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Devenir médical, psychologique et affectif à l'âge d'un an des prématurés indemnes de handicap sévère. Étude prospective cas-témoins
Abstract
Background
This case-control prospective study was conducted to determine whether and how medical, psychological and affective development differs from premature to full-term newborns without severe disability.
Population and methods
Newborns under or at 33 weeks gestation (W) were included from December 1992 to January 1994 and were matched with two controls. The same examiners evaluated each infant at the effective postnatal age of nine to ten months.
Results
Fifty premature babies (average gestational age [GA] = 30.7 W) were compared to 100 controls. The main problems were bronchopulmonary (P = 0.03) and sleep (P = 0.027) disorders. Motor disability was suspected in 9% of the cases and none control (P = 0.00003, OR = 3.44). By multivariate analysis, cases differed from the controls by infant-mother relation disturbances (OR = 13.3), motherhood anxiety (OR = 13.3), poor expressiveness (OR = 5.6), peripheral tonus anomalies (OR = 39.5) and sleep troubles (OR = 5.8).
Conclusion
Premature newborns had risks for the child-mother relation but not for psychoaffective development disturbances.
En milieu hospitalier, dans les services de chirurgie maxillo-faciale, ORL et stomatologie, les patients se retrouvent parfois dans l'impossibilité de parler durant les premiers jours suivant leur opération. Une minorité de ces patients appartiennent à la population dite en situation d'illettrisme, d'analphabétisme, ou bien peuvent être d'origine étrangère (touristes ou primo-arrivants) ne maîtrisant pas la langue française. Cette population privée de la parole et ne pouvant pas s'exprimer par écrit se retrouve alors sans moyen de communication efficace. L'objectif de ce mémoire est donc de proposer un outil de communication pour soutenir la communication non verbale durant la phase postopératoire de ces patients. Il s'agit d'un tableau qui répond aux situations de communication propres au contexte hospitalier et à la phase postopératoire. Il faut que l?outil de communication envisagé ne nécessite aucun apprentissage de la part du patient pour son utilisation et il faut qu'il soit adapté au mieux aux compétences et connaissances de l'écriture de ce public. Ce mémoire consiste à présenter la démarche technique de la conception d'un tableau de communication et d'en explorer son usage.
La périnatalité en Guyane est marquée par une mortalité double de celle des autres chiffres nationaux. Dans le cadre d’un projet global faisant intervenir tous les acteurs autour de la naissance, l’unité de néonatologie du centre hospitalier de Cayenne (CHC) a bénéficié depuis 1996 d’un programme de mise à niveau pour pallier le retard considérable de structure et de moyens. Notre étude avait un double objectif : établir après 2 ans de mise en place du programme la qualité de la prise en charge des prématurés de moins de 33 semaines d’aménorrhée (SA) nés en 1998 ; évaluer le devenir médical et familial de ce groupe d’enfants.
To be born “ very-low-birth-weight children ”, and after ?
Progresses in foetal medicine and the development of medically-assisted procreation have produced a new population of particularly vulnerable children : the “ very-low-birth-weight children ”. These young survivors are exposed to many risks including early and severe neurological lesions. Many will also develop cognitive and behavioral troubles later in life, generally defined as “ sequaele ” and attributed to “ lesions or minimal neurological dysfunction ”. Our study of a group of ten seven-year-old children and their parents clearly reveals the power of sequel-linked psychic productions with, on one side, the children in a battle against the process of individuation, and on the other side, parents who seem ill-disposed to support them because they are still traumatized by the unexpected and perilous birth situation. This psychopathological approach, which is more attuned to the implication of psychic inscriptions than to neurologically oriented explanations should open up new therapeutic and preventive perspectives which are not yet in current use because then have not been sufficiently studied in a context which is largely dominated by the lesional model. The destiny of these children has created a new interest for the îlate syndrome of one-time premature babiesî. described by I. Lézine and J. Bergès thirty years ago.
