| ObjectiveTo build a synthetical evaluation model on health-related quality of life (HRQOL) in childhood aged 0- to 12-year-old with low birth weight (LBW) based on six domains of physical growth, neuropsychological development, social adaptation, family function, and subjective quality of life for the consideration of health care interventions.MethodAll subjects were from birth cohorts in Tongling City and Hefei City from Anhui province. In June 2006, we collated and collected relevant information for LBW infants in the cohort and followed up 0- to 12-year-old LBW children (born from June 1994 to June 2005) who were single births and resided in the urban district. There were 687 LBW children met the inclusion criteria of the study (excluded the cases from multiplets, stillborn fetus, and birth defects), and 404 of them were followed-up, 210 boys and 194 girls with an average birth weight of 2032.2 g. Meanwhile, NBW children were matched 1:1 with same sex LBW children, with an age gap less than 3 months and living in the same administrative district as the cohort, to serve as the control group. Follow-up appointments with children and their parents were scheduled one of three ways: telephone calls, letters, and home visits.A self-designed questionnaire and serial standard scales were used to collect the demographic characteristics, habitation, behavior and social adaptation, family function, subjective QOL of all children, as well as QOL of their parents. Physical growth and intellectual development of the children were measured by corresponding instruments. Chi-square tests and student-t tests were performed to analyze the data; scatter plots and level curves were used to describe the variation of the indexes.The weight of domains was determined by Specialist counseling with analytical hierarchy process (AHP) for different age stages. Indices of each domain were flexibly elected according to expert-consulting and child health care practice. Data processing was based on the attribute of the index, mainly with the integrate score of each domain by standardizing qualitative data and principal component analysis. Discriminatory analysis was used to analyze the results of each domain and the whole life quality, and elicit the main outcome of the study sample.ResultsThere are significantly differences in many aspects of physical growth domain between LBW and NBW children. The peak of body height augmentation velocity appeared before 3 years of age for both LBW and NBW children and then kept slowly upward, while LBW children always lag behind NBW children before 12-year-old; the body weight augmentation velocity remained stable and slow before 6-year-old, and then turned to accelerate, however, LBW children still lag behind NBW children all along. Boys and girls showed the same growth features as above. The percentages of children with middle-low and low growth level in height and weight were significantly higher in LBW children than in NBW children before 6-year-old. During 0- to 6-year-old, head circumference of LBW is significantly smaller than that of NBW children; LBW children exhibited obvious catch-up growth at the age of 1 year, and then slowly grow until 6 years old when they almost catch up with peers of NBW. Boys showed the same as girls in head circumference growth.The results showed that 0- to 6-year-old LBW children were lower than that of NBW children in all terms of development quotient including the dimensions in adaptive, motor, language, and social communication detected by Gesell development diagnosis scale (GDDS), especially in girls. The scores of Wechsler Intelligence Scale for Children-Chinese revision (C-WISC) subtests as picture arrangement, block map, and operation test than NBW children, and the total IQ of 7- to 12-year-old LBW children were lower than those of NBW children, particularly for girls. In social adaptation domain, scores of independent living ability, sports, exercise, interpersonal interaction ability, collective activity, self-management, and the total standard score of 0- to 6-year-old LBW children were lower than those of NBW children, also especially in girls.The differences in family function between LBW and NBW children only reflected in the scores of role and behavior control which were lower in LBW children than NBW children of boys. Only the score of environment in QOL for parents of 0- to 6-year-old LBW children was lower than that for parents of NBW children, particularly for LBW girls'parents; whereas, the Z-score of social functioning for 7- to 12-year-old LBW children's parents was higher than that for NBW children's parents, particularly for LBW boys'parents. No statistical significant difference was found in the cognition, affection, and general satisfaction of children's subjective life quality between 7-to12-year-old LBW and NBW children.All the synthetical evaluation results for HRQOL of LBW children at different age stages had statistical significance. Stepwise discriminatory analysis showed that physical growth, neuropsychological, and social adaptation domains entered the appraisal model for age 0-3 children; physical growth, and neuropsychological domains entered the model for age 4-6 children; physical growth , neuropsychological, and subjective QOL domains entered the model for age 7-12 children. These results indicated that the contribute proportion of each QOL domain varied by age stage in establishing Synthetical evaluation model for appraising HRQOL of LBW children, and this was related to the weight assignment and index choosing.ConclusionLBW children lag behind NBW children in physical growth, neuropsychological development, and social adaptation, particularly in girls. However, there is little difference between LBW and NBW groups in family function, QOL of parents, and children's subjective life of quality. It is suggested that Synthetical evaluation of HRQOL can effectively unearth the difference of QOL domains for LBW children and provide valuable information in making health care intervention for LBW children.
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