Kristie McNealy, MD

In my experience, it’s pretty much the norm for parents of preemies to worry about the longterm problems their babies may face as the result of their prematurity. A recently published study examining preemies born before 33 weeks gestation in France (in 1997 – after the introduction of artificial surfactant) shows that at 5 years of age, nearly 40% had some degree of physical or mental disability.

Cerebral palsy was seen in 9% of the preemies studied, and 32% had mental processing composite scores less than 85 (more than 1 standard deviation below the mean of 100). While I’ve only seen the abstract of this study, so I don’t know if they broke out their data by gestational age, I can only imagine that disability was more prevalent at earlier gestational ages. Yet, the fact that nearly 1/3 of the preemies in the study had lower than normal mental processing scores still gave me reason to spend the rest of the day wondering what the future really holds for our 31 weeker.

To me, the thing this study highlights is the need for more longterm follow-up of preemies as they reach school age and beyond. Trends and standards of care in neonatology have changed a lot over the past decade, impacting the use of steroids, theophylline and other medical interventions both before and after delivery. The only way we’ll know the true impact of these changes will be to watch these kids over time. HIPAA has made keeping track of preemies outside of the NICU and following up on their condition more difficult. I think more serious consideration needs to be given to the concept of opt in registries of former preemies which would allow larger follow-up studies to be performed and outcome data to be tracked more efficiently.

Reference: B Larroque, P Ancel, S Marret, L Marchand, M André, C Arnaud, V Pierrat, J Rozé, J Messer, G Thiriez, A Burguet, J Picaud, G Bréart and M Kaminski. Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study. March 2008. The Lancet, Vol 371: 9615.

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