Aim – To determine cognitive performances and affective development of a cohort of very premature babies at the age of 4 years.Population and methods – Longitudinal case–control study. Newborns less than 33 weeks gestation were included from 1992 to 1994 and were matched with two full-term newborns. At 4 years of age, they have been evaluated for medical status, cognitive functions with the K-ABC test and affective condition with the PSA and Conners' tests.Results – The preterm group was significantly different from the controls for: a smaller heigth, (P < 0.01), a lower socioeconomic level (P = 0.027), a lower nursery school level (44% versus 27,6%, P = 0.05), the incapacity to draw “a bonhomme” (55,3% versus 93%, P < 0.001), lower performances for the K-ABC and PSA tests, a pathologic Conners score (20.4% versus 2.4%, P < 0.001). Multivariate analysis by logistic regression showed a similar neuropsychological results: a lower score of K-ABC (< 80, P = 0.0006, odds-ratio = 33.2), and a lower social competence score of PSA (< 45, P = 0.004, odds-ratio = 35.9).Conclusion – Follow-up of premature babies is required, and measures to prevent or minimize cognitive and social disabilities are mandatory.
Case report. – Two children were admitted for poisoning by organophosphate pesticides applied as hair rinses against lice. These chemical agents inhibit the acetylcholinesterase enzyme at various sites. The resultant accumulation of the transmitter acetylcholine causes abnormal signs and symptoms. The diagnosis is based on a reduction in the blood cholinesterase activity. The specific treatment comprises the administration of atropine and pralidoxime.Conclusion. – Accidental poisoning by organophosphate insecticides may occur, due to the misuse of such substances as shampoo against lice. An accurate information for users is necessary.
The aim of the study was to compare the rehospitalization rate in the first year of life between 2 groups of very preterm infants born on 1997 and 2002; then we compared the very preterm infants' rehospitalization rate between our retrospective 1997 group and literature (including French cohort Epipage).
Our retrospective study included all neonates born<or=33 GA, living in Gironde, discharged from neonatal unit at children's hospital of Bordeaux on 1997 and 2002 and rehospitalized during their first year of life.
Respectively 29.1% and 30.1% premature infants were rehospitalized (at least once) in 1997 and 2002 (38.2% in Epipage cohort, no statistical difference). Mean number of rehospitalizations was 1.66 in 1997 and 1.77 in 2002. Mean duration of rehospitalization was 11.8 days in 1997 and 16.8 days in 2002. These data showed no statistical difference between 1997 and 2002. Respiratory disease was the first reason of rehospitalization. Several factors were correlated with an increase risk of rehospitalization: birth weight less than 1000 g, chronic lung disease and gestational age less than 28 weeks at birth (only in 2002 cohort).
Rehospitalization rate remained stable between 1997 and 2002 whereas during this period of time, the gravity of these preterm infants had increased. The use of specific hospital discharge procedure represents a real benefit for premature infants. It must be continued after the discharge with the establishment of a strong network with the implication of parents, infants, hospital and city health workers. It may contribute to limit the very premature babies' rehospitalization rate.
Our goal was to compare the prevalence of behavioral problems between very preterm children and term children at 3 years of age and examine the factors associated with behavioral problems in very preterm children.
We conducted a prospective population-based cohort study: the EPIPAGE (Etude Epidémiologique sur les Petits Ages Gestationnels) study. All infants born between 22 and 32 weeks of gestation in 9 regions of France in 1997 were included and compared with a control group of infants born at term. Sociodemographic status, obstetric, and neonatal data were collected at birth and in the neonatal units. At 3 years of age, the behavioral problems of 1228 very preterm singleton children without major neurodisabilities, and 447 term children were studied using the Strengths and Difficulties Questionnaire completed by the parents.
