Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks’ gestation in France in 2011: EPIPAGE-2 cohort study

Abstract

Objectives To describe neurodevelopmental outcomes at 2 years corrected age for children born alive at 22-26, 27-31, and 32-34 weeks’ gestation in 2011, and to evaluate changes since 1997. Design Population based cohort studies, EPIPAGE and EPIPAGE-2. Setting France. Participants 5567 neonates born alive in 2011 at 22-34 completed weeks’ gestation, with 4199 survivors at 2 years corrected age included in follow-up. Comparison of outcomes reported for 3334 (1997) and 2418 (2011) neonates born alive in the nine regions participating in both studies. Main outcome measures Survival; cerebral palsy (2000 European consensus definition); scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ; at least one of five domains below threshold) if completed between 22 and 26 months corrected age, in children without cerebral palsy, blindness, or deafness; and survival without severe or moderate neuromotor or sensory disabilities (cerebral palsy with Gross Motor Function Classification System levels 2-5, unilateral or bilateral blindness or deafness). Results are given as percentage of outcome measures with 95% confidence intervals. Results Among 5170 liveborn neonates with parental consent, survival at 2 years corrected age was 51.7% (95% confidence interval 48.6% to 54.7%) at 22-26 weeks’ gestation, 93.1% (92.1% to 94.0%) at 27-31 weeks’ gestation, and 98.6% (97.8% to 99.2%) at 32-34 weeks’ gestation. Only one infant born at 22-23 weeks survived. Data on cerebral palsy were available for 3599 infants (81.0% of the eligible population). The overall rate of cerebral palsy at 24-26, 27-31, and 32-34 weeks’ gestation was 6.9% (4.7% to 9.6%), 4.3% (3.5% to 5.2%), and 1.0% (0.5% to 1.9%), respectively. Responses to the ASQ were analysed for 2506 children (56.4% of the eligible population). The proportion of children with an ASQ result below threshold at 24-26, 27-31, and 32-34 weeks’ gestation were 50.2% (44.5% to 55.8%), 40.7% (38.3% to 43.2%), and 36.2% (32.4% to 40.1%), respectively. Survival without severe or moderate neuromotor or sensory disabilities among live births increased between 1997 and 2011, from 45.5% (39.2% to 51.8%) to 62.3% (57.1% to 67.5%) at 25-26 weeks’ gestation, but no change was observed at 22-24 weeks’ gestation. At 32-34 weeks’ gestation, there was a non-statistically significant increase in survival without severe or moderate neuromotor or sensory disabilities (P=0.61), but the proportion of survivors with cerebral palsy declined (P=0.01). Conclusions In this large cohort of preterm infants, rates of survival and survival without severe or moderate neuromotor or sensory disabilities have increased during the past two decades, but these children remain at high risk of developmental delay.

Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin on length of stay in the neonatal intensive care unit

“…35 Similarly, a study of 2901 livebirths at 22-32 completed weeks' gestation in 1997 in France, reported that at 5-years of age 14% of the children had moderate to severe disability and 25% had minor disability. Specialized health-care resources were used by 34% of the children born prematurely, compared with only 16% in a reference group of children born at 39-40 weeks.…”

Developmental cascades of social inhibition and friendships in preterm and full‐term children

“…The sample was recruited between 1985 and 1986, and thus replications with more recent samples are necessary, given that with improvements in neonatal care, survival of preterm infants has substantially improved over the past decades. Nevertheless, in general, the long‐term neurodevelopmental outcomes after preterm birth appear to be comparable, even in more recent samples (Cheong et al, ; Pierrat et al, ; Wolke, Strauss, et al, ). Despite the exceptionally good fit of the data to the model in the current study, it only explained a small amount of variance.…”

Protection of brain development by antenatal magnesium sulphate for infants born preterm

“…In contrast, rates were as high as 90 per cent in the Haute‐Normandie region. A recent EPIPAGE 2 benchmarking study in several regions in France observed that the rate of CP in Haute‐Normandie (2/87; 2.1%; range: 0.2%–7.7%]) was half that in France overall (4.6%; 95% CI: 3.9–5.5) …”

“…Since 1980, the rate of CP in children born preterm has declined in Europe . In France the rate of CP decreased from 9 per cent in children born very preterm in 1997 to 5.4 per cent in 2011 …”

“…2 In France the rate of CP decreased from 9 per cent in children born very preterm in 1997 to 5.4 per cent in 2011. 3 The purpose of this review is to compile and analyse the existing scientific data (pharmacological effects, experimental data, observational epidemiological studies, and randomized trials) concerning the antenatal use of magnesium sulphate as a protective measure against CP in children born preterm.…”