Comparison of neurological outcome at one and two years age of very preterm infants: risk factors for a misdiagnosis of cerebral impairment at one year of age
A. Burguet et al., Comparison of neurological outcome at one and two years age of very preterm infants: risk factors for a misdiagnosis of cerebral impairment at one year of age, ARCH PED, 7(2), 2000, pp. 125-131
Background. - The purpose of this population-based study was firstly to com
pare the neurodevelopmental outcome at one and two years of very preterm in
fants, and secondly to identify the risk factors for a misdiagnosis of cere
bral impairment at the age of one year:
Population and methods. - The preterm cohort included 203 infants born betw
een 25 and 32 weeks of gestational age in the region of Franche-Comte (Fran
ce) during a two-year period. The control group included 196 full-term infa
nts born in the same maternity wards. Neuro-developmental assessments were
performed by pediatricians or physicians, both at one and two years of age,
on 94% (161/171) surviving preterms and 89% (173/195) full-terms.
Results. - There is a fair correlation between the two neurological evaluat
ions of the control group (170/173, 98% have the same classification at the
age of one and two). There is a weak correlation (kappa = 0.37) between th
e two neurological evaluations of the preterm group. Sixteen preterms (10%)
had been classified more abnormal at one year than they were at two years.
The presence of a broncho-pulmonary dysplasia, linked to male sex and extr
eme prematurity was statistically linked to this first kind of misclassific
ation. Seventeen preterms (10%) had been considered more normal at one year
than they were at flue years. The presence of a diplegia, family precariou
sness and the examination at one year of age by a general practitioner were
statistically linked to this second kind of misclassification.
Conclusion. - This prospective population-based study identifies structural
situations (bronchopulmonary dysplasia linked to extreme prematurity) and
environmental situations (family precariousness, examiner's qualifications)
linked to a misclassification of the neurological status of one-year-old f
ormer preterm infants. (C) 2000 Editions scientifiques et medicales Elsevie
r SAS.