Neurodevelopmental outcomes at age 5 among children born preterm: EPIPAGE-2 cohort study

Abstract

Objectives: To describe neurodevelopment at age 5 among children born preterm.

Design: Population based cohort study, EPIPAGE-2.

Setting: France, 2011.

Participants: 4441 children aged 5½ born at 24-26, 27-31, and 32-34 weeks MAIN OUTCOME MEASURES: Severe/moderate neurodevelopmental disabilities, defined as severe/moderate cerebral palsy (Gross Motor Function Classification System (GMFCS) ≥2), or unilateral or bilateral blindness or deafness, or full scale intelligence quotient less than minus two standard deviations (Wechsler Preschool and Primary Scale of Intelligence, 4th edition). Mild neurodevelopmental disabilities, defined as mild cerebral palsy (GMFCS-1), or visual disability ≥3.2/10 and <5/10, or hearing loss <40 dB, or full scale intelligence quotient (minus two to minus one standard deviation) or developmental coordination disorders (Movement Assessment Battery for Children, 2nd edition, total score less than or equal to the fifth centile), or behavioural difficulties (strengths and difficulties questionnaire, total score greater than or equal to the 90th centile), school assistance (mainstream class with support or special school), complex developmental interventions, and parents' concerns about development. The distributions of the scores in contemporary term born children were used as reference. Results are given after multiple imputation as percentages of outcome measures with exact binomial 95% confidence intervals.

Results: Among 4441 participants, 3083 (69.4%) children were assessed. Rates of severe/moderate neurodevelopmental disabilities were 28% (95% confidence interval 23.4% to 32.2%), 19% (16.8% to 20.7%), and 12% (9.2% to 14.0%) and of mild disabilities were 38.5% (33.7% to 43.4%), 36% (33.4% to 38.1%), and 34% (30.2% to 37.4%) at 24-26, 27-31, and 32-34 weeks, respectively. Assistance at school was used by 27% (22.9% to 31.7%), 14% (12.1% to 15.9%), and 7% (4.4% to 9.0%) of children at 24-26, 27-31, and 32-34 weeks, respectively. About half of the children born at 24-26 weeks (52% (46.4% to 57.3%)) received at least one developmental intervention which decreased to 26% (21.8% to 29.4%) for those born at 32-34 weeks. Behaviour was the concern most commonly reported by parents. Rates of neurodevelopment disabilities increased as gestational age decreased and were higher in families with low socioeconomic status.

Conclusions: In this large cohort of children born preterm, rates of severe/moderate neurodevelopmental disabilities remained high in each gestational age group. Proportions of children receiving school assistance or complex developmental interventions might have a significant impact on educational and health organisations. Parental concerns about behaviour warrant attention.

Fig 1

Study population. *No survivors were born at 22 weeks and only one survivor was born at 23 weeks, who was lost to follow-up at 5½ years. ELFE= Étude Longitudinale Française depuis l’Enfance

Fig 2

Survival at 5½ years, survival without severe/moderate neurodevelopmental disabilities, and survival without any neurodevelopmental disabilities by week of gestational age at birth, among preterm born children in the EPIPAGE-2 study. Data corrected for study design and respondent selection. *Severe or moderate cerebral palsy (Gross Motor Function Classification System level 2-5), vision (bilateral binocular visual acuity <3.2/10), hearing (unilateral-bilateral hearing loss ≥40 dB not corrected or partially corrected with hearing aid), and full scale intelligence quotient less than two standard deviations below the mean of the reference sample born at term (web appendix 1). †Includes no cerebral palsy, no vision or hearing disabilities, full scale intelligence quotient greater than or equal to one standard deviation below the mean, no developmental coordination disorder, and no behavioural difficulties (table 1). CI=confidence interval

Fig 3

Outcome at 5½ years by week of gestational age among survivors in the EPIPAGE-2 study. Data corrected for study design and respondent selection. *Full scale intelligence quotient less than minus two standard deviations, with cut-off point of the distribution related to the reference sample born at term (37-41 weeks; web appendix 1). †Severe or moderate cerebral palsy (Gross Motor Function Classification System level 2-5), vision (bilateral binocular visual acuity <3.2/10), hearing (unilateral-bilateral hearing loss ≥40 dB not corrected or partially corrected with hearing aid), and full scale intelligence quotient less than two standard deviations below the mean of the reference sample born at term (web appendix 1). CI=confidence interval