Special Care and School Difficulties in 8-Year-Old Very Preterm Children: The Epipage Cohort Study

OBJECTIVES: To investigate school difficulties, special care and behavioral problems in 8 year-old very preterm (VPT) children. PATIENT AND METHODS: Longitudinal population-based cohort in nine regions of France of VPT children and a reference group born at 39-40 weeks of gestation (WG). The main outcome measures were information about school, special care and behavioral problems using Strengths and Difficulties Questionnaire from a questionnaire to parents. RESULTS: Among the 1439 VPT children, 5% (75/1439) were in a specialised school or class, 18% (259/1439) had repeated a grade in a mainstream class and 77% (1105/1439) were in the appropriate grade-level in mainstream class; these figures were 1% (3/327) , 5% (16/327) and 94% (308/327) , respectively, for the reference group. Also, 15% (221/1435) of VPT children in a mainstream class received support at school versus 5% (16/326) of reference group. More VPT children between the ages of five and eight years received special care (55% (794/1436)) than children born at term (38% (124/325)); more VPT children (21% (292/1387)) had behavioral difficulties than the reference group (11% (35/319)). School difficulties, support at school, special care and behavioral difficulties in VPT children without neuromotor or sensory deficits varied with gestational age, socioeconomic status, and cognitive score at the age of five. CONCLUSIONS: Most 8-year-old VPT children are in mainstream schools. However, they have a high risk of difficulty in school, with more than half requiring additional support at school and/or special care. Referral to special services has increased between the ages of 5 and 8 years, but remained insufficient for those with borderline cognitive scores

Altered autonomic control in preterm newborns with impaired neurological outcomes

Purpose: Very preterm newborns are at high risk of neurological injury. The objective of this work was to study the impact of neurological aggression on the autonomic nervous system. Methods: We studied polysomnography recordings, at term corrected gestational age, for 38 preterm infants born at less than 28 weeks or weighing less than 1 kg. These infants were seen by a neuropediatrician, average age at follow up was 54.4 months. We created two groups: one with children who did not have any neurological disorder, including cerebral palsy (CP), language or mental retardation, visual or hearing disability, and attention disorder; the second group contained children with at least one of these impairments. From the polysomnography recordings, using coarse-graining spectral analysis, we compared heart rate variability indices between preterm infants with normal and abnormal neurological outcomes. Results: Twenty infants had an impaired neurological outcome. Regarding the clinical characteristics, there were more babies born from smoking mothers (p = 0.025), with early-onset neonatal sepsis (p = 0.04), and abnormal results on cerebral magnetic resonance imaging (p = 0.014) in the group with impaired neurological outcomes. Spectral parameters were significantly different between active and quiet sleep. Total powers, harmonic and non-harmonic powers, high frequency and low frequency powers were higher in active sleep compared with those in quiet sleep. Preterm babies with impaired neurological development, in particular those with CP, had lower total power and non-harmonic power especially in active sleep than those with normal neurological outcome. Conclusion: These findings suggest that, in very preterm infants, perinatal neurological injuries could be associated with abnormal maturation of the autonomic nervous system.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Cardiovascular control during sleep in infants: Implications for Sudden Infant Death Syndrome

In infants the cardiorespiratory system undergoes significant functional maturation after birth and these changes are sleep-state dependent. Given the immaturity of these systems it is not surprising that infants are at risk of cardiorespiratory instability, especially during sleep. A failure of cardiovascular control mechanisms in particular is believed to play a role in the final event of Sudden Infant Death Syndrome (SIDS). The " triple risk model" describes SIDS as an event that results from the intersection of three overlapping factors: (1) a vulnerable infant, (2) a critical development period in homeostatic control, and (3) an exogenous stressor. This review summarises normal development of cardiovascular control during sleep in infants and describes the association of impaired cardiovascular control with the three overlapping factors proposed to be involved in SIDS pathogenesis. © 2010.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Sudden infant death syndrome from epidemiology to pathophysiology: Exploring the connections

The sudden and unexplained death of sleeping infants aged less than 1 year, the sudden infant death syndrome (SIDS), is still the principal cause of postneonatal mortality in many industrialized countries. Since initiation of education and information campaigns to inform the public on preventable risk factors, SIDS incidence has dropped significantly in most countries. Questions have, however, been raised on the physiological mechanisms underlying the environmental factors increasing the risk for SIDS. From the scientific literature, it appears that various mechanisms responsible for the control of respiratory, cardiac, thermoregulation, neurovegetative, and waking systems could be impaired before or after birth of future victims of SIDS. To understand how various factors contribute to SIDS deaths, we studied the characteristics of sleeping infants in two different populations, in future SIDS victims and in healthy infants exposed to conditions known to favor SIDS. This paper will review research carried out by our laboratory over the past 20 years.SCOPUS: ch.binfo:eu-repo/semantics/publishe

Maturation of Spontaneous Arousals in Healthy Infants

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Maturation of spontaneous arousals in healthy infants

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Type of schooling and special care for very preterm children without severe deficiencies^a at the age of 5 by cognitive score^b at the age of 5.

a<p>Children assessed at 5 excluding children with cerebral palsy unable to walk without aid and those with severe visual deficiency (<3/10 for both eyes) or severe hearing deficit.</p>b<p>Cognitive score: Mental Processing Composite Scale of the Kaufmann Assessment Battery for Children.</p>c<p>The statistical test includes only children with a cognitive score.</p

Number of children in very preterm and term groups.

<p>Number of children in very preterm and term groups.</p