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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopment and healthcare utilisation at age 5-6 years in bronchopulmonary dysplasia: an EPIPAGE-2 cohort study
Ludovic Tréluyer1,2, Alexandra Nuytten3,4, Isabelle Guellec5
1Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, Paris Cité University, Paris, France ludovic.treluyer@inserm.fr.
Insights
Bronchopulmonary dysplasia (BPD) in very preterm infants is linked to significant neurodevelopmental disabilities at age 5-6. Early intervention and improved management of BPD are crucial for better long-term outcomes.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Public Health
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting preterm infants.
- Preterm birth is associated with increased risks of neurodevelopmental impairments.
- Understanding the long-term neurodevelopmental impact of BPD is critical for early intervention.
Purpose of the Study:
- To investigate neurodevelopmental outcomes in very preterm children with BPD at 5-6 years of age.
- To assess healthcare utilization in this cohort.
- To identify associations between BPD and specific neurodevelopmental disabilities.
Main Methods:
- Prospective, national, population-based study of children born before 32 weeks' gestation in 2011.
- Standardized neurodevelopmental assessments by trained specialists at 5-6 years.
- Analysis of overall neurodevelopmental disabilities, behavioral issues, IQ, cerebral palsy, and rehospitalization.
Main Results:
- 11.7% of very preterm children (n=3186) had BPD.
- BPD was strongly associated with mild, moderate, and severe neurodevelopmental disabilities (ORs ranging from 1.49 to 2.71).
- Children with BPD showed higher rates of developmental coordination disorders, behavioral difficulties, lower IQ, rehospitalization, and need for developmental support.
Conclusions:
- Bronchopulmonary dysplasia is independently associated with a wide range of neurodevelopmental disabilities in very preterm children.
- Improving medical and neurodevelopmental care for BPD is essential to mitigate long-term consequences.
- Targeted interventions are needed to support the neurodevelopmental trajectories of these children.
Objective:
We aimed to study neurodevelopmental outcomes and healthcare utilisation at age 5-6 years in very preterm children with bronchopulmonary dysplasia (BPD).
Design:
Prospective and national population-based study.
Setting:
All the neonatal units in 25 French regions (21 of the 22 metropolitan regions and 4 overseas regions).
Patients:
Children born before 32 weeks' gestation in 2011.
Interventions:
Blind, comprehensive and standardised assessment by trained neuropsychologists and paediatricians at age 5-6 years.
Main Outcome Measures:
Overall neurodevelopmental disabilities, behavioural difficulties, developmental coordination disorders, full-scale IQ, cerebral palsy, social interaction disorders, rehospitalisation in the previous 12 months and detailed developmental support.
Results:
Of the 3186 children included, 413 (11.7%) had BPD. The median gestational age of children with BPD was 27 weeks (IQR 26.0-28.0) and without BPD was 30 weeks (28.0-31.0). At age 5-6 years, 3150 children were alive; 1914 (60.8%) had a complete assessment. BPD was strongly associated with mild, moderate and severe overall neurodevelopmental disabilities (OR 1.49, 95% CI 1.05 to 2.20; 2.20, 1.41 to 3.42 and 2.71, 1.67 to 4.40). BPD was associated with developmental coordination disorders, behavioural difficulties, lower IQ score as well as rehospitalisation in the last 12 months and developmental support. The association between BPD and cerebral palsy was statistically significant before adjustment but not in adjusted analyses.
Conclusions:
BPD was strongly and independently associated with many neurodevelopmental disabilities. Improving medical and neurodevelopmental management of BPD in very preterm children should be a priority to reduce its long-term consequences.
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