Outcomes at Age 5 for French Children Born Prematurely

In France, prematurity is the leading cause of neonatal mortality and is responsible for half of all disabilities of perinatal origin. It affects around 55,000 births each year, or approximately 7.5% of all births in the country.

The British Medical Journal has recently published the EPIPAGE-2 study, which initially included 5170 premature children born between April and December 2011. The follow-up of these children from 25 regions in France was carried out for several years. Headed by researchers from “INSERM, (French National Institute of Health and Medical Research) several teams [1] evaluated the children’s progress, their school integration, their recourse to social assistance, and their parents’ concerns about them. The researchers tried to better understand how prematurity impacts children, more specifically their neuro-motor, sensory, cognitive, and behavioral development as well as their learnings.

Children born between 24-26 weeks of amenorrhea are classified as extremely premature; between 27-31 weeks as very premature; and those born between 32-34 weeks as moderately premature.

A total of 3083 children were seen at 5½ years of age during consultations by specialists participating in the study. “The age of 5½ is a key time in a child’s development, making it possible to diagnose learning difficulties and study cognitive skills, which is much more difficult to explore in younger children”, emphasizes Pierre-Yves Ancel, EPOPé team leader.

The results of the study show that at age 5½ years, near-normal developmental outcomes can be expected for 35% of children born extremely premature, for around 45% of those born very prematurely, and for 55% of those born moderately prematurely.

The study also demonstrated that regardless of the degree of prematurity, over one-third of children had “minor difficulties”. Indeed, the more premature the birth, the more the child’s schooling needs to be adapted.

While 93% of moderately preterm children were enrolled in regular classes (with no specific support), this proportion was only 73% for children born extremely preterm.

The study revealed that over half of the children born extremely preterm, one third of those born very preterm, and one quarter of those born moderately preterm were benefiting from complex developmental aid such as speech therapy, physiotherapy, psychological support, etc. However, 20 to 40% of children with severe difficulties received no support. “It is unacceptable that children and families who need help do not have access to this help when it is available,” Professor Ancel declared during an online conference.

Prematurity is a real source of concern for parents, even when the child’s development is considered normal. Parents were most frequently facing behavioral disorders such as attention deficiency disorders, difficulty in controlling emotions, etc. The study highlights the importance of the environment in which the child develops and reinforces the need to offer families coordinated medical, educational and social support. In 2017, the British Medical Journal published the first part of this study, which showed that for the past 20 years, the children born prematurely have been living better and have fewer sequels to premature births.

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[1] EPIPAGE-2 Study, carried out by the researchers from the Inserm-University of Paris team EPOPé – ” Obstetrical, Perinatal and Pediatric Epidemiology Research Team ” from the Center of Research in Epidemiology and Statistics (CRESS, Unit 1153) and involving teams from the AP-HP as well as from the Lille University Hospital.

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