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Published on: August 25, 2014
Behavioral outcome at 3 years of age in very preterm infants: the EPIPAGE study
Malika Delobel-Ayoub1, Monique Kaminski, Stéphane Marret
1Research Unit on Perinatal Health and Women's Health, Villejuif, France.
Insights
Very preterm children show increased behavioral problems by age 3. Medical conditions and sociodemographic factors like maternal age are linked to these difficulties in preterm infants.
Area of Science:
- Pediatric Health
- Developmental Psychology
- Neonatal Care
Background:
- Preterm birth is a significant global health concern.
- Understanding long-term neurodevelopmental outcomes in preterm infants is crucial.
- Behavioral problems can impact a child's social and academic development.
Purpose of the Study:
- To compare behavioral problem prevalence between very preterm and term-born children at 3 years.
- To identify factors associated with behavioral problems in very preterm children.
Main Methods:
- Prospective population-based cohort study (EPIPAGE).
- Inclusion of infants born between 22-32 weeks gestation and term-born controls.
- Assessment of behavioral problems using the Strengths and Difficulties Questionnaire at 3 years.
Main Results:
- Very preterm children exhibited higher rates of behavioral difficulties compared to controls.
- Medical conditions (cerebral lesions, hospitalization, poor health, psychomotor delay) and sociodemographic factors (high birth order, young maternal age, low maternal education) were associated with increased difficulties.
- Significant differences persisted after adjusting for confounding factors, particularly for hyperactivity, conduct, and peer problems.
Conclusions:
- Very preterm children face an elevated risk of behavioral problems at 3 years of age.
- Child's health and neurodevelopmental status are key predictors of behavioral difficulties.
Objectives:
Our goal was to compare the prevalence of behavioral problems between very preterm children and term children at 3 years of age and examine the factors associated with behavioral problems in very preterm children.
Methods:
We conducted a prospective population-based cohort study: the EPIPAGE (Etude Epidémiologique sur les Petits Ages Gestationnels) study. All infants born between 22 and 32 weeks of gestation in 9 regions of France in 1997 were included and compared with a control group of infants born at term. Sociodemographic status, obstetric, and neonatal data were collected at birth and in the neonatal units. At 3 years of age, the behavioral problems of 1228 very preterm singleton children without major neurodisabilities, and 447 term children were studied using the Strengths and Difficulties Questionnaire completed by the parents.
Results:
Very preterm children were more likely than controls to have behavioral difficulties. Among very preterm children, several medical conditions were associated with a high total difficulty score: major neonatal cerebral lesions diagnosed by cranial ultrasonographic studies, hospitalization within the last year, poor health, and psychomotor delay. A high birth order and sociodemographic factors such as young maternal age and low educational level of the mother were also identified as risk factors for behavioral difficulties. The differences between very preterm children and controls remained significant after adjustment for sociodemographic characteristics, neonatal complications, and neurodevelopmental status, for a high total difficulties score, hyperactivity, conduct problems, and for peer problems. For emotional problems, the difference was at the limit of significance.
Conclusions:
Very preterm children have a higher risk of behavioral problems at 3 years of age compared with term-born children. Health and neurodevelopmental status of the child were significantly associated with behavioral difficulties.