Very preterm children were more likely than controls to have behavioral difficulties. Among very preterm children, several medical conditions were associated with a high total difficulty score: major neonatal cerebral lesions diagnosed by cranial ultrasonographic studies, hospitalization within the last year, poor health, and psychomotor delay. A high birth order and sociodemographic factors such as young maternal age and low educational level of the mother were also identified as risk factors for behavioral difficulties. The differences between very preterm children and controls remained significant after adjustment for sociodemographic characteristics, neonatal complications, and neurodevelopmental status, for a high total difficulties score, hyperactivity, conduct problems, and for peer problems. For emotional problems, the difference was at the limit of significance.
Very preterm children have a higher risk of behavioral problems at 3 years of age compared with term-born children. Health and neurodevelopmental status of the child were significantly associated with behavioral difficulties.
The hospitalisation of low birth weight neonates has an effect on the parent-child relationship. A prospective study on the effects of returning home and on home conditions was conducted in the neonatal unit over a 6-month period. Fifty infants were included in the study. The results showed that difficulties in the parent-child relationship took place after the infant returned home in 11 cases (22%). Examination of the possible role of factors prior to or during the hospital stay indicated the significance of the following: premature delivery, disturbances during the childhood one of the parent's, and the infant's stay in the neonatal intensive care unit.
remature birth is a factor of impaired infant-parent attachment. In addition it is frequently associated with other factors of impaired attachment related either to the infant (mainly the various pathologies of the premature infants and the hospitalization) and/or to the parents, specially the mother. The main characteristics of the normal process of infant-parent interaction are described as a basis for the early recognition and assessment of impaired interaction and preventive intervention.
Aim. - The purpose of this population-based study was to compare the incidence of neurodevelopmental disability and its risk factors between preterm and full-term infants matched as control group. Population and methods. - The preterm cohort included 203 infants born between 25 and 33 weeks of gestational age in the region of Franche-Comté (France) during a two-year-period. The control group included 196 full-term infants born in the same maternities. Survival up to the date of follow-up was 171203 (84%) for preterms and 195196 (99.5%) for full-term infants (uncorrected age, mean 12months). Neurodevelopmental assessements were performed by pediatricians or physicians on 164171 surviving preterms (96% follow-up) and 179195 full-terms (92%) Results. - Thirty-two (19.5%) preterm infants had disability, ten of these (6%) showing severe disability. Five (2.8%) full-term infants had disability, one of these (.5%) having severe disability. Risk factors predicting a disability included in a multivariate approach: prematurity (odds-ratio [OR]: 7.8), maternal age > 37 (OR: 3.0), lack of profession for both parents (OR: 3.7), male gender (OR: 2.9). The pediatrician observed a disability more frequently than the physician (OR: 2.46). Likewise, risk factors predicting a severe disability included: prematurity (OR: 10.8), lack of profession for both parents (OR: 5.8) and monochorial twin-placentation (OR: 4.5). Conclusions. - Prematurity is not the only risk factor to be taken into account for neurodevelopmental evaluation of premature infants, but its influence still remains widely predominant.
summarize the current status of the NBAS [Neonatal Behavioral Assessment Scale] and attempt to outline its appropriateness as a research instrument / explore some of the conceptual and methodological issues involved in utilizing the NBAS to facilitate communication between parents, professionals, and the new baby / psychometric issues of reliability and validity, including its use in predicting the baby's later developmental outcome, will also be addressed (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Abstract The impact of prematurity on the responsiveness of mothers and their 4-nionih-old infants was examined across three channels of communication: attentional, vocal and affective. Loglinear models were used to determine how the behavior of one partner was conditional upon the behavior of the other during home observations of '24 preterm and 24 term infants and their mothers. Visual attention was elicited by vocalization, and the onset of infant gaze was marled by a maternal smile. Mothers and infants responded to vocalizations with vocalizations, and mothers responded to smiles with smiles. Mothers of preterm infants were particularly responsive to their infants' signals within the: attentional. vocal and affective channels. Preterm infants demonstrated correspondingly heightened responsiveness within the vocal and affective channels.
