Children born at 34 weeks of pregnancy are likely to have cognitive problems in five years

A study of EPIPAGE group shows that children born between 30 and 34 weeks of pregnancy have a significant morbidity at birth and cognitive problems that are common to the age of five, although they decreased significantly with gestational age.
While morbidity and mortality in very preterm babies (born before 33 weeks of pregnancy) have been studied, there are few data on moderately preterm children born at 33-34 weeks of pregnancy, stress Dr. Stephane Marret of Rouen University Hospital and research group Avenir Inserm and colleagues.

Advances in intensive care and neonatal care for premature led to a greater acceptance of earlier deliveries before 34 weeks, in some pregnancies.

As part of the epidemiological investigation EPIPAGE, 2,467 children aged nine French regions, born or stillborn in 1997 between 30 and 34 weeks gestation were studied and 1,461 of them were also examined in five years.

The increase in gestational age from 30 to 34 weeks was associated with a progressive decline in in-hospital mortality from 8.1% to 0.4%.

Neonatal complications also decreased gradually between 30 and 34 weeks gestational age at birth, the rate of respiratory distress syndrome from 43.8% to 2.6%, the maternofetal infection rate of 7.2% to 2.6% and the rate of serious injury to the white matter from 5.5% to 1.3%.

Children born at 33 and 34 weeks rarely had necrotizing enterocolitis, bronchopulmonary dysplasia or nosocomial infections, but they still need an endotracheal ventilation, antibiotics or parenteral nutrition.

At the age of five, children who were born at a gestational age greater were significantly less cerebral palsy (6.3% against 0.7% 30 weeks to 34 weeks) as well as mild cognitive impairment to severe, although this disorder still concerned about a quarter (23.9%) children born at 34 weeks, against 35.3% of those born at 30 weeks.

"These results suggest that prolonged pregnancy beyond 34 weeks is probably desirable whenever possible," the authors conclude, adding that children born between 30 and 34 weeks should be closely monitored to ensure detection and decision support rapid neurodevelopmental deficits.