[For what reasons is the neurologic status of very premature infants altered between 1 and 2 years in a follow-up study? The contribution of a Frache-Comté region study].
BACKGROUND
The purpose of this population-based study was firstly to compare the neuro-developmental outcome at one and two years of very preterm infants, and secondly, to identify the risk factors for a misdiagnosis of cerebral impairment at the age of one year.


METHODS
The preterm cohort included 203 infants born between 25 and 32 weeks of gestational age in the region of Franche-Comté (France) during a two-year period. The control group included 196 full-term infants born in the same maternity wards. Neuro-developmental assessments were performed by pediatricians or physicians, both at one and two years of age, on 94% (161/171) surviving preterms and 89% (173/195) full-terms.


RESULTS
There is a fair correlation between the two neurological evaluations of the control group (170/173, 98% have the same classification at the age of one and two). There is a weak correlation (kappa = 0.37) between the two neurological evaluations of the preterm group. Sixteen preterms (10%) had been classified more abnormal at one year than they were at two years. The presence of a broncho-pulmonary dysplasia, linked to male sex and extreme prematurity, was statistically linked to this first kind of misclassification. Seventeen preterms (10%) had been considered more normal at one year than they were at two years. The presence of a diplegia, family precariousness and the examination at one year of age by a general practitioner were statistically linked to this second kind of misclassification.


CONCLUSIONS
This prospective population-based study identifies structural situations (bronchopulmonary dysplasia linked to extreme prematurity) and environmental situations (family precariousness, examiner's qualifications) linked to a misclassification of the neurological status of one-year-old former preterm infants.
Burguet
A
A
Service de réanimation infantile polyvalente et prématurés, CHU de Besançon, France.
Monnet
E
E
Roth
P
P
Menget
A
A
D000367:Age Factors; D001927:Brain Diseases / Q000145:classification; D001997:Bronchopulmonary Dysplasia / Q000150:complications; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000145:classification*; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D005602:France; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D009460:Neurologic Examination; D010264:Paraplegia / Q000150:complications; D010372:Pediatrics; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors