Related Experiment Video
Updated: Jun 8, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental outcomes at age 5 among children born preterm: EPIPAGE-2 cohort study
Véronique Pierrat1,2, Laetitia Marchand-Martin3, Stéphane Marret4,5
1University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France veronique.pierrat@inserm.fr.
Insights
Neurodevelopmental disabilities remain high in preterm infants, increasing with lower gestational age. Behavioral concerns and need for school assistance are significant in these children.
Area of Science:
- Pediatrics
- Neuroscience
- Developmental Biology
Background:
- Preterm birth is a significant risk factor for adverse neurodevelopmental outcomes.
- Understanding the spectrum of neurodevelopmental disabilities in preterm infants is crucial for early intervention and support.
Purpose of the Study:
- To describe the neurodevelopmental status at age 5 in a large cohort of children born preterm.
- To identify rates of severe/moderate and mild neurodevelopmental disabilities across different gestational age groups.
Main Methods:
- Population-based cohort study (EPIPAGE-2) in France.
- Assessment of 3083 children born between 24-34 weeks gestational age at age 5½.
- Utilized standardized measures for neurodevelopmental disabilities, including cerebral palsy, visual/hearing impairments, cognitive function, and behavioral difficulties.
Main Results:
- High rates of severe/moderate neurodevelopmental disabilities were observed, ranging from 12% to 28% across gestational age groups.
- Mild neurodevelopmental disabilities affected 34% to 38.5% of preterm children.
- School assistance, developmental interventions, and parental concerns about behavior were common, particularly in the most preterm infants.
Conclusions:
- Severe/moderate neurodevelopmental disabilities persist in preterm infants across all studied gestational ages.
- Significant proportions of preterm children require school assistance and developmental interventions, impacting health and educational systems.
- Parental concerns regarding behavior in preterm children warrant focused attention and support.
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.
