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Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks' gestation in France in 2011: EPIPAGE-2 cohort study.

Abstract Objectives To describe neurodevelopmental outcomes at 2 years corrected age for children born alive at 22-26, 27-31, and 32-34 weeks' gestation in 2011, and to evaluate changes since 1997.Design Population based cohort studies, EPIPAGE and EPIPAGE-2.Setting France.Participants 5567 neonates born alive in 2011 at 22-34 completed weeks' gestation, with 4199 survivors at 2 years corrected age included in follow-up. Comparison of outcomes reported for 3334 (1997) and 2418 (2011) neonates born alive in the nine regions participating in both studies.Main outcome measures Survival; cerebral palsy (2000 European consensus definition); scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ; at least one of five domains below threshold) if completed between 22 and 26 months corrected age, in children without cerebral palsy, blindness, or deafness; and survival without severe or moderate neuromotor or sensory disabilities (cerebral palsy with Gross Motor Function Classification System levels 2-5, unilateral or bilateral blindness or deafness). Results are given as percentage of outcome measures with 95% confidence intervals.Results Among 5170 liveborn neonates with parental consent, survival at 2 years corrected age was 51.7% (95% confidence interval 48.6% to 54.7%) at 22-26 weeks' gestation, 93.1% (92.1% to 94.0%) at 27-31 weeks' gestation, and 98.6% (97.8% to 99.2%) at 32-34 weeks' gestation. Only one infant born at 22-23 weeks survived. Data on cerebral palsy were available for 3599 infants (81.0% of the eligible population). The overall rate of cerebral palsy at 24-26, 27-31, and 32-34 weeks' gestation was 6.9% (4.7% to 9.6%), 4.3% (3.5% to 5.2%), and 1.0% (0.5% to 1.9%), respectively. Responses to the ASQ were analysed for 2506 children (56.4% of the eligible population). The proportion of children with an ASQ result below threshold at 24-26, 27-31, and 32-34 weeks' gestation were 50.2% (44.5% to 55.8%), 40.7% (38.3% to 43.2%), and 36.2% (32.4% to 40.1%), respectively. Survival without severe or moderate neuromotor or sensory disabilities among live births increased between 1997 and 2011, from 45.5% (39.2% to 51.8%) to 62.3% (57.1% to 67.5%) at 25-26 weeks' gestation, but no change was observed at 22-24 weeks' gestation. At 32-34 weeks' gestation, there was a non-statistically significant increase in survival without severe or moderate neuromotor or sensory disabilities (P=0.61), but the proportion of survivors with cerebral palsy declined (P=0.01).Conclusions In this large cohort of preterm infants, rates of survival and survival without severe or moderate neuromotor or sensory disabilities have increased during the past two decades, but these children remain at high risk of developmental delay.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title bmj (clinical research ed.)
Publication Year Start




PMID- 28814566
OWN - NLM
STAT- MEDLINE
DA  - 20170817
DCOM- 20170830
LR  - 20170830
IS  - 1756-1833 (Electronic)
IS  - 0959-535X (Linking)
VI  - 358
DP  - 2017 Aug 16
TI  - Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34
      weeks' gestation in France in 2011: EPIPAGE-2 cohort study.
PG  - j3448
LID - 10.1136/bmj.j3448 [doi]
AB  - Objectives To describe neurodevelopmental outcomes at 2 years corrected age for
      children born alive at 22-26, 27-31, and 32-34 weeks' gestation in 2011, and to
      evaluate changes since 1997.Design Population based cohort studies, EPIPAGE and
      EPIPAGE-2.Setting France.Participants 5567 neonates born alive in 2011 at 22-34
      completed weeks' gestation, with 4199 survivors at 2 years corrected age included
      in follow-up. Comparison of outcomes reported for 3334 (1997) and 2418 (2011)
      neonates born alive in the nine regions participating in both studies.Main
      outcome measures Survival; cerebral palsy (2000 European consensus definition);
      scores below threshold on the neurodevelopmental Ages and Stages Questionnaire
      (ASQ; at least one of five domains below threshold) if completed between 22 and
      26 months corrected age, in children without cerebral palsy, blindness, or
      deafness; and survival without severe or moderate neuromotor or sensory
      disabilities (cerebral palsy with Gross Motor Function Classification System
      levels 2-5, unilateral or bilateral blindness or deafness). Results are given as 
      percentage of outcome measures with 95% confidence intervals.Results Among 5170
      liveborn neonates with parental consent, survival at 2 years corrected age was
      51.7% (95% confidence interval 48.6% to 54.7%) at 22-26 weeks' gestation, 93.1%
      (92.1% to 94.0%) at 27-31 weeks' gestation, and 98.6% (97.8% to 99.2%) at 32-34
      weeks' gestation. Only one infant born at 22-23 weeks survived. Data on cerebral 
      palsy were available for 3599 infants (81.0% of the eligible population). The
      overall rate of cerebral palsy at 24-26, 27-31, and 32-34 weeks' gestation was
      6.9% (4.7% to 9.6%), 4.3% (3.5% to 5.2%), and 1.0% (0.5% to 1.9%), respectively. 
