University of Oulu

Alenius, S, Kajantie, E, Sund, R, et al. Out‐of‐home care placements of children and adolescents born preterm: A register‐based cohort study. Paediatr. Perinat. Epidemiol.. 2020; 34: 38– 47.

Out‐of‐home care placements of children and adolescents born preterm : a register‐based cohort study

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Author: Alenius, Suvi1,2; Kajantie, Eero1,2,3,4; Sund, Reijo5,6;
Organizations: 1Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
2Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
3Faculty of Medicine, PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
4Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
5Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
6Faculty of Social Sciences, Centre for Research Methods, University of Helsinki, Helsinki, Finland
7Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2020
Publish Date: 2020-12-22


Background: Preterm birth predisposes to child protection action in the form out‐of‐home care. The impact of the degree of preterm birth on the likelihood for OHC placement(s) and their timing is unknown.

Methods: This population‐based register‐linkage study assessed the likelihood of OHC placement in different gestational age groups using multivariable Cox regression models. All 193 033 traceable singleton (8324 preterm, 4.3%) liveborn in Finland (January 1987‐September 1990), as the first index child of each mother within the cohort period, were followed up until their 18th birthday.

Results: A total of 6562 children (3.4%) experienced OHC. In comparison with full‐term children (39‐41 weeks), those born at 23‐33 completed weeks were predisposed to OHC (hazard ratio [HR] 2.11, 95% confidence interval [CI] 1.74, 2.56). For those born late preterm (34‐36 weeks) and early term (37‐38 weeks), the HR were 1.54 (95% CI 1.37, 1.73) and 1.19 (95% CI 1.12, 1.26), respectively. Adjustment for parental and child characteristics attenuated the HRs: 23‐33 weeks: 1.31 (95% CI 1.07, 1.59), 34‐36 weeks: 1.17 (95% CI 1.04, 1.31), and 37‐38 weeks: 1.08 (95% CI 1.02, 1.16). However, the adjusted HRs for first OHC entries at 0‐5 years of age were higher: 23‐33 weeks 2.29 (95% CI 1.72, 3.05), 34‐36 weeks 1.76 (95% CI 1.46, 2.13), and 37‐38 weeks 1.40 (95% CI 1.25, 1.56). Among those born preterm or early term, in comparison with their term born peers, no excess risk for OHC was seen after 5 years.

Conclusions: A dose‐response relationship exists between the level of preterm birth and OHC placement risk. OHC placements are more common among early and late preterm, and early term children, compared with those born full term, and occur at younger age. Perinatal and postnatal adverse circumstances appear to explain the phenomenon only partly.

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Series: Paediatric and perinatal epidemiology
ISSN: 0269-5022
ISSN-E: 1365-3016
ISSN-L: 0269-5022
Volume: 34
Issue: 1
Pages: 38 - 47
DOI: 10.1111/ppe.12626
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: The study is supported by the Academy of Finland (Skidi‐Kids program for 2010‐2013 and grants 127437, 129306, 130326, 134791, 263924, 274794, and 315690 to Dr Kajantie, and Clinical Researcher Grant 288966 to Dr Hovi); European Commission (Horizon 2020 award 733280 RECAP Research on Children and Adults Born Preterm to Dr Kajantie); the Doctoral Programs of public Health, University of Helsinki (to Dr Alenius); the Finnish Foundation for Pediatric Research (to Drs. Kajantie and Hovi); the Signe and Ane Gyllenberg Foundation (to Drs. Alenius, Kajantie and Hovi); the Alli Paasikivi Foundation (to Dr Hovi); the Sigrid Jusélius Foundation (to Dr Kajantie); the Juho Vainio Foundation (to Drs. Kajantie and Alenius); the Novo Nordisk Foundation (to Dr Kajantie); the Finnish Foundation for Cardiovascular Research (to Drs. Kajantie and Hovi); the Emil Aaltonen Foundation (to Dr Kajantie and Dr Hovi); the Paulo Foundation (to Dr Alenius); and the Finnish Medical Foundation (to Dr Alenius). The study funders had no role in the study design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
Copyright information: © 2019 John Wiley & Sons Ltd. "This is the peer reviewed version of the following article: Alenius, S, Kajantie, E, Sund, R, et al. Out‐of‐home care placements of children and adolescents born preterm: A register‐based cohort study. Paediatr. Perinat. Epidemiol.. 2020; 34: 38– 47, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.