The relation between neurodevelopmental status at one and eight years of age was investigated in a cohort of 207 infants born between 1979 and 1982 at <33 weeks of gestation. The probability of a major disabling impairment at eight years was only 1 per cent among 164 children with normal neurodevelopment at one year, but 56 per cent for the 43 impaired children and 92 per cent for the 23 of these who had major disabling impairments. Close correspondence was found between the type of major impairment diagnosed at one and eight years. Neurodevelopmental status at one year also predicted the need for extra educational provision by eight years, with probabilities of 9 per cent for children without impairment at one year, 56 per cent for impaired children and 87 per cent for those with major impairments. Similarly, neurodevelopmental status predicted an IQ of more than 2 SD below the mean (<70), with probabilities of 0, 30 per cent and 48 per cent, respectively.
RÉSUMÉ
Relation entre l'état neurodéveloppemental à un et huit ans de nourrissons grands prématurés
La relation entre l'état neurodevéloppemental à un et huit ans a étéévaluée sur un groupe de 207 nourrissons nés entre 1979 et 1982 à moins de 33 semaines de gestation. La probabilityé d'une incapacityé majeure à huit ans était seulement de un pour cent parmi les 164 enfants présentant un état neurodéveloppemental normal à un an, mais de 56 pour cent pour les 43 nourrissons atteints à un an, et de 92 pour cent pour les 23 nourrissons présentant des incapacityés majeures à un an. Une correspondance étroite a été trouvée dans le type d'incapacité majeure diagnostiquée à un et huit ans. l'état neurodéveloppemental à un an permettait également de prévoir Ie besoin d'une approche éducative spécialisée à huit ans. De même, l'état neurodéveloppemental permettait de prévoir un Q.I. de plus de deux écarts‐types au dessous de la moyenne (<70).
ZUSAMMENFASSUNG
Entwicklungsneurologischer Status mil einem und acht Jahren bei Kindern mil sehr niedrigem Gestationsalter
Bei einer Gruppe von 207 Kindern, die zwischen 1979 und 1982 mit einem Gestationsalter von <33 Wochen geboren wurden, wurde mit einem und acht Jahren der entwicklungsneurologische Status untersucht. Die Wahrscheinlichkeit einer schweren Behinderung im Alter von acht Jahren betrug bei 164 Kindern, die mit einem Jahr einen normalen entwicklungsneurologischen Status hatten, nur ein Prozent, dagegen 56 Prozent für die 43 Kinder mit Störungen und 92 Prozent für 23 dieser Kinder, die schwere Behinderungen hatten. Es bestand ein enger Zusammenhang zwischen dem Behinderungstyp, der mit einem Jahr, bzw mit acht Jahren diagnostizert wurde. Aufgrund des entwicklungsneurologischen Status mit einem Jahr konnte vorausgesagt werden, ob mit acht Jahren eine Sonderschulung notwendig sein wiirde. Desgleichen konnte anhand des entwicklungs‐neurologischen Status ein IQ von mehr als 2 SD unter dem Mittel (<70) vorausgesagt werden.
RESUMEN
Relatión entre el estatus neuroevolutivo en niños muy pretermino, al aho y a los ocho años de edad Se investingó la relación entre el estatus neuroevolutivo al año y ocho años de edad, en un grupo de 207 lactantes nacidos entre 1979 y 1982 a las <33 semanas de gestateón. La probabilidad de una alteratión mayor incapacitante a los ocho años era só1o de 1 por ciento en 164 niños, con un desarroiio neuroevolutivo normal al año de edad, pero del 56 por ciento en 43 niños afectos y del 93 por ciento de los 23 de éstos que tenian unas discapacidades mayores. Se halló una clara correspondencia entre el tipo de discapacidad mayor diagnosticada al año de edad y a los ocho años. El estatus neuroevolutivo al aflo de edad predecia la necesidad que se tendria a los ocho años de una education extra. Igualmente, el estatus neuroevolutivo predecia un CI de mas de 2 SD por debajo del promedio (<70).
