Behavioral Problems and Cognitive Performance at 5 Years of Age After Very Preterm Birth: The EPIPAGE Study

TLDR

Very preterm birth is associated with long‑term behavioral and cognitive challenges, yet it is unclear whether these problems persist after accounting for cognitive performance and environmental factors. This study compared the frequency of behavioral problems in very preterm versus term children at age five. Using the EPIPAGE prospective cohort, researchers collected neonatal and obstetric data at birth and assessed sociodemographic status, neurodevelopment, cognition, and maternal well‑being at age five, while parents completed the Strengths and Difficulties Questionnaire for 1102 very preterm and 375 term singletons. Very preterm children exhibited twice the prevalence of behavioral problems, which were linked to lower cognitive performance, developmental delay, hospitalizations, young maternal age, and poor maternal mental health, and remained higher than term peers even after adjustment; early screening and maternal support are therefore recommended.

Abstract

We compared the frequency of behavioral problems in very preterm and term children at 5 years of age. We hypothesized that behavioral problems would be associated with cognitive impairment and environmental factors and that differences between the 2 groups would be reduced but persist after adjusting for cognitive performance and environmental factors.The Etude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE) study was a prospective population-based cohort study that included all births occurring between 22 and 32 weeks' gestation and a control group of infants born at 39 to 40 weeks' gestation in 1997 in 9 French regions. Neonatal and obstetrics data were collected at birth. At 5 years of age, sociodemographic status and neurodevelopmental and cognitive development of the children, as well as maternal mental well-being, were assessed. The behavioral problems of 1102 very preterm and 375 term singletons without major impairments were studied by using the parent-completed Strengths and Difficulties Questionnaire.Parents of very preterm children reported significantly more behavioral problems, with a twofold higher prevalence compared with term children for hyperactivity/inattention, emotional symptoms, and peer problems. Behavioral problems were associated with low cognitive performance, developmental delay, hospitalizations of the child, young maternal age, and poor maternal mental well-being. Very preterm children were still at higher risk of behavioral problems compared with term children after adjustment for cognitive performance and all others factors.Behavioral problems were strongly related to cognitive impairment, but very preterm children were still at higher risk even after adjusting for cognitive performance. Early screening for behavioral problems should be encouraged for all very preterm children, and maternal well-being should also be the focus of special attention.