Children born prematurely represent a growing 'burden' to their families and healthcare providers

The team’s findings are based on 3,083 French children whose progress is being tracked in a study titled EPIPAGE-2 – an investigation into outcomes in preterm children that has been running for 15 years. There is a comparison group of 600 children who were born at full term.

For The BMJ study, Dr Pierrat and colleagues examined the progress of the preterm children at the age of five and a half. It emerged that developmental difficulties were commonly reported among those who were born at an extremely preterm stage (from 22 to 26 weeks), as well as among those born at a very and moderately preterm stage (from 27 to 34 weeks).

The study focuses on neurodevelopmental outcomes – such as cerebral palsy, sensory impairments (blindness and deafness), and cognition – as well as behavioural difficulties and movement disorders. These were assessed using recognised tests.

Family and social 'burdens'

In addition, the family and social burdens associated with prematurity were examined. These ‘burdens’ included the need for extra support at school, visits to a psychiatrist, speech therapist or physiotherapist, and parental concerns about development.

After adjusting for other potentially influential factors, the researchers found that the rates of neurodevelopmental disabilities increased as gestational age fell.

Rates of severe to moderate neurodevelopmental disabilities found in the study were:

• 28 per cent at 24-26 weeks
• 19 per cent at 27-31 weeks
• 12 per cent at 32-34 weeks
• rates of mild disabilities were 39 per cent, 36 per cent and 34 per cent, respectively, at the same stages

About half of the children born at 24-26 weeks received at least one developmental intervention, falling to 26 per cent among those born at 32-34 weeks. Assistance at school was used by 27, 14 and 7 per cent of children born at 24-26, 27-31 and 32-34 weeks, respectively.

Factors that improved survival rates, particularly among extremely preterm babies, include advances in perinatal intensive care, such as an increase in the use of antenatal corticosteroids, exogenous surfactant and non-invasive respirator support. An avoidance of the liberal use of postnatal corticosteroids to treat bronchopulmonary dysplasia has also been a key factor, according to the paper.

The concern most likely to be reported by parents was their child’s behaviour – an issue that warrants more attention, the paper suggests. It notes that rates of neurodevelopmental disabilities were higher in families with low socioeconomic status.

Extra educational assistance and complex developmental resources were often used, even for children born moderately preterm or with no, or mild, neurodevelopmental disabilities [Véronique Pierrat and colleagues]

Difficulties 'should not be underestimated' 

The authors suggest that preterm birth ‘continues to pose a large burden for families, healthcare, and educational systems'.

About one child in three (35 per cent) of children in the moderately to extremely preterm group had mild disabilities requiring special care or educational services.

‘Extra educational assistance and complex developmental resources were often used, even for children born moderately preterm or with no, or mild, neurodevelopmental disabilities.

'Difficulties faced by these groups of children and their families should not be underestimated,’ the authors conclude.

To view the article, titled Neurodevelopmental outcomes at age 5 among children born preterm: EPIPAGE-2 cohort study, visit: www.bmj.com/content/373/bmj.n741

The study was funded by the French Institute of Public Health Research/Institute of Public Health and partners; National Research Agency through the French EQUIPEX programme of investments in the future; PREMUP Foundation; Foundation of France; Foundation for Medical Research; and Epinutri, a hospital clinical research programme.