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Profiles of Functioning in 5.5-Year-Old Very Preterm Born Children in France: The EPIPAGE-2 Study
E Sabrina Twilhaar1, Véronique Pierrat2, Laetitia Marchand-Martin1
1Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.
Insights
Very preterm children exhibit varied neurodevelopmental outcomes. Researchers identified four distinct subgroups based on motor, cognitive, and psychosocial functioning, aiding tailored interventions.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatrics
Background:
- Very preterm birth (<32 weeks' gestation) poses risks for neurodevelopmental impairments across multiple domains.
- Individual outcomes for these children vary significantly, necessitating a nuanced understanding of their functioning.
- Identifying distinct subgroups is crucial for developing targeted support strategies.
Purpose of the Study:
- To distinguish subgroups of very preterm children with unique functioning profiles across motor, cognitive, behavioral, and psychosocial domains.
- To investigate the relationship between these identified profiles and neonatal/social-environmental factors.
Main Methods:
- Latent profile analysis was employed on data from 1977 very preterm children (EPIPAGE-2 cohort) at 5.5 years of age.
- Functioning was assessed across motor, cognitive, behavioral, and psychosocial domains.
- Multivariable multinomial logistic regression analyzed associations between outcome profiles and risk factors.
Main Results:
- Four distinct subgroups emerged: no deficits (45%), motor/cognitive deficits (31%), behavioral/psychosocial deficits (16%), and multiple domain deficits (8%).
- Male sex, bronchopulmonary dysplasia, low parental education, and parental non-European immigrant status were associated with increased odds of suboptimal outcomes.
- These factors predicted general impairments rather than domain-specific ones.
Conclusions:
- Subgroups of very preterm children at 5.5 years exhibit distinct outcome profiles, varying in severity and type of deficits.
- Understanding these profiles is vital for tailoring interventions to specific needs across multiple developmental domains.
- General neonatal and social-environmental factors can aid in early identification of children at risk for broad impairments.
Objective:
Very preterm born children are at risk for impairments in multiple neurodevelopmental domains, but outcomes vary between individuals. The present study aimed to distinguish subgroups with distinct profiles of functioning across motor, cognitive, behavioral, and psychosocial domains. These profiles were related to neonatal and social/environmental factors.
Method:
The sample included 1977 children born very preterm (<32 weeks' gestation) in 2011 from the French population-based EPIPAGE-2 cohort. Using latent profile analysis, subgroups of children were distinguished based on their functioning at 5.5 years. The relation between outcome profiles and neonatal and social/environmental factors was tested using multivariable multinomial logistic regression analysis.
Results:
Four subgroups with distinct outcome profiles were distinguished: no deficit in any domain (45%); motor and cognitive deficits without behavioral/psychosocial deficits (31%); primarily behavioral and psychosocial deficits (16%); and deficits in multiple domains (8%). Male sex (odds ratio [OR] = 2.1-2.7), bronchopulmonary dysplasia (OR = 2.1-2.8), low parental education level (OR = 1.8-2.1), and parental non-European immigrant status (OR = 2.3-3.0) were independently associated with higher odds for all suboptimal outcome profiles compared to the favorable outcome profile.
Conclusion:
Among 5.5-year-old very preterm born children, subgroups can be distinguished with distinct outcome profiles that vary in severity, type, and combinations of deficits. This information is important for the development of interventions that are tailored to the needs of large subgroups of children across multiple domains of functioning. General neonatal and social/environmental factors may be useful for early identification of very preterm born children at risk for general rather than domain-specific impairments.
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