Objective:
The objective of this study was to examine the effect of family and neighborhood income on health care use of young children born prematurely and of low birth weight (N = 619).
Design:
A birth cohort was enrolled in a clinical randomized trial of early childhood educational and family services.
Settings/participants:
Infant Health and Development Program provided a sample of low birth weight premature infants stratified by clinical site, birth weight, and treatment group. Maternal reports of health care use, family income, and heath insurance were obtained at 12, 24, and 36 months of corrected age. Neighborhood income was based on census tract residence at birth.
Main outcome measures:
Maternal reports of hospitalizations, doctor visits, and emergency department visits were used; data were averaged over the child's first 3 years of life.
Results:
Children from poorer families were more likely to be hospitalized and to have more emergency department visits than were children from more affluent families. Residence in poor and middle-income neighborhoods was associated with more emergency department visits than residence in affluent neighborhoods. Families in middle-income neighborhoods reported more doctor visits than families in poor or affluent neighborhoods.
Conclusion:
Neighborhood residence influences health care use by poor and nonpoor families and by insured and uninsured families. The use of the emergency department for low birth weight premature children in middle-income and poor neighborhoods is discussed.
Thesis (doctoral)--Université de Lausanne, 1981.
To examine the relationship among infant temperament, maternal background, social support, confidence, and mother-infant interaction in a low socieconomic status population.
Interaction between 49 premature infants and their mothers was assessed longitudinally at ages 4 months and 8 months using feeding and play scales. Social support, maternal confidence, and infant temperament were also assessed by questionnaires given to the mother.
At 4 months, mother-child interaction was significantly correlated with length of hospitalization, birthweight, temperament, and social support. At 8 months, only temperament and social support were correlated with mother-infant interaction.
Efforts should be focused on early assessment of mother's perceptions of their infants. Support systems should be evaluated prior to discharge.
In a long-term prospective study, 46 unselected infants born before 35 completed weeks of gestation were compared with 26 full-term infants. At four years of age, 44 preterms and 25 full-terms were available to follow-up. The preterms were somewhat shorter in stature and lighter in weight than the full-terms but fell well within the normal range for Swedish children. Head circumference in the preterm group was significantly correlated to neurological development. Psychometric evaluation with Griffiths' mental developmental scale showed the preterms to fall within the normal range, though their performance was inferior to that of the full-terms. The greatest differences between the groups were in scores for the subscales eye and hand coordination, performance, and practical reasoning. There was no correlation within the preterm group between the test results and birthweight, gestational age, prenatal score, perinatal score, or parental social status or education. Language development was delayed among the preterms, more of whom required speech therapy. Visual and hearing disorders were more common among preterms than expected. Although they were all in good health, more preterms than full-terms needed hospital care during the first four years of life.
The sleep states and wakefulness of 100 prematurely born infants were recorded for 24-hour periods in the home when the infants were 1, 2, 3, 4, and 5 weeks postterm. Sleep monitoring was accomplished using the Home Monitoring System: analog signals from respiration and body movement are recorded while the infant is on a pressure sensitive crib pad. The signals are computer scored and visually edited in 30-second epochs for quiet sleep, active-quiet transitional sleep, active sleep, sleep-wake transition, and waking. At 3 years of age, the babies were classified into one of four groups: those who were normal and those with neurodevelopmental, physical, or minor mental problems. Assignment to groups was based on Bayley Scales administered at one year, biannual questionnaires throughout the 3 years, and a home visit at 3 years. Individual state measures differentiated the abnormal outcome groups from the normal one, and profiles of state parameters were unique for each outcome group. Profile measures gave greater prediction for individuals than did clinical risk factors. The findings indicate that specific forms of later disabilities in premature infants are expressed in differential organization of sleep states during the early postterm period.
