In very premature children, the levels of brain and motor impairment increase with decreasing gestational age. Further, prevention of learning disabilities in these children is a key goal for future research. These are the conclusions of authors of an Article published in this week's edition of The Lancet.
In Europe, 1.1-1.6% of livebirths are very preterm, ie, born before 33 weeks gestation. The number of children surviving very preterm birth has gradually increased because of progress in therapy and quality of care. However, the increasing survival rate has raised issues about an increase in the rate of adverse developmental outcomes.
Dr Beatrice Larroque and Dr Pierre-Yves Ancel, INSERM Research Unit on Perinatal Health and Women's Health, Villejuif, France, and Universite Pierre et Marie-Curie-Paris 6, Paris, France, and colleagues did the EPIPAGE study, which analysed 2901 livebirths between 24 and 32 completed weeks of gestation in nine regions of France, and a reference group of 667 children from the same regions born at 39-40 weeks of gestation. At five years of age, children had a medical examination and a cognitive assessment with the Kaufman assessment battery for children (K-ABC), with scores on the mental processing composite (MPC) scale recorded. Medical healthcare history was also collected from parents. Severe disability was defined as non-ambulatory cerebral palsy, MPC score less than 55, or severe visual or hearing deficiency; moderate disability as cerebral palsy walking with aid or MPC 55-69; and minor disability as cerebral palsy walking without aid, MPC score of 70-84, or visual deficit.
In total, 1817 (77%) of the 2357 surviving children born very preterm had a medical assessment at five years and 396 (60%) of 664 in the reference group. In the very preterm group, 5% had severe disability, 9% moderate disability and 25% minor disability. In the reference group, these values were 0.3%, 3%, and 8% respectively. Disability was highest in children born between 24 and 28 weeks gestation. Further, they found special healthcare resources were used by 42% of children born at 24-28 weeks and 31% of those born 29-32 weeks -- compared with only 16% of those born at 39-40 weeks.
The authors conclude: "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."
In an accompanying Comment, Dr Mary Jane Platt, Division of Public Health, University of Liverpool, UK, says: "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."
Dr Pierre-Yves Ancel, INSERM Research Unit on Perinatal Health and Women's Health, Villejuif, France, and Universite Pierre et Marie-Curie-Paris 6, Paris, France T) +33 1 56 01 83 63 E) ancel@vjf.inserm.fr
Dr Beatrice Larroque, INSERM Research Unit on Perinatal Health and Women's Health, Villejuif, France, and Universite Pierre et Marie-Curie-Paris 6, Paris, France T) +33 1 44 23 60 73 E) larroque@vjf.inserm.fr
Dr Mary Jane Platt, Division of Public Health, University of Liverpool, UK T) +44 (0)151 794 5580 E) mjplatt@liverpool.ac.uk
PDF OF ARTICLE: http://multimedia.thelancet.com/pdf/press/EPIPAGE.pdf
Journal
The Lancet