Brain injury in very preterm children and neurosensory and cognitive disabilities during childhood: the EPIPAGE cohort study

PLoS One. 2013 May 2;8(5):e62683. doi: 10.1371/journal.pone.0062683. Print 2013.

Abstract

Objective: To investigate the association of motor and cognitive/learning deficiencies and overall disabilities in very preterm (VPT) children and their relations to gestational age (GA) and brain lesions.

Design setting and participants: EPIPAGE is a longitudinal population-based cohort study of children born before 33 weeks' gestation (WG) in 9 French regions in 1997-1998. Cumulating data from all follow up stages, neurodevelopmental outcomes were available for 90% of the 2480 VPT survivors at 8 years. Main outcomes were association of motor and cognitive deficiencies and existence of at least one deficiency (motor, cognitive, behavioral/psychiatric, epileptic, visual, and/or hearing deficiencies) in three GA groups (24-26, 27-28, and 29-32WG) and four groups of brain lesions (none, minor, moderate, or severe).

Results: VPT had high rates of motor (14%) and cognitive (31%) deficiencies. Only 6% had an isolated motor deficiency, 23% an isolated cognitive one and 8% both types. This rate reached 20% among extremely preterm. Psychiatric disorders and epilepsy were observed in 6% and 2% of children, respectively. The risks of at least one severe or moderate deficiency were 11 and 29%. These risks increased as GA decreased; only 36% of children born extremely preterm had no reported deficiency. Among children with major white matter injury (WMI), deficiency rates reached 71% at 24-26WG, 88% at 27-28WG, and 80% at 29-32WG; more than 40% had associated motor and cognitive deficiencies. By contrast, isolated cognitive deficiency was the most frequent problem among children without major lesions.

Conclusions: In VPT, the lower the GA, the higher the neurodisability rate. Cerebral palsy is common. Impaired cognitive development is more frequent. Its occurrence in case without WMI or early motor disorders makes long-term follow up necessary. The strong association between motor impairments, when they exist, and later cognitive dysfunction supports the hypothesis of a common origin of these difficulties.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain / pathology
  • Brain / physiopathology*
  • Brain Injuries / complications*
  • Child
  • Child, Preschool
  • Cognition Disorders / complications*
  • Cohort Studies
  • Female
  • Gestational Age
  • Humans
  • Infant
  • Infant, Newborn
  • Learning
  • Motor Activity
  • Pregnancy
  • Premature Birth / diagnostic imaging
  • Premature Birth / physiopathology*
  • Sensation
  • Skull / diagnostic imaging
  • Ultrasonography

Grant support

The EPIPAGE study was supprted by grants from INSERM (National Institute of Health and Medical Research), the Directorate General for Health at the Ministry for Social Affairs, Merck-Sharp and Dohme-Chibret, the Medical Research Foundation, and "Hospital Program for Clinical Research 2001 n°AOM01117" of the French Ministry of Health. The 8-year follow-up was supported by the "Hospital Program for Clinical Research 2004/054/HP" of the French Ministry of Health, the Wyeth Foundation for Children and Adolescents, and the FEDER "European Funds for Regional Development" of Haute-Normandie 2010–2013. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. In particular, the commercial funder (Merck-Sharp and Dohme-Chibret) does not alter the authors‚ adherence to all the PLOS ONE policies on sharing data and materials.