title: Brain injury in very preterm children and neurosensory and cognitive disabilities during childhood: the EPIPAGE cohort study.
abstract: OBJECTIVE
  To investigate the association of motor and cognitive/learning deficiencies and overall disabilities in very preterm (VPT) children and their relations to gestational age (GA) and brain lesions.
  
  
  METHODS
  EPIPAGE is a longitudinal population-based cohort study of children born before 33 weeks' gestation (WG) in 9 French regions in 1997-1998. Cumulating data from all follow up stages, neurodevelopmental outcomes were available for 90% of the 2480 VPT survivors at 8 years. Main outcomes were association of motor and cognitive deficiencies and existence of at least one deficiency (motor, cognitive, behavioral/psychiatric, epileptic, visual, and/or hearing deficiencies) in three GA groups (24-26, 27-28, and 29-32WG) and four groups of brain lesions (none, minor, moderate, or severe).
  
  
  RESULTS
  VPT had high rates of motor (14%) and cognitive (31%) deficiencies. Only 6% had an isolated motor deficiency, 23% an isolated cognitive one and 8% both types. This rate reached 20% among extremely preterm. Psychiatric disorders and epilepsy were observed in 6% and 2% of children, respectively. The risks of at least one severe or moderate deficiency were 11 and 29%. These risks increased as GA decreased; only 36% of children born extremely preterm had no reported deficiency. Among children with major white matter injury (WMI), deficiency rates reached 71% at 24-26WG, 88% at 27-28WG, and 80% at 29-32WG; more than 40% had associated motor and cognitive deficiencies. By contrast, isolated cognitive deficiency was the most frequent problem among children without major lesions.
  
  
  CONCLUSIONS
  In VPT, the lower the GA, the higher the neurodisability rate. Cerebral palsy is common. Impaired cognitive development is more frequent. Its occurrence in case without WMI or early motor disorders makes long-term follow up necessary. The strong association between motor impairments, when they exist, and later cognitive dysfunction supports the hypothesis of a common origin of these difficulties.
authors: Department of Neonatal Medicine, Rouen University Hospital and Region-INSERM Team, ERI 28, NeoVasc, Institute for Biomedical Research and Innovation, Rouen University, Rouen, France. stephane.marret@chu-rouen.fr
authors: Stéphane
authors: S
authors: Marret
authors: Laetitia
authors: L
authors: Marchand-Martin
authors: Jean-Charles
authors: JC
authors: Picaud
authors: Jean-Michel
authors: JM
authors: Hascoët
authors: Catherine
authors: C
authors: Arnaud
authors: Jean-Christophe
authors: JC
authors: Rozé
authors: Patrick
authors: P
authors: Truffert
authors: Béatrice
authors: B
authors: Larroque
authors: Monique
authors: M
authors: Kaminski
authors: Pierre-Yves
authors: PY
authors: Ancel
mesh_terms: D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D001930:Brain Injuries / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007858:Learning; D009043:Motor Activity; D011247:Pregnancy; D047928:Premature Birth / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012677:Sensation; D012886:Skull / Q000000981:diagnostic imaging; D014463:Ultrasonography
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