Children born of very premature births can have levels of brain and motor impairment that increase as the term of gestation decreases in time. According to an article published in the March 8, 2008 issue of The Lancet, this means that preventing learning disabilities in these children is an important goal for future research.
A very preterm birth is defined as a gestation period less than 33 weeks, while a full term of gestation is generally considered to be 40 weeks. In Europe, between 1.1% and 1.6% of livebirths fit this very premature category. The number of children who survive very preterm birth has increased gradually because of advances in therapies and quality of care. However, this increasing survival rate has raised issues about increases in presentation of adverse developmental outcomes.
To learn more about this, Dr. Beatrice Larroque and Dr Pierre-Yves Ancel, of the INSERM Research Unit on Perinatal Health and Women’s Health, Villejuif, France, and Universite Pierre et Marie-Curie-Paris, Paris, France, and colleagues did the EPIPAGE study, which examined 2,901 livebirths occurring between 24 and 32 complete weeks of gestation in nine regions of France. These children were compared to a reference 667 children from the same geographical regions born at 39-40 weeks of gestation. At five years of age, the children were examined medically and assessed for cognitive function using the Kaufman assessment battery for children (K-ABC), recording scores on the mental processing composite (MPC) scale. Medical healthcare history was also collected from the parents.
The children were categorized according to levels of disability. A severe disability was defined as one or more of the following: non-ambulatory cerebral palsy, MPC score less than 55, or severe visual or hearing deficiency. Moderate disability was defined as cerebral palsy allowing walking with aid or an MPC score of 55-69. Minor disability was classified as cerebral palsy involving walking without aid, MPC score of 70-84, or visual deficit.
Of the 2357 surviving children born very prematurely, 1817 (77%) had a medical assessment at the five year follow up point. Of the 664 in the reference group, 396 (60%) were also evaluated. In the very preterm group, 5% had severe disability, 9% moderate disability and 25% minor disability. In the reference group, 0.3%, 3%, and 8% of the children were in these categories respectively. Disability levels were highest in children born between 24 and 28 weeks of gestation. Additionally, special healthcare resources were used more by very preterm children: 42% of children born between 24 and 28 weeks, 31% between 29-32 weeks needed these services; only 16% of the children between 39 and 40 weeks did.
The authors conclude with suggestions for further directions of research: “These results raise questions about health and provision of rehabilitation services, and the cost of these services to families and society. Further work is needed to identify the best and most effective early developmental interventions to improve the functional prognosis of motor disabilities. As they grow older, children with cognitive deficits will have difficulties at school and will need help or special education. No conclusive results about the enhancement of cognitive outcome in the long term have yet been established, and studies investigating such interventions are needed.
Dr Mary Jane Platt, Division of Public Health, University of Liverpool, UK, contributed an accompanying Comment in which she reiterates the need for care after a very preterm birth: “The EPIPAGE study reminds us that children born before 33 weeks need care and support that lasts far beyond discharge from the neonatal care unit.”
Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study
Béatrice Larroque MD, Pierre-Yves Ancel MD, Prof Stéphane Marret MD, Laetitia Marchand MSc, Monique André MD, Catherine Arnaud MD, Véronique Pierrat MD, Prof Jean-Christophe Rozé MD, Prof Jean Messer MD, Gérard Thiriez MD, Antoine Burguet MD, Prof Jean-Charles Picaud MD, Prof Gérard Bréart MD and Monique Kaminski MSc, for the EPIPAGE Study group
The Lancet 2008; 371:813-820
DOI:10.1016/S0140-6736(08)60380-3
Written by Anna Sophia McKenney