Co-occurrence et gravité du poids neurodéveloppemental (déficience cognitive, paralysie cérébrale, trouble du spectre de l'autisme et épilepsie) à l'âge de 10 ans chez les enfants nés grands prématurés

Aperçu: G.M.

Cette étude vise à déterminer la prévalence des déficiences neurodéveloppementales à l'âge de dix ans chez les enfants nés extrêmement prématurés (moins de 28 semaines d'âge gestationnel) et à offrir un cadre de catégorisation des limitations neurologiques.Une étude de suivi de cohorte prospective multicentrique a recruté 889 enfants de 10 ans nés entre 2002 et 2004. Les chercheurs ont évalué la prévalence de la déficience cognitive, mesurée par quotient intellectuel et les tests de fonction exécutive, la paralysie cérébrale (PC), le "trouble du spectre de l'autisme" (TSA), et l'épilepsie seule et en combinaison. Les trois niveaux de gravité de la déficience étaient les suivants: catégorie I - absence de déficience neurodéveloppementale majeure; capacité cognitive normale de catégorie II avec CP, TSA et / ou épilepsie; et catégorie III - enfants atteints de déficience cognitive.Au total, 214 des 873 enfants (25%) avaient des troubles cognitifs, 93 des 849 enfants (11%) avaient une CP, 61 des 857 enfants (7%) avaient des TSA et 66 des 888 enfants (7%) souffraient d'épilepsie. De plus, 19% de tous les enfants avaient un diagnostic, 10% avaient deux diagnostics et 3% avaient trois diagnostics. La diminution de l'âge gestationnel était associée à l'augmentation du nombre de déficiences (P <0,001). La moitié des enfants atteints de déficience cognitive et un tiers des enfants atteints de PC, de TSA ou d'épilepsie présentaient une seule déficience.

Six cent un (68% [IC 95%, 64,5% -70,7%]) étaient dans la catégorie I, 74 (8% [IC 95%, 6,6% -10,3%]) dans la catégorie II, et 214 (24% [IC à 95% 21,7% -27,4%]) étaient dans la catégorie III.Les trois quarts des enfants avaient un intellect normal à l'âge de dix ans; Près de 70% étaient exempts de déficience neurodéveloppementale. Quarante pour cent des enfants atteints de déficiences ont eu plusieurs diagnostics. 

Pediatr Neurol. 2017 Nov 13. pii: S0887-8994(17)30718-X. doi: 10.1016/j.pediatrneurol.2017.11.002.

Co-occurrence and Severity of Neurodevelopmental Burden (Cognitive Impairment, Cerebral Palsy, Autism Spectrum Disorder, and Epilepsy) at Age 10 Years in Children Born Extremely Preterm

Hirschberger RG¹, Kuban KCK², O'Shea TM³, Joseph RM⁴, Heeren T⁵, Douglass L², Stafstrom CE⁶, Jara H⁷, Frazier JA⁸, Hirtz D⁹, Rollins J³, Paneth N¹⁰; ELGAN Study Investigators.

Collaborators (66)

Ware J¹¹, Coster T¹¹, Hanson B¹¹, Wilson R¹¹, McGhee K¹¹, Lee P¹¹, Asgarian A¹¹, Sadhwani A¹¹, Perrin E¹², Neger E¹², Mattern K¹², Walkowiak J¹², Barron S¹², Shah B¹³, Singh R¹³, Smith A¹³, Klein D¹³, McQuiston S¹³, Venuti L¹⁴, Powers B¹⁴, Foley A¹⁴, Dessureau B¹⁴, Wood M¹⁴, Damon-Minow J¹⁴, Ehrenkranz R¹⁵, Benjamin J¹⁵, Romano E¹⁵, Tsatsanis K¹⁵, Chawarska K¹⁵, Kim S¹⁵, Dieterich S¹⁵, Bearrs K¹⁵, Peters N¹⁶, Brown P¹⁶, Ansusinha E¹⁶, Waldrep E¹⁶, Friedman J¹⁶, Hounshell G¹⁶, Allred D¹⁶, Engelke SC¹⁷, Darden-Saad N¹⁷, Stainback G¹⁷, Warner D¹⁸, Wereszczak J¹⁸, Bernhardt J¹⁸, McKeeman J¹⁸, Meyer E¹⁸, Pastyrnak S¹⁹, Rathbun J¹⁹, Nota S¹⁹, Crumb T¹⁹, Lenski M²⁰, Weiland D²⁰, Lloyd M²⁰, Hunter S²¹, Msall M²¹, Ramoskaite R²¹, Wiggins S²¹, Washington K²¹, Martin R²¹, Prendergast B²¹, Scott M²¹, Klarr J²², Kring B²², DeRidder J²², Vogt K²².

