Cerebral Palsy Among Very Preterm Children in Relation to Gestational Age and Neonatal Ultrasound Abnormalities: The EPIPAGE Cohort Study

Background and objectiveVery preterm children may be at risk of voice abnormalities (dysphonia). Risk factors previously identified in extremely preterm children include female gender, multiple intubations, complicated intubation and very low birth weight. This study sought to identify the prevalence of dysphonia in very preterm children, at school age.MethodsChildren born between 23 and 32 weeks’ gestation were included in this prospective observational study. Participants were randomly selected from a sample stratified by gestational age and number of intubations, and were aged between 5 and 12 years at the time of assessment. Clinical voice assessments were conducted by a speech pathologist, and a diagnosis of dysphonia was made based on the presence and severity of disturbance to the voice. Retrospective chart review identified medical and demographic characteristics.Results178 participants were assessed. The prevalence of dysphonia in this cohort was 61%. 31% presenting with significant dysphonia, that is, voice disturbance of greater than mild in severity. Female gender (p=0.009), gestational age (p=0.031) and duration of intubation (p=0.021) were significantly associated with dysphonia although some preterm children with dysphonia were never intubated.ConclusionsSignificant voice abnormalities were observed in children born at up to 32 weeks’ gestation, with intubation a major contributing factor.Trial registration numberACTRN12613001015730.

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Developmental outcome at 18 and 24 months of age in very preterm children: a cohort study from 1996 to 1997

Early Human Development ◽

10.1016/s0378-3782(03)00011-2 ◽

2003 ◽

Vol 72 (2) ◽

pp. 83-95 ◽

Cited By ~ 55

Author(s):

Gerlinde M.S.J. Stoelhorst ◽

Monique Rijken ◽

Shirley E. Martens ◽

Paul H.T. van Zwieten ◽

J. Feenstra ◽

...

Keyword(s):

Cohort Study ◽

Developmental Outcome ◽

Preterm Children ◽

Very Preterm

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

BMJ ◽

10.1136/bmj.n741 ◽

2021 ◽

pp. n741

Author(s):

Véronique Pierrat ◽

Laetitia Marchand-Martin ◽

Stéphane Marret ◽

Catherine Arnaud ◽

Valérie Benhammou ◽

...

Keyword(s):

Cerebral Palsy ◽

Cohort Study ◽

Outcome Measures ◽

Low Socioeconomic Status ◽

Gestational Age ◽

Intelligence Quotient ◽

Full Scale ◽

Neurodevelopmental Outcomes ◽

Neurodevelopmental Disabilities ◽

Full Scale Intelligence Quotient

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.

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Associations between antenatal and perinatal risk factors and cerebral palsy: a Swedish cohort study

BMJ Open ◽

10.1136/bmjopen-2020-038453 ◽

2020 ◽

Vol 10 (8) ◽

pp. e038453

Author(s):

Anna Jöud ◽

Andréa Sehlstedt ◽

Karin Källén ◽

Lena Westbom ◽

Lars Rylander

Keyword(s):

Risk Factors ◽

Cerebral Palsy ◽

Gestational Age ◽

Small For Gestational Age ◽

Caesarian Section ◽

Neonatal Care ◽

Late Preterm ◽

P Values ◽

Factors Associated ◽

Very Preterm

ObjectivesTo investigate known and suggested risk factors associated with cerebral palsy in a Swedish birth cohort, stratified by gestational age.SettingInformation on all births between 1995 and 2014 in Skåne, the southernmost region in Sweden, was extracted from the national birth register.ParticipantsThe cohort comprised a total of 215 217 children. Information on confirmed cerebral palsy and subtype was collected from the national quality register for cerebral palsy (Cerebral Palsy Follow-up Surveillance Programme).Primary and secondary outcome measuresWe calculated the prevalence of risk factors suggested to be associated with cerebral palsy and used logistic regression models to investigate the associations between potential risk factors and cerebral palsy. All analyses were stratified by gestational age; term (≥37 weeks), moderately or late preterm (32–36 weeks) and very preterm (<32 weeks).ResultsIn all, 381 (0.2 %) children were assigned a cerebral palsy diagnosis. Among term children, maternal preobesity/obesity, small for gestational age, malformations, induction, elective and emergency caesarian section, Apgar <7 at 5 min and admission to neonatal care were significantly associated with cerebral palsy (all p values<0.05). Among children born moderately or late preterm, small for gestational age, malformations, elective and emergency caesarian section and admission to neonatal care were all associated with cerebral palsy (all p values <0.05), whereas among children born very preterm no factors were significantly associated with the outcome (all p values>0.05).ConclusionOur results support and strengthen previous findings on factors associated with cerebral palsy. The complete lack of significant associations among children born very preterm probably depends on to the small number of children with cerebral palsy in this group.

