MedicalResearch.com Interview with:
Dr. Andrei Morgan and Dr.Veronique Pierrat
Obstetrical, Perinatal, and Pediatric Epidemiology Team,
Epidemiology and Biostatistics Sorbonne
Cité Research Center INSERM, Paris France
Descartes University, Paris, France
Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France.
MedicalResearch.com: What is the background for this study?
Response: The risk of neurodevelopmental and behavioural disabilities remains high in children and adults born preterm. In the 2000s, outcomes of neonates born extremely preterm was described in several settings, but the outcome of neonates born very and moderately preterm was rarely reported. However, in absolute numbers, these infants represent a larger proportion of preterm births and account for more children with long-term deficits and learning disabilities.
EPIPAGE-2 is a national study which aims to study short and long term outcomes of children born at 22-26 weeks’gestation, 27-31 weeks’gestation and 32-34 weeks’gestation in France in 2011. We also compared results from this study with the first EPIPAGE study, carried out in 1997. At two years of age, neuro motor and sensory impairment, as well as overall development, were investigated by sending questionnaires to the attending physician and the parents.
MedicalResearch.com: What are the main findings?
Response: In 2011 the overall rate of cerebral palsy, the most severe motor impairment, was 7% among extremely preterm children (22-26 weeks’gestation), 4% among those born very preterm (27-31 weeks’gestation) and 1% among those born moderately preterm (32-34 weeks’gestation). Between 1997 and 2011, severe neonatal morbidities in French children born preterm decreased, accompanied by a significant increase in survival without severe/moderate neuro-motor or sensory disabilities at 2 years of age. However, based on results from the parental questionnaire, between half and one third of children born preterm have low scores of development (lower than would be expected in the general population of children at the same age) and are considered at risk of developmental delay.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Despite improvements in neuro-motor and sensory outcomes, a high number of children born before 34 weeks are at risk of developmental delay, and need further evaluation. These results were most marked in children at the lowest gestations, but more children are born moderately preterm than are born extremely preterm, meaning a large number of children are potentially affected. In many countries, children born moderately preterm are not involved in structured follow-up programs. Using parental questionnaires as a first step approach to assess development represents a promising alternative for early identification of children at risk of later difficulties, and may allow clinical resources to be focused on those most likely to benefit.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Long-term follow up studies are needed to evaluate subtle cognitive difficulties and learning difficulties at school age. We are currently evaluating outcomes of the surviving children at 5.5 years of age, and have plans to continue follow-up until the children are 12 years old.
Further investigation is required to demonstrate the efficacy of the parental questionnaire approach, and to see whether interventions can be provided to improve the prognosis for these children.
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Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks’ gestation in France in 2011: EPIPAGE-2 cohort study.
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