Author information

1

Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts. Electronic address: rachel.hirschberger@childrens.harvard.edu.

2

Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.

3

University of North Carolina, Chapel Hill, North Carolina.

4

Department of Psychology and Neuroanatomy, Boston University, Boston, Massachusetts.

5

Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.

6

Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland.

7

Department of Radiology, Boston Medical Center, Boston University, Boston, Massachusetts.

8

Departments of Psychiatry and Pediatrics, UMASS Medical School/ University of Massachusetts Memorial Health Care, Worcester, Massachusetts.

9

National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.

10

Department of Epidemiology and Biostatistics and Pediatrics and Human Development, Michigan State University, East Lansing, Michigan.

11

Boston Children's Hospital, Boston, Massachusetts.

12

Tufts Medical Center, Boston, Massachusetts.

13

Baystate Medical Center.

14

University of Massachusetts Medical School, Worcester, Massachusetts.

15

Yale University School of Medicine, New Haven, Connecticut.

16

Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina.

17

University Health Systems of Eastern Carolina, Greenville, North Carolina.

18

North Carolina Children's Hospital, Chapel Hill, North Carolina.

19

Helen DeVos Children's Hospital, Grand Rapids, Michigan.

20

Sparrow Hospital, Lansing, Michigan.

21

University of Chicago Medical Center, Chicago, Illinois.

22

William Beaumont Hospital, Royal Oak, Michigan.

Abstract

BACKGROUND:

This study aims to determine the prevalence of neurodevelopmental impairments at age ten years among children born extremely preterm (less than 28 weeks gestational age) and to offer a framework for categorizing neurological limitations.

METHODS:

A multicenter, prospective cohort follow-up study recruited 889 ten-year-old children born from 2002 to 2004. We assessed prevalence of cognitive impairment, measured by intelligent quotient and tests of executive function, cerebral palsy (CP), autism spectrum disorder (ASD), and epilepsy singly and in combination. The three levels of impairment severity were: category I-no major neurodevelopmental impairment; category II-normal cognitive ability with CP, ASD, and/or epilepsy; and category III-children with cognitive impairment.

RESULTS:

A total 214 of 873 children (25%) had cognitive impairment, 93 of 849 children (11%) had CP, 61 of 857 children (7%) had ASD, and 66 of 888 children (7%) had epilepsy. Further, 19% of all children had one diagnosis, 10% had two diagnoses, and 3% had three diagnoses. Decreasing gestational age was associated with increasing number of impairments (P < 0.001). Half the children with cognitive impairment and one third of children with CP, ASD, or epilepsy had a single impairment. Six hundred one (68% [95% CI, 64.5%-70.7%]) children were in category I, 74 (8% [95% CI, 6.6%-10.3%]) were in category II, and 214 (24% [95% CI 21.7%-27.4%]) were in category III.

CONCLUSIONS:

Three quarters of children had normal intellect at age ten years; nearly 70% were free of neurodevelopmental impairment. Forty percent of children with impairments had multiple diagnoses.

Copyright © 2017 Elsevier Inc. All rights reserved.

PMID:29310907

DOI:10.1016/j.pediatrneurol.2017.11.002