In the JournalsPerspective

More premature babies surviving, but risk for developmental delay still high

Rates of developmental delays are still high among premature babies despite increased survival rates over the past 20 years, according to findings recently published in BMJ.

“The Ages and Stages Questionnaire is the most commonly used parent-completed developmental screening test worldwide and is accepted by the American Academy of Pediatrics as a valid developmental screening tool,” Véronique Pierrat, neonatologist and researcher, obstetrical, perinatal and pediatric epidemiology team, Paris Descartes University, and colleagues wrote. “It could thus be useful for both large cohort studies and routine follow-up as a first step approach to increase early detection of neurodevelopmental delay. However, its use in a national population of preterm children has never been evaluated.”

To assess the tool, researchers compared rates of survival and neurodevelopmental outcomes among children born alive in France at 22 to 26 weeks, 27 to 31 weeks, and 32 to 34 weeks in 2011 with those of neonates born 1997.

Pierrat and colleagues found that among 5,170 live births, survival at 2 years corrected age was 51.7% at 22 to 26 weeks’ gestation; 93.1% at 27 to 31 weeks’ gestation; and 98.6% at 32 to 34 weeks’ gestation. Of the 3,599 infants where data on cerebral palsy were available, the overall rate of that disorder was at 6.9% at 24 to 26 weeks’ gestation; 4.3% at 27 to 31 weeks’ gestation; and 1% at 32 to 34 weeks’ gestation.

In addition, researchers reported that of 2,506 answers to The Ages and Stages Questionnaire, the proportion of children with results of at least one of that questionnaire’s five domains below threshold at 24 to 26 weeks’ gestation were 50.2%; 40.7% at 27 to 31 weeks’ gestation; and 36.2% at 32 to 34 weeks’ pregnancy. The only significant change in survival without severe or moderate neuromotor or sensory disabilities between 1997 and 2011 was among those born at 25 to 26 weeks gestation; the rate went from 45.5% to 62.3%.

The authors suggested an alternative to what they called the “costly” and “time consuming” Bayley Scales of Infant Development that is currently frequently used ascertain a young child’s development.

“Parental questionnaires are increasingly popular to assess development, as they are easy to administer and interpret, have a short completion time, and can decrease medical expenditure,” Pierrat and colleagues wrote. “In addition, they may be used in the community, have the capacity to facilitate parental involvement, and enable clinicians to focus on those children suspected of having developmental delay and hence needing further developmental assessment.” – by Janel Miller

Disclosures: Healio Family Medicine was unable to determine researchers' relevant financial disclosures prior to publication.

Rates of developmental delays are still high among premature babies despite increased survival rates over the past 20 years, according to findings recently published in BMJ.

“The Ages and Stages Questionnaire is the most commonly used parent-completed developmental screening test worldwide and is accepted by the American Academy of Pediatrics as a valid developmental screening tool,” Véronique Pierrat, neonatologist and researcher, obstetrical, perinatal and pediatric epidemiology team, Paris Descartes University, and colleagues wrote. “It could thus be useful for both large cohort studies and routine follow-up as a first step approach to increase early detection of neurodevelopmental delay. However, its use in a national population of preterm children has never been evaluated.”

To assess the tool, researchers compared rates of survival and neurodevelopmental outcomes among children born alive in France at 22 to 26 weeks, 27 to 31 weeks, and 32 to 34 weeks in 2011 with those of neonates born 1997.

Pierrat and colleagues found that among 5,170 live births, survival at 2 years corrected age was 51.7% at 22 to 26 weeks’ gestation; 93.1% at 27 to 31 weeks’ gestation; and 98.6% at 32 to 34 weeks’ gestation. Of the 3,599 infants where data on cerebral palsy were available, the overall rate of that disorder was at 6.9% at 24 to 26 weeks’ gestation; 4.3% at 27 to 31 weeks’ gestation; and 1% at 32 to 34 weeks’ gestation.

In addition, researchers reported that of 2,506 answers to The Ages and Stages Questionnaire, the proportion of children with results of at least one of that questionnaire’s five domains below threshold at 24 to 26 weeks’ gestation were 50.2%; 40.7% at 27 to 31 weeks’ gestation; and 36.2% at 32 to 34 weeks’ pregnancy. The only significant change in survival without severe or moderate neuromotor or sensory disabilities between 1997 and 2011 was among those born at 25 to 26 weeks gestation; the rate went from 45.5% to 62.3%.

The authors suggested an alternative to what they called the “costly” and “time consuming” Bayley Scales of Infant Development that is currently frequently used ascertain a young child’s development.

“Parental questionnaires are increasingly popular to assess development, as they are easy to administer and interpret, have a short completion time, and can decrease medical expenditure,” Pierrat and colleagues wrote. “In addition, they may be used in the community, have the capacity to facilitate parental involvement, and enable clinicians to focus on those children suspected of having developmental delay and hence needing further developmental assessment.” – by Janel Miller

Disclosures: Healio Family Medicine was unable to determine researchers' relevant financial disclosures prior to publication.

    Perspective
    Jay S. Greenspan

    Jay S. Greenspan

    The study by Pierrat et al. in the BMJ describes the follow-up of preterm infants born at 22-34 weeks gestation in France, in 2011, in their EPIPAGE-2 trial. These findings can inform future caregivers and parents on what to expect as these infants leave the intensive care nursery.

    First, fragile and complicated newborns will continue to enter our primary care medical homes and intentional efforts must include pristine hand-offs from the NICU, carepaths around follow-up and care of the high risk, and pathways for early intervention. In addition, maternal health starts at or before adolescence. The medical home must be engaged in adolescent health, prepregnancy planning, proper nutrition and behavioral assessment and intervention and, of course, the health of our local population. Preterm prevention starts in pediatrics and the health of our communities. 

    Though results vary between countries, and those with more aggressive approaches to the very preterm infant may demonstrate greater survival in the smallest of infants, the resulting disabilities remain a grave concern across the globe. Data in the United States likely have many similarities to that of France. All preterm infants are at risk for developmental delay and need to be evaluated frequently following hospital discharge with aggressive intervention provided. Of specific concern in the United States is the increase in preterm birth rates over the past 2 years (according to the March of Dimes). As has been seen in this country, risk factors for preterm birth in France continue to hinge on social determinants of maternal health such as socioeconomics, and neonatal outcomes can be improved by good antenatal care such as maternal steroids. Efforts must be made to prevent prematurity and optimize the care of the mother in preterm labor and infant soon after delivery, because, despite a lot of research, resource and effort, once born the preterm infant continues to have significant challenges in both survival and beyond.

    • Jay S. Greenspan, MD, MBA
    • pediatrician-in-chief, Nemours Alfred I. duPont Hospital for Children Robert L. Brent Professor & Chairman, department of pediatrics, Nemours/Sidney Kimmel Medical College at Thomas Jefferson University

    Disclosures: Greenspan is a volunteer with the March of Dimes.