We would like to present our 2018 newsletter to you. With your help, it was possible to publish several important results from our longterm study, two examples of which we present here:

Changes in the basal forebrain explain the association between birth complications and cognitive performance in pretermborn adults

(Source: Grothe MJ, Schee L, Bäuml J, Meng C, Daamen M, Baumann N, Zimmer C, Teipel S, Bartmann P, Boeker H, Wolke D, Wohlschläger A and Sorg C, Reduced Cholinergic Basal Forebrain Integrity Links Neonatal Complications and Adult Cognitive Deficits After Premature Birth. Biol Psychiatry. 2017 Jul 15;82(2):119-126 doi: 10.1016/j.biopsych.2016.12.008)

Earlier studies have shown that in pretermborn individuals there is a relationship between medical birth complications and longterm cognitive performance, i.e., the more complications, the more likely cognitive deficits are. However, it has remained unclear how the brain “mediates” this relationship. For example, it may be that medical complications (such as oxygen deprivation at preterm birth) may lead to alterations in particularly vulnerable brain regions, which could ultimately result in lower cognitive performance in adulthood. One brain region that may be involved in this due to its particular vulnerability to early disturbances is the socalled basal forebrain. The basal forebrain consists of a cluster of nerve cells that produce the neurotransmitter acetylcholine and are located centrally beneath the frontal lobes. When these nerve cells become active, they release acetylcholine and thereby influence the activity of other regions in the brain. For this reason, the basal forebrain is ascribed an important role in various cognitive processes (e.g., attention). Therefore, in the present study we examined the hypothesis of whether anatomical changes in the basal forebrain (i.e., a reduced volume as an expression of altered development) can explain or “mediate” the association between medical complications and longterm cognitive performance.

For this purpose, we examined 99 preterm and 106 fullterm young adults from the Bavarian Longitudinal Study using magnetic resonance imaging.

We found that the volume of the basal forebrain was reduced by approximately 5% in the pretermborn adults compared to their fullterm counterparts. The degree of volume reduction mediated the effect of medical birth complications on longterm cognitive performance in adulthood.

Our analyses therefore suggest a “causal chain”: medical complications that can occur in the context of preterm birth lead to alterations in the development of the basal forebrain, which ultimately influence longterm cognitive performance. Fortunately, the basal forebrain is therapeutically well “accessible”, which means there are a number of ways to influence the development and function of this structure. For example, there are certain “cholinergic” diets (for mothers and/or infants) that can positively affect the activity of the basal forebrain and thereby cognitive performance; there are also medications (e.g., cholinesterase inhibitors) capable of achieving similar effects. Our study is a first step towards potentially targeting the basal forebrain in pretermborn individuals in the future using promising interventions to positively influence the longterm consequences of preterm birth.

Quality of life of parents 27 years after the birth of a preterm infant

(Source: Very Preterm Birth and Parents' Quality of Life 27 Years Later Wolke D, Baumann N, Busch B, Bartmann P., Very Preterm Birth and Parents’ Quality of Life 27 Years Later. Pediatrics. 2017Sep;140(3) DOI: 10.1542/peds.2017-1263)

The birth of a preterm infant is a very stressful situation for most parents. Due to the immaturity of the child, medical problems often occur after birth, requiring a long stay in the hospital. Even after discharge, further therapies and worries are more common in families of pretermborn children than in families with fullterm children. Problems in school, mental health, and peer relationships are additional challenges. We wanted to examine the effects of these particular challenges on the quality of life and satisfaction of parents.

For this purpose, we asked the parents of our on average 27 year old participants, how they assess their current life situation and satisfaction. We then compared the responses of parents of pretermborn children with those of parents of fullterm children. The group of pretermborn children was defined as being born before 32 weeks of gestation, i.e., at least 8 weeks before the expected due date, and/or with a birth weight of less than 1500 g.

W used the World Health Organization’s qualityoflife scale (WHO) for this survey. This is a test for assessing general quality of life. We asked questions about physical and mental health (e.g., “Are you dependent on medical treatment?”, “Are you able to enjoy life?”), social relationships (e.g., “Do you receive support from friends?”), and the general environment (e.g., “How healthy are the environmental conditions in your neighbourhood?”). In addition, life satisfaction was assessed using the “Satisfaction With Life Scale” (e.g., “So far I have achieved the important things I want in my life.”). Altogether, we were able to survey parents of 219 pretermborn and 227 fullterm children.

It became apparent that parents’ life satisfaction was the same in both groups. Parents of pretermborn children were very resilient to the increased burdens they faced due to preterm birth. Determining factors for satisfaction were not disabilities and school performance of their children or the parentchild relationship. Parents in both groups were more satisfied with their lives when their children were happy and had good friends. In short: parents are well when their children are well. Evidence of the strength and stability of parents.

European research project for preterm children and adults

In this newsletter we would also like to inform you about the latest research projects at the European level. The Bavarian Longitudinal Study is a member of “Research on European Children and Adults Born Preterm” (RECAP). This research project brings together a total of 20 populationbased studies from 13 European countries. The work of gynaecologists, neonatologists, paediatricians, psychologists, educators, health insurance providers, and above all the patients and their parents is brought together here.

In addition, socalled registry studies from four Nordic countries, which contain data from national registries of entire countries, are also included.

All data are combined in anonymised form and thus made available for comparison. This makes it possible to examine statements about rare health problems, risk and resilience factors with greater certainty. The different birth cohorts were collected in different countries, at different times, and with different medical standards. By combining the data, findings can be standardized for the first time, which has greater explanatory power than individual studies.

If you would like to explore this research project yourself, you can do so on the RECAP website: https://recap-preterm.eu.

Repeat telephone and online survey

One of the most important tasks of a longitudinal study is to keep contact with study participants up to date. Therefore, we continuously work to keep your contact information updated. In this newsletter, we would once again like to ask you to inform us if you move or if your telephone number or email address has changed. You can do this easily at any time via the contact form on our website (www.bayerische-entwicklungsstudie.de).

Our last personal contact with most of our study participants took place between 2010 and 2013. Since several years have passed since then, we would like to contact you again by telephone and, in a short conversation, ask a few questions about your current life situation. We are curious to hear what has changed for you in the meantime. In addition, we would like to try to reach those study participants whom we were unable to contact during the last wave, or who were unable to participate for various reasons. The Bavarian Longitudinal Study is unique in Germany and needs every study member enrolled at birth! Only in this way can the value and significance of the study’s findings be maintained at this high level. Today’s doctors and nurses but also patients and parents benefit from this.

In the second half of the year, we would also like to use an onlinesurvey tool for the first time, which you will probably know from other contexts. We will explain the procedure and the main questions to you during the next telephone contact.

We thank you for your continued connection to the study and wish you all the best.
Warm greetings from the study office in Bonn,

Prof.Dr. Dr. Peter Bartmann           Prof. Dr. Dr. Dieter Wolke                Dr. Barbara Busch

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