Children born prematurely (before 37 weeks pregnant) remain at high risk for developmental difficulties that can affect their behavior and ability to learn, according to a study published by BMJ today.
These difficulties were found not only in children born extremely premature (22-26 weeks) but also in those born very and moderately premature (between 27 and 34 weeks), say the researchers.
The survival of premature babies has increased around the world. Children born early often have developmental problems, but studies have mainly focused on people born extremely premature (22 to 26 weeks gestation) and less is known about children born very and moderately premature (27 to 34 weeks gestation).
Given the importance of identifying the children most at risk for developmental difficulties, French researchers have attempted to describe the neurodevelopment of children born before 35 weeks compared to children born at term.
Their results are based on 3,083 French children aged 5.5 years born after 24-26, 27-31 and 32-34 weeks gestation who participated in the EPIPAGE-2 study (designed to investigate the outcomes of premature infants in over the past 15 years) and a comparison group of 600 full-term infants.
Neurodevelopmental outcomes such as cerebral palsy, sensory impairments (blindness and deafness) and brain function (cognition), as well as behavioral difficulties and movement disorders, were assessed using recognized tests.
To further assess the family and social burden of prematurity, measures such as the need for additional support in school, visits to a psychiatrist, speech language pathologist or physiotherapist, and parental concerns about development were also assessed. recorded.
After adjusting for other potentially influencing factors, the researchers found that rates of neurodevelopmental disabilities increased as gestational age decreased.
For example, among the 3,083 children assessed, the rates of severe to moderate neurodevelopmental disabilities were 28%, 19% and 12% and the rates of mild disability were 39%, 36% and 34% among children born between 24 and 26 years, 27- 31 and 32-34 weeks, respectively.
School aid was used by 27%, 14% and 7% of children born at 24-26, 27-31 and 32-34 weeks, respectively. And about half of infants born at 24-26 weeks received at least one developmental intervention which dropped to 26% for those born at 32-34 weeks.
Behavior was the most common concern reported by parents.
Rates of neurodevelopmental disabilities were also higher in families with lower socioeconomic status.
This is an observational study, so cannot establish the cause, and the researchers point out some limitations that may have affected their results. However, by assessing a wide range of developmental and behavioral issues, they were better able to reflect the complexity of the challenges faced by these children and their families.
As such, they say their findings indicate that premature birth “continues to pose a heavy burden on families, health care and education systems.”
Although rates of severe to moderate neurodevelopmental impairment decline with increasing gestational age, they point out that about 35% of children born moderately to extremely premature had mild disabilities requiring special care or educational services.
And a considerable proportion of parents are concerned about their child’s development, especially behavior, which deserves attention, they add.
“The difficulties encountered by these groups of children and their families should not be underestimated,” they conclude.
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