Neurodevelopment at two years and appropriate schooling at five years in children born very preterm

Abstract

Preterm birth affects about 15 million children per year worldwide; in France, 12,000 infants are born before 32 weeks' gestational age every year. 1 Despite improved survival of preterm infants, the risk of motor, sensory or cognitive disorder during childhood is high. 2Cognitive disorders such as delayed language development, attention disorder or dyspraxia are associated with lower academic performance. [3][4][5][6][7][8] In a large cohort of preterm infants born in France in 1997, a previous study estimated that 30% of children born under or at 32 weeks' gestational age had schooling difficulties. 9 Early detection of potential disorders is a public health challenge in order to offer adapted care: speech therapy, physiotherapy, psychomotricity or a special needs teaching assistant. Previous studies showed that efficacy is improved if such management is started early on, in the preschool period. 10,11 Consequently, follow-up has been standardised in France up to 6-7 years of age, with regional outpatient networks.

Evaluation of Survival and Neurodevelopmental Outcomes in Neonates Born Very Preterm

“…[30] Our follow-up rate of 88.1% is higher than what is reported in other studies and close to the value referred to as ideal in this age group by the guidelines of the American Academy of Pediatrics (90%). [3,7,34] In our study, the survival rate without sequelae exceeded the number of deaths at 25 weeks of GA. Similar data was reported in a 2006 study (EPICure).…”

“…Because lower GA is related to more risk of morbidities, the literature is more centered in EPT, so there are limited studies about neurodevelopment outcomes in VPT. [1,5,7,40,41] Concerning sex, there are theories about differences in brain organization and genetic or hormonal factors predisposing males to be more vulnerable to injury. [2,14,42,43] However, a systematic review, that included studies conducted later in childhood, revealed that the in uence of sex on general cognition was largely diminished at ve years old.…”

“…[6] It is described that the increased survival of EPT infants is accompanied by a higher incidence of morbidity. [5,7] However, in the last decade, the rates of survival and survival without severe or moderate disabilities have increased, although these children remain at high risk of neurodevelopmental impairment (NDI). [3] The majority of studies analyses infants born EPT, however, there are limited literature about survival and neurodevelopment outcomes in infants born very preterm (VPT).…”

Psychomotor development, emotional regulation, and executive functions in 2-years-old children after a threatened preterm labour: a prospective study

“…In particular, preterm infants show certain characteristic temperamental traits, coined by some authors as "preterm behavioural phenotype", not always related to a clinical diagnosis 8 but deserving further consideration. Several studies have reported an increased risk of emotional dysregulation and behavioural problems in preterm children at preschool and school ages 22,46 whereas other works failed to detect signi cant differences compared to full term pairs 47,48 . These discrepancies may be explained due to methodological issues such as sample heterogeneity, time of assessment of type of instrument.…”

“…Although traditionally studies focused on psychomotor impairments detected at school ages 1,4 , more recent research indicate that preterm babies may show some emotional di culties since the rst months of life [6][7][8] . Moreover, latest studies reveal that late-preterm infants without neurological abnormalities also present alterations in neurodevelopment [19][20][21][22] , suggesting the in uence of other factors apart from brain immaturity linked to preterm birth. In addition, it is known that maternal stress during pregnancy can have an impact on offspring's neurodevelopment [23][24][25][26][27] , and a threatened preterm labour (TPL) episode itself represents a stressful event for women 28 .…”