Anecdotal reports have suggested that sleeping problems are a frequent complaint from parents of preterm infants. This prospective epidemiological study examined the incidence and stability of sleeping problems of very preterm (< 32 weeks gestation at birth), preterm (32-36 weeks gestation) and fullterm infants, all admitted to special care baby units (SCBU) after birth, in comparison to healthy term infants over the first 5 years of life. Preterm infants were found to have fewer and shorter night-wakings at 5 months. No differences in sleeping behaviour compared with healthy term children were found at 20 and 56 months of age. Similar significant, and moderate, stability of nightwaking from one age to the next were found for exSCBU-graduates and healthy fullterm infants. Parental interventions such as staying with the child until sleep and taking the infant into bed af night were related to nightwaking problems and increased parental distress. It is concluded that prematurity, and thus neurological immaturity and special care experience are less important than caretaking behaviour in the development of sleeping problems in both preterm and fullterm infants.
To apply a multiattribute health status (MAHS) classification system to data available on two cohorts of school-aged children to describe several dimensions of health simultaneously. The MAHS system describes both the type and severity of functional limitations according to seven attributes: sensation, mobility, emotion, cognition, self-care, pain, and fertility (fertility not applicable in this study), with four or five levels of function within each attribute.
The MAHS system was applied retrospectively to clinical and psychometric data collected prospectively at age 8 years. MAHS application was by selection of items from the database and development of computer-assisted algorithms to assign functional levels within each attribute.
Geographically defined region in central-west Ontario, Canada.
One hundred fifty-six extremely low birth weight (ELBW) survivors born between 1977 and 1982 (follow-up rate 90%) and 145 reference children matched for age, sex, and socioeconomic status.
14% of ELBW subjects had no functional limitations, 58% had reduced function for one or two attributes, and 28% had at least three affected. The corresponding figures for the reference group were 50%, 48%, and 2% (p < 0.0001). The limitations were more severe and complex in the ELBW group, and were notably in cognition (58%), sensation (48%), mobility (21%), and self-care (17%), compared with 28%, 11%, 1%, and 0% for reference children (all p < 0.0001).
These data indicate that fewer ELBW than reference children were free of functional limitations and a significantly higher proportion had multiple attributes affected. The MAHS classification approach is a useful instrument to compare the health status of different groups and populations, and to monitor changes with time.
To describe the mental and emotional well-being of children born at different birth weights assessed at school age and to identify neonatal, intervening health, and sociodemographic and environmental factors associated with mental and emotional well-being.
To address this issue, we used a prospective cohort study involving two previously studied cohorts, which were recontacted at 8 to 10 years of age to provide a multisite sample of 247 children weighing 1000 g or less at birth, 364 weighing 1001 to 1500 g, 724 weighing 1501 to 2500 g, and 533 weighing more than 2500 g. Maternal reports were obtained on three standardized measures of mental and emotional well-being (the Rand General Well-being Scale, the Behavior Problem Index, and the Harter Scale of Child Competence) and on intervening health, sociodemographic, and environmental variables. Neonatal variables were derived from records at birth. Statistical techniques included analysis of variance and ordinary least squares multiple regression.
Lower birth weight children did not differ on the General Well-being Scale but were more likely to have behavior problems and to be considered less competent. Other important correlates of mental and emotional well-being included childhood illness, maternal mental health, home environment score, and exposure to household cigarette smoking.
Although lower birth weight children have poorer mental and emotional well-being, a substantial portion of this adverse outcome reflects modifiable environmental factors.
Fœtus et nouveau-né de faible poids. Biologie et médecine
- Gold
Conditions du retour à domicile de l'enfant de faible poids de naissance après hospitalisation néonatale prolongée: étude prospective de 50 cas
- Gold
La naissance et l'hospitalisation initiale des prématurés d'âge gestationnel inférieur à 32 semaines: quels souvenirs en gardent les parents un an après? Enquête sur 94 cas
- Brémond
Changes in survival patterns of very-low-birth-weight infants from 1980 to 1993
- Roth