At age 10, the majority of parents surveyed reported that their children born prematurely were in good overall health, and almost all were attending school. However, some experienced behavioural and academic difficulties that may require specialised healthcare and/or educational support, as well as more limited participation in certain social activities.
These findings come from a comparison of data from the EPIPAGE-2 cohort, which has followed 2,181 children born prematurely since birth, with data from 7,286 children born at term who are part of the ELFE cohort, conducted by Inserm and Ined.
The study was carried out by researchers from Inserm, Université Paris Cité and the Créteil Intercommunal Hospital Center, with the results published in eClinicalMedicine.
In France, 7% of births occur before term, defined as a gestational age of less than 37 weeks of amenorrhea (see box below). Premature birth can lead to structural and functional alterations in several organs, particularly the brain.
A better understanding of the difficulties that children born prematurely and their families may face during development is essential to improving their follow-up and care.
Since 2011, researchers from the Oppale team at the Center for Research in Epidemiology and Statistics (Inserm/Université Paris Cité) have been monitoring the development of a cohort of children born prematurely in France.
As part of the EPIPAGE-2 study, researchers are now presenting a new assessment at age 10, based on data from 2,181 children born prematurely. They compared these findings with data from 7,286 children born at term who are part of the ELFE cohort (see box below).
Data were collected through telephone interviews with parents and provide information on children’s behaviour, use of developmental healthcare services, schooling, and participation in social activities.
Behavioural development and healthcare use
According to the survey results, at age 10, 16% of children born prematurely exhibited behavioural difficulties, compared with 12% of children born at term. Difficulties related to emotional regulation were the most frequently reported.
By age 10, nearly half of children born extremely preterm had received at least one form of care related to developmental difficulties. This proportion decreased with increasing gestational age, with 73% of children born moderately preterm not receiving any developmental healthcare. The proportion receiving at least two different forms of healthcare ranged from 27% among the most premature children to 11% among those born moderately preterm.
Statistical analyses showed that children in each preterm gestational-age group had an increased risk of behavioural difficulties and a greater need for developmental healthcare compared with children born at term. Nevertheless, healthcare use among children born at term was not negligible — an important finding given the much larger number of children in this group.
Schooling and participation in extracurricular and social activities
School attendance in mainstream schools and classes was almost universal across all groups. However, grade repetition was reported for 16%, 11% and 4% of children in mainstream classes born at 24–26, 27–31 and 32–34 weeks of amenorrhea, respectively, compared with 3% of children born at term.
Overall, 23% of children born prematurely received educational support, ranging from 35% among children born at 24–26 weeks to 20% among those born at 32–34 weeks, compared with 12% of children born at term.
Of the premature children who received developmental healthcare and/or educational support at age 5, 57% were still receiving support at age 10. Among those who had not received support at age 5, 27% were receiving it at age 10.
The survey found that 69% of children born prematurely participated in sports, compared with 77% of children born at term. More than half (55%) had had a party with friends for their most recent birthday, compared with 60% of children born at term. However, fewer had been invited to spend the night at a friend’s house during the previous 12 months: 54% compared with 63% of children born at term.
Participation in extracurricular and social activities varied significantly depending on whether children had behavioural difficulties, both among those born prematurely and those born at term. Participation was also lower among children receiving educational support, regardless of whether they were receiving developmental healthcare.
Parents’ perceptions of their child’s health
Parents were also asked to assess their child’s overall health. The vast majority considered their child to be in good overall health.
However, according to parental reports, 14% of children born at 24–26 weeks and 4% of those born at 32–34 weeks experienced limitations in their daily activities. These limitations were primarily associated with neurodevelopmental disorders.
Approximately 20% of parents of children born prematurely reported significant emotional, behavioural or relationship difficulties.
According to their parents, children born prematurely were more likely to report having no close friends, being dissatisfied with their peer network and spending less time interacting face-to-face with friends.
Among children born prematurely who were enrolled in a mainstream class corresponding to their expected grade level, approximately 70% of parents reported that their child experienced no particular difficulties in French or mathematics, compared with 80% of parents of children born at term.
The results of our study show that children born prematurely remain a vulnerable population at age 10. They reinforce the importance of offering families personalised support for these children, particularly those born extremely preterm. These recommendations should cover the transition from childhood to adolescence in order to promote health, education and social inclusion.
Véronique Pierrat, first author of the study, Inserm researcher and neonatologist at the Créteil Intercommunal Hospital Center
Beyond the difficulties faced by children born prematurely, these findings raise questions about the impact these difficulties can have on family well-being. The frequency of behavioural, academic and daily-activity challenges, together with the significant need for specialised support, can have a lasting impact on parents’ daily lives.
Pierre-Yves Ancel, author of the study, head of the Oppale team and professor at Université Paris Cité
The EPIPAGE-2 cohort
The EPIPAGE-2 cohort is a French study led by Inserm that initially included 7,819 children born prematurely between April and December 2011, at between five and seven and a half months of pregnancy. One of the study’s objectives is to better understand the consequences of premature birth for children — including their neuromotor, sensory, cognitive and behavioural development, as well as their learning — and for their families.
The ELFE cohort
The ELFE cohort is the first large-scale French study conducted by Inserm and Ined to follow nearly 18,000 children born in 2011, from birth to age 20. Interviews, questionnaires and biological samples are collected at different stages of the children’s lives to document their development and health. The ELFE study aims to understand how children’s environment influences their development, health and socialisation from the prenatal period through adolescence and into adulthood.
Definitions
Extremely preterm: birth at 24–26 completed weeks of amenorrhea.
Very preterm: birth at 27–31 completed weeks of amenorrhea.
Moderately preterm: birth at 32–34 completed weeks of amenorrhea.
Developmental healthcare includes interventions aimed at addressing developmental, behavioural, language or learning difficulties, particularly support provided by speech therapists, psychologists and psychiatrists.
