Abstract
Premature birth is a worldwide public health priority. One in ten children is born before 37 weeks of gestational age and, in developed countries, survival rates without major neonatal morbidity are increasing. Although severe sequelae associated with these births have decreased, their neurobehavioral difficulties, often associated in multiple fields, remain stable but still widespread. These neurobehavioral difficulties hamper the normal development of academic achievements and societal integration and intensify the children’s needs for rehabilitation during their preschool and academic years. Severe sequelae increase when gestational age decreases. This is even truer if the socio-cultural background is impeded by low income, education and language skills as compared with defined averages. However, moderate and/or minor neurocognitive and/or behavioral difficulties are almost identical for a moderate or a late preterm birth. Obtaining a better clinical description of neurobehavioral characteristics of those pretermly born, once they reach preschool age, is essential to detect behavioral issues as well as early specific cognitive difficulties (working memory, planning, inhibition, language expression and reception, attention and fine motor skills, etc.). Such information would provide a better understanding of the executive functions’ role in brain connectivity, neurodevelopment and neuroanatomical correlation with premature encephalopathy.
Highlights
Comprehensive research over the past three decades has profiled the neurodevelopmental consequences of preterm birth
The objective of this review is to provide a complete and current characterization of the neurobehavioral phenotype and highlight the main gaps in knowledge, mainly with regard to the evolution of symptoms, the co-occurrence of disorders in the same individual, associations with chronological age and degree of prematurity
It is under this new perspective that the neurodevelopmental outcome of five-year-old children in the EPIPAGE 2 cohort was recently presented with a composite score of evaluation of “neurobehavioral” disorders at four levels, namely, no deficit, mild deficit, moderate deficit, or severe deficit, including the analysis of the intelligence quotient (Wechsler IV); the screening of visual and auditory disorders; the study of motor disorders (cerebral palsy (CP), via the Gross Motor Function Classification System (GMFCS), and coordination acquisition disorder (CAD) via the Movement Assessment Battery for Children—Second Edition (M-ABC2)); and behavior (Strengths and Difficulties Questionnaire (SDQ))
Summary
Comprehensive research over the past three decades has profiled the neurodevelopmental consequences of preterm birth. Studies were considered for inclusion in this review if they investigated the neurobehavioral and/or emotional outcomes and/or dysexecutive syndrome and/or neurodisabilities of children and adolescents born premature, and if they made explicit reference to the premature neurobehavioral phenotype in the background or discussion of the study when interpreting the findings The objective of this narrative review is to describe, as precisely as possible, the long-term neurobehavioral profile of the premature infant, its characteristics compared with those of the infant born at term and the relevance of this assessment, that is, the social consequences and/or quality of life and the role of executive functions in the genesis of the profile. Large international cohort of 11 countries focused on VP-born children, mortality declined between 2007 and 2015 and, except for Canada, there was an increase in bronchopulmonary dysplasia in most countries [3,9]
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