life (HRQOL) were compromised during the COVID-19 pandemic. We investigated changes in adherence to physical activity and screen time recommendations of children and adolescents throughout the pandemic, and their association with HRQOL. Methods Longitudinal data in 1769 primary (grades 1-6) and secondary (7-9) school children ages 6-17 years was taken from Ciao Corona, a school-based prospective cohort study in Zurich, Switzerland, with 5 online questionnaires between June 2020 and July 2022. HRQOL was assessed using the KINDL questionnaire. Meeting physical activity and screen time recommendations was defined by the world health organization (WHO). Results Adherence to physical activity recommendations dropped in 2020, but returned to pre-pandemic levels by 2022. Fewer children met screen time recommendations in 2020 and 2021 than pre-pandemic. HRQOL reduced 3 points between 2020 and 2022, and was 9.7 points higher (95% CI 3.0 - 16.3) in March 2021 in children who met both recommendations. Conclusions Adherence to WHO guidelines on physical activity and screen time during the pandemic had a consistent association with HRQOL despite longitudinal changes in behavior.

The purpose of this study is to describe the prevalence and severity of respiratory symptoms in children born very preterm and to assess their association with parents’ health-related quality of life (HRQoL) and family functioning. We conducted a cross-sectional study and recruited children born less than 32 weeks’ gestation between January 2006 and December 2019, in the greater Zurich area, Switzerland. Between May and December 2021, parents were invited to complete an online survey for their preterm child and for a control term born (≥ 37 weeks’ gestation) sibling aged 1 to 18 years. We used a validated questionnaire to assess respiratory symptoms and the Pediatrics Quality of Life Family Impact Module (PedsQL FIM) to assess parents’ HRQoL and family functioning. The survey was completed for 616 very preterm children (99 with bronchopulmonary dysplasia (BPD)) and 180 controls. Girls made up 45% (46% in controls) of the sample, and 63% (60% in controls) of participants were aged 6 to 18 years (school-age). Very preterm children reported a higher risk of respiratory symptoms than controls, especially preschoolers and those with moderate-to-severe BPD. Parents of children with “mild” and “moderate-severe” respiratory symptoms had on average −3.9 (95%CI: −6.6 to −1.1) and −8.2 (−11.2 to −5.2) lower PedsQL FIM total score, respectively, than parents of children with no symptoms. The same pattern was observed after stratifying by age categories.  Conclusions: Our study suggests that respiratory morbidity in very preterm children has a negative impact on parents’ HRQoL and family functioning, even beyond the first years of life. What is Known:• The burden of respiratory morbidity associated with very premature birth is high and last far beyond the neonatal period.• Respiratory morbidity contributes to lower health-related quality of life (HRQoL) in parents of very preterm children in early infancy. What is New:• Respiratory morbidity in very preterm children has a negative impact on parents’ HRQoL and family functioning beyond the first years of life.• Parents of very preterm children with moderate and severe respiratory symptoms are the ones who report lower scores, both for preschool and school-age children.

Rationale: Early-life exposures may influence lung function at different stages of the life course. However, the relative importance of characteristics at different stages of infancy and childhood are unclear.Objectives: To examine the associations and relative importance of early-life events on lung function at age 24 years.Methods: We followed 7545 children from the Avon Longitudinal Study of Parents and Children from birth to 24 years. Using previous knowledge, we classified an extensive list of putative risk factors for low lung function, covering sociodemographic, environmental, lifestyle and physiological characteristics, according to timing of exposure: 1) demographic, maternal and child; 2) perinatal; 3) postnatal; 4) early childhood; and 5) adolescence characteristics. Lung function measurements (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), FEV₁/FVC and forced expiratory flow at 25–75% of FVC) were standardised for sex, age and height. The proportion of the remaining variance explained by each characteristic was calculated. The association and relative importance (RI) of each characteristic for each lung function measure was estimated using linear regression, adjusted for other characteristics in the same and previous categories.Results: Lower maternal perinatal body mass index (BMI), lower birthweight, lower lean mass and higher fat mass in childhood had the largest RI (0.5–7.7%) for decreased FVC. Having no siblings, lower birthweight, lower lean mass and higher fat mass were associated with decreased FEV₁(RI 0.5–4.6%). Higher lean mass and childhood asthma were associated with decreased FEV₁/FVC (RI 0.6–0.8%).Conclusions: Maternal perinatal BMI, birthweight, childhood lean and fat mass and early-onset asthma are the factors in infancy and childhood that have the greatest influence on early-adult lung function.

Importance It is not known whether respiratory morbidity associated with very premature birth and bronchopulmonary dysplasia (BPD) influence parents’ health and family functioning beyond infancy. Objective To describe the prevalence and severity of respiratory symptoms in children born very preterm and to assess their association with parents’ health-related quality of life (HRQoL) and family functioning. Design, setting and participants In this cross-sectional study, we recruited children born less than 32 weeks’ gestation between January 2006 and December 2019, in the greater Zurich area, Switzerland. Between May and December 2021, parents were invited to complete an online survey for their preterm child and for a control term born (≥37 weeks’ gestation) sibling aged 1 to 18 years. Children with severe chronic conditions or with a recent COVID-19 infection were excluded. Exposure Respiratory symptoms, categorised as ‘none’, ‘mild’ and ‘moderate-severe’. Main outcomes and measures The Total Score, the Parent HRQoL Score, and the Family Functioning Score of the Pediatrics Quality of Life Family Impact Module (PedsQL FIM) questionnaire. Associations between respiratory symptoms and these scores were assessed using multivariable linear regression, adjusted for potential confounders. Results Of 1,697 eligible very preterm children, the survey was completed for 616 of them (99 with BPD) and 180 controls. Girls made up 45% (46% in controls) of the sample and 63% (60% in controls) of participants were aged 6 to 18 years (school-age). Overall, very preterm children reported a higher risk of respiratory symptoms than controls, especially the preschool group and those with moderate-to-severe BPD. Parents of children with ‘mild’ and ‘moderate-severe’ respiratory symptoms had on average -3.9 [95%CI: -6.6 to -1.1] and -8.2 [-11.2 to -5.2] lower Total Score respectively than parents of children with no symptoms. The same pattern was observed for the other summary scores, and after stratifying by age categories. Conclusions and relevance Our study suggests that respiratory morbidity in very preterm children has a negative impact on parents’ HRQoL and family functioning, even beyond the first years of life. This finding highlights the need for appropriate monitoring and support for families of survivors of very premature birth. Question Is respiratory morbidity in survivors of very premature birth associated with parents’ health-related quality of life (HRQoL) and family functioning beyond the first years of life? Findings In this cross-sectional study including 616 children born very preterm and 185 term born controls, both aged 1 to 18 years, we found that very preterm children remain at increased risk of respiratory morbidity through childhood, and that this is associated with decreased parents’ HRQoL and family functioning. Meaning Families of survivors of very premature birth need appropriate monitoring and support to cope with the burden of respiratory morbidity.