Preemies face a high risk of neurodevelopmental problems at 5 years of age, even when they're born at 32 to 34 weeks of gestation, according to a large cohort study from France. "The focus in the past has frequently been on only following-up those children who are born at the youngest gestational ages, as they are fewer in number and therefore perhaps easier to manage in clinics," said Dr. Andrei Morgan of the Center for Research on Epidemiology and Statistics Sorbonne Paris Cite (CRESS), who worked on the study. The new findings, he told Reuters Health by email, suggest that a wider range of preterm-born children should be offered medical follow-up appointments to better identify and address developmental issues at the earliest available opportunity. "Families who are less well off are much more likely to be affected by the consequences of preterm birth," Dr. Morgan said, "so particular attention should be given to these children to help reduce subsequent problems." An expanded set of risk factors, including socioeconomic status and infant size at preterm birth, would better identify children who would most benefit from early interventions, he added. For their study, published in The BMJ, the researchers used data from EPIPAGE-2, a 2011 French national cohort designed to track the outcomes of children born before 35 weeks of gestation. All births between 22 and 32 weeks' gestation from maternity wards across France and its overseas regions were eligible for inclusion. More than 3,000 children survived and completed a comprehensive neurodevelopmental assessment at age 5-and-a-half. Severe/moderate neurodevelopmental disabilities were defined as severe/moderate cerebral palsy (Gross Motor Function Classification System score of 2 or more), unilateral or bilateral blindness or deafness, or full-scale intelligence quotient less than minus two standard deviations. Among the extremely preterm cases (22-26 weeks), 28% were found to have severe/moderate neurodevelopmental disabilities. This was true of 19% of the very preterm cases (27-31 weeks) and 12% of the moderately preterm cases (32-34 weeks). The presence of mild disabilities also tracked with gestational age, being present in 39% of extremely preterm cases, 36% of very preterm cases and 34% of moderately preterm cases. The percentage of children receiving assistance at school was found to be 27%, 14% and 7%, respectively. "We expected to see higher levels of impairments with decreasing gestational age at birth, but thought that all children with severe impairment would be receiving help," Dr. Morgan said. "We were therefore surprised to see substantially lower proportions of children born at 32-34 weeks than for those born at 24-26 weeks in relation to receipt of support." In cases of severe neurodevelopmental disabilities, for example, children born nearer to term in the 32-34 week group were found to be significantly less likely to receive support or special schooling (65% vs. 81% for 32-34 and 24-26 weeks, respectively). They were also less likely to receive a follow-up with at least one specialized service. About half of the children born between 24-26 weeks received one or more developmental interventions, a figure that decreased markedly for the moderately preterm births (26%). "Behaviour was the concern most commonly reported by parents," the researchers report. "Rates of neurodevelopment disabilities increased as gestational age decreased and were higher in families with low socioeconomic status." "Parental concerns about behaviour warrant attention," they conclude. —Matthew Phelan Source
