Neurodevelopmental outcome at early school age in a Swiss national cohort of very preterm children
Infants born very preterm are at higher risk of long-term neurodevelopmental problems than children born at term. Although there are increasing numbers of reports on outcomes from international cohorts of premature infants, a Swiss national report on infants after 2 years of age is lacking.
AIMS OF THE STUDY
To describe neurodevelopmental outcomes at early school age of preterm children born in Switzerland with a special focus on the cognitive abilities.
This prospective national cohort study included children born alive before 30 weeks of gestation in 2006. At 5 years of age, children underwent a neurological examination and intelligence testing with the Kaufman Assessment Battery for Children first edition (K-ABC). We assessed the mental processing composite score (MPC) and its subscales to explore specific cognitive deficits. The primary outcome was cognitive impairment (MPC score <−1 standard deviation from the normative mean), motor impairment (cerebral palsy), or sensory impairment (any visual or hearing deficiency). The need for early intervention or therapies and the association of perinatal factors with cognitive impairment were secondary and tertiary outcomes. Logistic regression models were used to analyse associations between neonatal factors and cognitive outcome.
Of 289 survivors, 235 were assessed. Of the 199 children with results obtained from the K-ABC, 42 (21%) showed cognitive impairment and 80 (40%) showed impairment in short-term memory. Cerebral palsy was diagnosed in 14 (6%), and visual and auditory impairment in 36 (15%) and 12 (5%) children, respectively; 63 (27%) needed early intervention or therapies. Cognitive impairment was associated with low socioeconomic status, but not with gestational age, small birthweight for gestational age, bronchodysplasia, or significant brain injury. A total of 146 children (63%) survived without any impairment.
This is the first study to report neurodevelopmental outcomes at early school age in a Swiss cohort. The majority had favourable outcomes, but 21% of children demonstrated cognitive impairment, which was most pronounced in short-term memory. Our findings were similar to those of international cohorts and indicate that preterm children born before 300/7 gestational weeks, especially those living in unfavourable social environments, are at an increased risk of cognitive impairment and need close monitoring beyond early school age.
Trial registration no
- Chen F, Bajwa NM, Rimensberger PC, Posfay-Barbe KM, Pfister RE ; Swiss Neonatal Network. Thirteen-year mortality and morbidity in preterm infants in Switzerland. Arch Dis Child Fetal Neonatal Ed. 2016;101(5):F377–83. doi:.https://doi.org/10.1136/archdischild-2015-308579
- Cheong JLY, Anderson PJ, Burnett AC, Roberts G, Davis N, Hickey L, et al.; Victorian Infant Collaborative Study Group. Changing Neurodevelopment at 8 Years in Children Born Extremely Preterm Since the 1990s. Pediatrics. 2017;139(6):e20164086. doi:.https://doi.org/10.1542/peds.2016-4086
- Woodward LJ, Moor S, Hood KM, Champion PR, Foster-Cohen S, Inder TE, et al. Very preterm children show impairments across multiple neurodevelopmental domains by age 4 years. Arch Dis Child Fetal Neonatal Ed. 2009;94(5):339–44. doi:.https://doi.org/10.1136/adc.2008.146282
- Ancel PY, Goffinet F, Kuhn P, Langer B, Matis J, Hernandorena X, et al.; EPIPAGE-2 Writing Group. Survival and morbidity of preterm children born at 22 through 34 weeks’ gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatr. 2015;169(3):230–8. doi:.https://doi.org/10.1001/jamapediatrics.2014.3351
- Johnson S, Hennessy E, Smith R, Trikic R, Wolke D, Marlow N. Academic attainment and special educational needs in extremely preterm children at 11 years of age: the EPICure study. Arch Dis Child Fetal Neonatal Ed. 2009;94(4):F283–9. doi:.https://doi.org/10.1136/adc.2008.152793
- Schlapbach LJ, Adams M, Proietti E, Aebischer M, Grunt S, Borradori-Tolsa C, et al.; Swiss Neonatal Network & Follow-up Group. Outcome at two years of age in a Swiss national cohort of extremely preterm infants born between 2000 and 2008. BMC Pediatr. 2012;12(1):198. doi:.https://doi.org/10.1186/1471-2431-12-198
- Wong HS, Santhakumaran S, Cowan FM, Modi N ; for Medicines for Neonates Investigator Group. Developmental Assessments in Preterm Children: A Metaanalysis. Pediatrics. 2016;138:2. doi:. https://doi.org/10.1542/peds.2016-0251
- Breeman LD, Jaekel J, Baumann N, Bartmann P, Wolke D. Preterm Cognitive function into adulthood. Pediatrics. 2015;136(3):415–23. doi:.https://doi.org/10.1542/peds.2015-0608
- van Noort-van der Spek IL, Franken MC, Weisglas-Kuperus N. Language functions in preterm-born children: a systematic review and meta-analysis. Pediatrics. 2012;129(4):745–54. doi:.https://doi.org/10.1542/peds.2011-1728
- Bodeau-Livinec F, Zeitlin J, Blondel B, Arnaud C, Fresson J, Burguet A, et al.; Etude Epidemiologique sur les Petits Ages Gestationnels (EPIPAGE) group. Do very preterm twins and singletons differ in their neurodevelopment at 5 years of age? Arch Dis Child Fetal Neonatal Ed. 2013;98(6):F480–7. doi:.https://doi.org/10.1136/archdischild-2013-303737
- Largo RH, Pfister D, Molinari L, Kundu S, Lipp A, Due G. Significance of prenatal, perinatal and postnatal factors in the development of AGA preterm infants at five to seven years. Dev Med Child Neurol. 1989;31(4):440–56. doi:.https://doi.org/10.1111/j.1469-8749.1989.tb04022.x
- Kaufman AKN. Kaufmann assessment battery for children. Minnesota: Circle Pines; 1983.
- Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8–14.
- McManus V, Guillem P, Surman G, Cans C. SCPE work, standardization and definition--an overview of the activities of SCPE: a collaboration of European CP registers. Zhongguo Dang Dai Er Ke Za Zhi. 2006;8(4):261–5.
- Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol. 2008;50(10):744–50. doi:.https://doi.org/10.1111/j.1469-8749.2008.03089.x
- Borenstein-Levin L, Synnes A, Grunau RE, Miller SP, Yoon EW, Shah PS ; Canadian Neonatal Network Investigators. Narcotics and sedative use in preterm neonates. J Pediatr. 2017;180:92–98.e1. doi:.https://doi.org/10.1016/j.jpeds.2016.08.031
- Profit J, Kowalkowski MA, Zupancic JA, Pietz K, Richardson P, Draper D, et al. Baby-MONITOR: a composite indicator of NICU quality. Pediatrics. 2014;134(1):74–82. doi:.https://doi.org/10.1542/peds.2013-3552
- Saldeño YP, Favareto V, Mirpuri J. Prolonged persistent patent ductus arteriosus: potential perdurable anomalies in premature infants. J Perinatol. 2012;32(12):953–8. doi:.https://doi.org/10.1038/jp.2012.31
- Draper ES, Manktelow BN, Cuttini M, Maier RF, Fenton AC, Van Reempts P, et al.; EPICE Cohort. Variability in very preterm stillbirth and in-hospital mortality across Europe. Pediatrics. 2017;139(4):e20161990. doi:.https://doi.org/10.1542/peds.2016-1990
- Larroque B, Ancel PY, Marret S, Marchand L, André M, Arnaud C, et al.; EPIPAGE Study group. Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study. Lancet. 2008;371(9615):813–20. doi:.https://doi.org/10.1016/S0140-6736(08)60380-3
- Brydges CR, Landes JK, Reid CL, Campbell C, French N, Anderson M. Cognitive outcomes in children and adolescents born very preterm: a meta-analysis. Dev Med Child Neurol. 2018;60(5):452–68. doi:.https://doi.org/10.1111/dmcn.13685
- Omizzolo C, Scratch SE, Stargatt R, Kidokoro H, Thompson DK, Lee KJ, et al. Neonatal brain abnormalities and memory and learning outcomes at 7 years in children born very preterm. Memory. 2014;22(6):605–15. doi:.https://doi.org/10.1080/09658211.2013.809765
- Anderson PJ. Neuropsychological outcomes of children born very preterm. Semin Fetal Neonatal Med. 2014;19(2):90–6. doi:.https://doi.org/10.1016/j.siny.2013.11.012
- Vincer MJ, Allen AC, Allen VM, Baskett TF, O’Connell CM. Trends in the prevalence of cerebral palsy among very preterm infants (<31 weeks’ gestational age). Paediatr Child Health. 2014;19(4):185–9. doi:.https://doi.org/10.1093/pch/19.4.185
- Marret S, Marchand-Martin L, Picaud JC, Hascoët JM, Arnaud C, Rozé JC, et al.; for the EPIPAGE Study Group. Brain injury in very preterm children and neurosensory and cognitive disabilities during childhood: the EPIPAGE cohort study. PLoS One. 2013;8(5):e62683. doi:.https://doi.org/10.1371/journal.pone.0062683
- Linsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Prognostic Factors for poor cognitive development in children born very preterm or with very low birth weight: a systematic review. JAMA Pediatr. 2015;169(12):1162–72. doi:.https://doi.org/10.1001/jamapediatrics.2015.2175
- van Veen S, Aarnoudse-Moens CSH, Oosterlaan J, van Sonderen L, de Haan TR, van Kaam AH, et al. Very preterm born children at early school age: Healthcare therapies and educational provisions. Early Hum Dev. 2018;117:39–43. doi:.https://doi.org/10.1016/j.earlhumdev.2017.12.010
- Spencer-Smith MM, Spittle AJ, Doyle LW, Lee KJ, Lorefice L, Suetin A, et al. Long-term benefits of home-based preventive care for preterm infants: a randomized trial. Pediatrics. 2012;130(6):1094–101. doi:.https://doi.org/10.1542/peds.2012-0426
- Sackett DL. Evidence-based medicine. Semin Perinatol. 1997;21(1):3–5. doi:.https://doi.org/10.1016/S0146-0005(97)80013-4