Published online May 26, 2009
PEDIATRICS Vol. 123 No. 6 June 2009, pp. 1485-1492 (doi:10.1542/peds.2008-1216)
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ARTICLE

Behavioral Problems and Cognitive Performance at 5 Years of Age After Very Preterm Birth: The EPIPAGE Study

Malika Delobel-Ayoub, MDa,b, Catherine Arnaud, MDa,b,c, Mélanie White-Koning, PhDa,b, Charlotte Casper, MD, PhDd, Véronique Pierrat, MD, PhDe,f, Micheline Garel, MScf,g, Antoine Burguet, MD, PhDf,h, Jean-Christophe Roze, MD, PhDi, Jacqueline Matis, MDj, Jean-Charles Picaud, MD, PhDk, Monique Kaminski, MScf,g, Béatrice Larroque, MD, PhDf,g for the EPIPAGE Study Group

a Institut National de la Santé et de la Recherche Médicale, U558, Research Unit on Perinatal Epidemiology, Child Health, and Development, Toulouse, France
b Department of Epidemiology, Université Toulouse III Paul Sabatier, Toulouse, France
c Epidemiology Service
d Department of Neonatology, University Hospital of Toulouse (CHU), Toulouse, France
e Department of Neonatology, Jeanne de Flandres Hospital, Lille, France
f Institut National de la Santé et de la Recherche Médicale, UMR S149, IFR 69, Epidemiological Research Unit on Perinatal Health and Women's Health, Villejuif, France
g Université Pierre et Marie Curie, UPMC Univ Paris 06, UMR S149, Paris, France
h Department of Neonatology, University Hospital (CHU), Dijon, France
i Department of Neonatology, Children's Hospital, Nantes, France
j Department of Neonatology, Hautepierre Hospital, Strasbourg, France
k Department of Neonatology, University Hospital (CHU) Montpellier, Arnaud de Villeneuve Hospital, Montpellier, France

OBJECTIVES. We compared the frequency of behavioral problems in very preterm and term children at 5 years of age. We hypothesized that behavioral problems would be associated with cognitive impairment and environmental factors and that differences between the 2 groups would be reduced but persist after adjusting for cognitive performance and environmental factors.

PATIENTS AND METHODS. The Etude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE) study was a prospective population-based cohort study that included all births occurring between 22 and 32 weeks' gestation and a control group of infants born at 39 to 40 weeks' gestation in 1997 in 9 French regions. Neonatal and obstetrics data were collected at birth. At 5 years of age, sociodemographic status and neurodevelopmental and cognitive development of the children, as well as maternal mental well-being, were assessed. The behavioral problems of 1102 very preterm and 375 term singletons without major impairments were studied by using the parent-completed Strengths and Difficulties Questionnaire.

RESULTS. Parents of very preterm children reported significantly more behavioral problems, with a twofold higher prevalence compared with term children for hyperactivity/inattention, emotional symptoms, and peer problems. Behavioral problems were associated with low cognitive performance, developmental delay, hospitalizations of the child, young maternal age, and poor maternal mental well-being. Very preterm children were still at higher risk of behavioral problems compared with term children after adjustment for cognitive performance and all others factors.

CONCLUSIONS. Behavioral problems were strongly related to cognitive impairment, but very preterm children were still at higher risk even after adjusting for cognitive performance. Early screening for behavioral problems should be encouraged for all very preterm children, and maternal well-being should also be the focus of special attention.

Key Words: very preterm children • behavioral problems • cognition disorders • cohort study

Abbreviations: EPIPAGE—Etude Epidémiologique sur les Petits Ages Gestationnels • SDQ—Strength and Difficulties Questionnaire • K-ABC—Kaufman Assessment Battery for Children • MPCS—Mental Processing Composite Scale • OR—odds ratio • CI—confidence interval

Accepted Sep 25, 2008.


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