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

Suvi Alenius, Eero Kajantie, Reijo Sund, Markku Nurhonen, Pieta Näsänen‐Gilmore, Marja Vääräsmäki, Mika Gissler, Petteri Hovi - Paediatric and Perinatal Epidemiology



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.


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.


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.


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.