Neurodevelopmental outcomes at age 5 among children born preterm: EPIPAGE-2 cohort study

Abstract

Objectives To describe neurodevelopment at age 5 among children born preterm. Design Population based cohort study, EPIPAGE-2. Setting France, 2011. Participants 4441 children aged 5½ born at 24-26, 27-31, and 32-34 weeks Main outcome measures Severe/moderate neurodevelopmental disabilities, defined as severe/moderate cerebral palsy (Gross Motor Function Classification System (GMFCS) ≥2), or unilateral or bilateral blindness or deafness, or full scale intelligence quotient less than minus two standard deviations (Wechsler Preschool and Primary Scale of Intelligence, 4th edition). Mild neurodevelopmental disabilities, defined as mild cerebral palsy (GMFCS-1), or visual disability ≥3.2/10 and <5/10, or hearing loss <40 dB, or full scale intelligence quotient (minus two to minus one standard deviation) or developmental coordination disorders (Movement Assessment Battery for Children, 2nd edition, total score less than or equal to the fifth centile), or behavioural difficulties (strengths and difficulties questionnaire, total score greater than or equal to the 90th centile), school assistance (mainstream class with support or special school), complex developmental interventions, and parents’ concerns about development. The distributions of the scores in contemporary term born children were used as reference. Results are given after multiple imputation as percentages of outcome measures with exact binomial 95% confidence intervals. Results Among 4441 participants, 3083 (69.4%) children were assessed. Rates of severe/moderate neurodevelopmental disabilities were 28% (95% confidence interval 23.4% to 32.2%), 19% (16.8% to 20.7%), and 12% (9.2% to 14.0%) and of mild disabilities were 38.5% (33.7% to 43.4%), 36% (33.4% to 38.1%), and 34% (30.2% to 37.4%) at 24-26, 27-31, and 32-34 weeks, respectively. Assistance at school was used by 27% (22.9% to 31.7%), 14% (12.1% to 15.9%), and 7% (4.4% to 9.0%) of children at 24-26, 27-31, and 32-34 weeks, respectively. About half of the children born at 24-26 weeks (52% (46.4% to 57.3%)) received at least one developmental intervention which decreased to 26% (21.8% to 29.4%) for those born at 32-34 weeks. Behaviour was the concern most commonly reported by parents. Rates of neurodevelopment disabilities increased as gestational age decreased and were higher in families with low socioeconomic status. Conclusions In this large cohort of children born preterm, rates of severe/moderate neurodevelopmental disabilities remained high in each gestational age group. Proportions of children receiving school assistance or complex developmental interventions might have a significant impact on educational and health organisations. Parental concerns about behaviour warrant attention.

Population birth outcomes in 2020 and experiences of expectant mothers during the COVID-19 pandemic: a ‘Born in Wales’ mixed methods study using routine data

“…Maternal stress and anxiety during pregnancy is also known to be associated with adverse neonatal and obstetric outcomes [7,8,9]. Specifically, anxiety and stress during pregnancy have been associated with premature birth and low birth weight [8,10,11], which are in turn associated with increased risk of neurodevelopmental and respiratory complications [12,13], and increased risk of infant mortality [14,15]. Stress in pregnancy has also been associated with stillbirth [16] and contributes to a higher likelihood of unplanned caesarean delivery and prolonged labour duration via the use of analgesia [17,18].…”

Early Screening of Visual Processing Dysfunctions in Children Born Very or Extremely Preterm

“…However, in a recent larger study in 209 children of the same risk group, we showed that abnormal (delayed) VOF at 1 year of age significantly contributed to the prediction of adverse neurodevelopmental outcome at 2 years of age ( Beunders et al, 2020 ). Other large cohort studies have shown that at 5 years of age, overall neurodevelopmental outcome of children born preterm is characterized by relatively high rates of severe and moderate disabilities, in multiple domains ranging from visual, auditory, and motor function to IQ, behavioral disorders and school assistance, irrespective of GA (e.g., Pierrat et al, 2021 ). Therefore, the signs of a relation of VOF abnormalities with abnormal neurodevelopmental outcome cannot be set aside and advocate for follow-up at later ages, i.e., at school age.…”

Association Between Early Amino Acid Intake and Full-Scale IQ at Age 5 Years Among Infants Born at Less Than 30 Weeks’ Gestation

“…The study was approved by the National Data Protection Authority, the Consultative Committee on the Treatment of Information on Personal Health Data for Research Purposes, and the Committee for the Protection of People Participating in Biomedical Research. 1 Recruitment and data collection occurred only after families had received information and provided oral informed consent to participate in the study. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline for cohort studies.…”

“…The primary outcome was binary and defined as a full-scale IQ (FSIQ) score greater than −1 SD (ie, ≥93 points) at age 5 years compared with a contemporaneous group of term-born children enrolled in the EPIPAGE-2 follow-up study. 1 Full-scale IQ was assessed using the French version of the Wechsler Preschool and Primary Scale of Intelligence, 4th edition. 20 The secondary outcome was FSIQ score at age 5 years considered as a continuous variable.…”