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Trends in the prevalence of cerebral palsy among very preterm infants (<31 weeks' gestational age)

Paediatrics & Child Health ◽

10.1093/pch/19.4.185 ◽

2014 ◽

Vol 19 (4) ◽

pp. 185-189 ◽

Cited By ~ 7

Author(s):

Michael J Vincer ◽

Alexander C Allen ◽

Victoria M Allen ◽

Thomas F Baskett ◽

Colleen M O'Connell

Keyword(s):

Cerebral Palsy ◽

Preterm Infants ◽

Gestational Age ◽

Very Preterm Infants ◽

Very Preterm

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Special Care and School Difficulties in 8-Year-Old Very Preterm Children: The Epipage Cohort Study

PLoS ONE ◽

10.1371/journal.pone.0021361 ◽

2011 ◽

Vol 6 (7) ◽

pp. e21361 ◽

Cited By ~ 55

Author(s):

Beatrice Larroque ◽

Pierre-Yves Ancel ◽

Laetitia Marchand-Martin ◽

Gilles Cambonie ◽

Jeanne Fresson ◽

...

Keyword(s):

Cohort Study ◽

Special Care ◽

Preterm Children ◽

Very Preterm

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Effects of a Home-Based Family-Centred Early Habilitation Program on Neurobehavioural Outcomes of Very Preterm Born Infants: A Retrospective Cohort Study

Neural Plasticity ◽

10.1155/2016/4323792 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Michela Poggioli ◽

Fabrizio Minichilli ◽

Tiziana Bononi ◽

Pasquina Meghi ◽

Paolo Andre ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Infant Development ◽

Control Group ◽

Preterm Children ◽

Very Preterm ◽

Home Based ◽

Increased Risk ◽

Early Developmental

Preterm children have an increased risk of neurodevelopmental impairments which include psychomotor and language retardation. The objectives of the present retrospective cohort study were to examine the effects of an individually adapted, home-based, and family-centred early developmental habilitation program on neurodevelopmental and behavioural outcomes of very preterm children compared with a standard follow-up at 2 years’ corrected age. Enrolled infants were retrospectively assigned to the intervention group (61 subjects) or to the control group (62 subjects) depending on whether they had or had not carried out a home-based family-centred early developmental habilitation program focused on environmental enrichment, parent-guided environmental interaction, and infant development. Developmental outcome was assessed for both groups at 24 months’ corrected age using the Bayley Scales of Infant Development 2nd Edition. Intervention significantly improved both cognitive and behavioural outcomes. In addition, males had significantly lower scores than females either before or after treatment. However, the treatment was effective in both genders to the same extent. In conclusion, a timely updated environment suitable to the infant’s developmental needs could provide the best substrate where the parent-infant relationship can be practised with the ultimate goal of achieving further developmental steps.

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Pulmonary Outcomes in Children Born Extremely and Very Preterm at 11 Years of Age

Frontiers in Pediatrics ◽

10.3389/fped.2021.635503 ◽

2021 ◽

Vol 9 ◽

Author(s):

Paola Di Filippo ◽

Cosimo Giannini ◽

Marina Attanasi ◽

Giulia Dodi ◽

Alessandra Scaparrotta ◽

...

Keyword(s):

Lung Function ◽

Gestational Age ◽

Blood Count ◽

Positive Association ◽

Diffusing Capacity ◽

Preterm Children ◽

Prick Test ◽

Very Preterm ◽

Preterm Group ◽

Respiratory Outcomes

Background: There is increasing evidence of prematurity being a risk factor for long-term respiratory outcomes regardless the presence of bronchopulmonary dysplasia (BPD).Aim: To assess the effect of prematurity on respiratory outcomes in children born ≤32 weeks of gestational age at 11 years of age.Materials and Methods: Fifty five ex-preterm children (≤ 32 weeks of gestational age), born in Chieti between January 1, 2006 and December 31, 2007, performed lung function and diffusing capacity test (DLCO) at 11 years of age. Furthermore, allergy evaluation by skin prick test (SPT), eosinophil blood count and assessment of eosinophilic airways inflammation by exhaled nitric oxide (FeNO) were performed. The ex-preterm group was compared to an age- and sex-matched group of term children.Results: No difference for atopic and respiratory medical history was found between ex-preterm children and term controls, except for preschool wheezing that resulted more frequent in ex-preterm children. No difference neither in school-aged asthma frequency nor in lung function assessment at 11 years of age was found between the two groups. Lower DLCO values in ex-preterm children compared to term controls regardless the presence of BPD were found; furthermore, we showed a positive association between DLCO and gestational age. Eosinophil blood count, positive SPTs and FeNO values were similar between the two groups.Conclusions: Diffusing lung capacity was decreased in ex-preterm children at 11 years of age in the absence of lung function impairment and eosinophil airway inflammation, suggesting a non-eosinophilic pattern underlying pulmonary alterations. It could be desirable to include the diffusing capacity assessment in follow-up evaluation of all ex-preterm children.

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