      Responses to the ASQ were analysed for 2506 children (56.4% of the eligible
      population). The proportion of children with an ASQ result below threshold at
      24-26, 27-31, and 32-34 weeks' gestation were 50.2% (44.5% to 55.8%), 40.7%
      (38.3% to 43.2%), and 36.2% (32.4% to 40.1%), respectively. Survival without
      severe or moderate neuromotor or sensory disabilities among live births increased
      between 1997 and 2011, from 45.5% (39.2% to 51.8%) to 62.3% (57.1% to 67.5%) at
      25-26 weeks' gestation, but no change was observed at 22-24 weeks' gestation. At 
      32-34 weeks' gestation, there was a non-statistically significant increase in
      survival without severe or moderate neuromotor or sensory disabilities (P=0.61), 
      but the proportion of survivors with cerebral palsy declined (P=0.01).Conclusions
      In this large cohort of preterm infants, rates of survival and survival without
      severe or moderate neuromotor or sensory disabilities have increased during the
      past two decades, but these children remain at high risk of developmental delay.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not
      already granted under a licence) please go to
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Pierrat, Veronique
AU  - Pierrat V
AD  - Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and
      Biostatistics Sorbonne Paris Cite Research Center (U1153), INSERM, Paris, France;
      Paris Descartes University, Paris, France [email protected]
AD  - CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, F-59000
      Lille, France.
FAU - Marchand-Martin, Laetitia
AU  - Marchand-Martin L
AD  - Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and
      Biostatistics Sorbonne Paris Cite Research Center (U1153), INSERM, Paris, France;
      Paris Descartes University, Paris, France.
FAU - Arnaud, Catherine
AU  - Arnaud C
AD  - INSERM UMR 1027, Universite Toulouse III Paul Sabatier, Toulouse, France.
FAU - Kaminski, Monique
AU  - Kaminski M
AD  - Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and
      Biostatistics Sorbonne Paris Cite Research Center (U1153), INSERM, Paris, France;
      Paris Descartes University, Paris, France.
FAU - Resche-Rigon, Matthieu
AU  - Resche-Rigon M
AD  - Biostatistics and Medical Information Department, AP-HP Saint-Louis Hospital,
      Paris, France.
FAU - Lebeaux, Cecile
AU  - Lebeaux C
AD  - Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and
      Biostatistics Sorbonne Paris Cite Research Center (U1153), INSERM, Paris, France;
      Paris Descartes University, Paris, France.
FAU - Bodeau-Livinec, Florence
AU  - Bodeau-Livinec F
AD  - Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and
      Biostatistics Sorbonne Paris Cite Research Center (U1153), INSERM, Paris, France;
      Paris Descartes University, Paris, France.
AD  - Ecole des Hautes Etudes en Sante Publique (EHESP), Rennes, France.
FAU - Morgan, Andrei S
AU  - Morgan AS
AD  - Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and
      Biostatistics Sorbonne Paris Cite Research Center (U1153), INSERM, Paris, France;
      Paris Descartes University, Paris, France.
FAU - Goffinet, Francois
AU  - Goffinet F
AD  - Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and
      Biostatistics Sorbonne Paris Cite Research Center (U1153), INSERM, Paris, France;
      Paris Descartes University, Paris, France.
AD  - Maternite Port-Royal, Universite Paris Descartes, Groupe Hospitalier Cochin Broca
      Hotel-Dieu, Assistance Publique-Hopitaux de Paris, DHU Risques et Grossesse,
      Paris, France.
FAU - Marret, Stephane
AU  - Marret S
AD  - Department of Neonatal Pediatrics, Intensive care, and Neuropediatrics, Rouen
      University Hospital, Rouen, France.
AD  - Research Unit U1245, Institute for Research and Innovation in Biomedicine, Rouen,
      France.
FAU - Ancel, Pierre-Yves
AU  - Ancel PY
AD  - Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and
      Biostatistics Sorbonne Paris Cite Research Center (U1153), INSERM, Paris, France;
      Paris Descartes University, Paris, France.
AD  - Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca
      Hotel-Dieu Hospital, Paris, France.
CN  - and the EPIPAGE-2 writing group
LA  - eng
PT  - Journal Article
DEP - 20170816
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
SB  - AIM
SB  - IM
MH  - Blindness/*epidemiology/etiology
MH  - Cerebral Palsy/*epidemiology/etiology
MH  - Child, Preschool
MH  - Developmental Disabilities/*epidemiology/etiology
MH  - Female
MH  - Follow-Up Studies
MH  - France/epidemiology
MH  - Gestational Age
MH  - Hearing Loss/*epidemiology/etiology
MH  - Humans
MH  - Infant, Extremely Premature
MH  - Infant, Premature, Diseases/*epidemiology/mortality/physiopathology
MH  - Male
MH  - Outcome Assessment (Health Care)
MH  - Prospective Studies
MH  - Survivors
PMC - PMC5558213
COI - Competing interests: All authors have completed the ICMJE uniform disclosure form
      at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation
      for the submitted work; no financial relationships with any organisations that
      might have an interest in the submitted work in the previous three years; no
      other relationships or activities that could appear to have influenced the
      submitted work.
EDAT- 2017/08/18 06:00
MHDA- 2017/08/31 06:00
CRDT- 2017/08/18 06:00
PST - epublish
SO  - BMJ. 2017 Aug 16;358:j3448. doi: 10.1136/bmj.j3448.