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Neurodevelopmental consequences of very preterm births

2008; Elsevier BV; Volume: 372; Issue: 9633 Linguagem: Inglês

10.1016/s0140-6736(08)61032-6

1474-547X

Christelle Roustit, Pierre Chauvin,

Neonatal and fetal brain pathology

Béatrice Larroque and colleagues (March 8, p 813)1Larroque B Ancel PY Marret S et al.Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study.Lancet. 2008; 371: 813-820Summary Full Text Full Text PDF PubMed Scopus (613) Google Scholar report different negative neurodevelopmental consequences of very preterm births in a 5-year follow-up cohort and the resulting use of rehabilitation care. This study reflects a dynamic of profound changes in obstetric and paediatric practices in France in the late 1990s, which included the creation of level III neonatal units and a neonatal care referral network between hospitals.2Swyer PR Organisation of perinatal/neonatal care.Acta Paediatr Suppl. 1993; 385: 1-18PubMed Google ScholarDespite the substantial advances in research on fetal growth and the neonatal adaptation to extrauterine life that drove this dynamic, the current state of scientific knowledge is insufficient for ruling out the risk of brain damage closely associated with the immaturity of the brain during its ex-utero development in very preterm children. Therefore, results from prospective investigations such as Larroque and colleagues' and others3Wood NS Marlow N Costeloe K Gibson AT Wilkinson AR Neurologic and developmental disability after extremely preterm birth. EPICure Study Group.N Engl J Med. 2000; 343: 378-384Crossref PubMed Scopus (1155) Google Scholar should be integrated in a teleological perspective beyond merely neonatal care, for these investigations provide essential arguments for preventing prematurity, which is feasible only with a two-pronged, biomedical and psychosocial approach.Indeed, women and practitioners should be reminded that, despite medical advances, the morbid outcomes of pregnancy, especially prematurity, are partly linked to psychosocial determinants4Ancel PY Saurel-Cubizolles MJ Di Renzo GC Papiernik E Bréart G Social differences of very preterm birth in Europe: interaction with obstetric history. Europop Group.Am J Epidemiol. 1999; 149: 908-915Crossref PubMed Scopus (61) Google Scholar such as pregnancy denial and precarious social situations. Advances in neonatal intensive care must not mask the need for, or be made to the detriment of, the means adopted to develop primary psychosocial prevention measures, especially since Larroque and colleagues' study found that loss to follow-up was more common in socially disadvantaged children.We declare that we have no conflict of interest. Béatrice Larroque and colleagues (March 8, p 813)1Larroque B Ancel PY Marret S et al.Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study.Lancet. 2008; 371: 813-820Summary Full Text Full Text PDF PubMed Scopus (613) Google Scholar report different negative neurodevelopmental consequences of very preterm births in a 5-year follow-up cohort and the resulting use of rehabilitation care. This study reflects a dynamic of profound changes in obstetric and paediatric practices in France in the late 1990s, which included the creation of level III neonatal units and a neonatal care referral network between hospitals.2Swyer PR Organisation of perinatal/neonatal care.Acta Paediatr Suppl. 1993; 385: 1-18PubMed Google Scholar Despite the substantial advances in research on fetal growth and the neonatal adaptation to extrauterine life that drove this dynamic, the current state of scientific knowledge is insufficient for ruling out the risk of brain damage closely associated with the immaturity of the brain during its ex-utero development in very preterm children. Therefore, results from prospective investigations such as Larroque and colleagues' and others3Wood NS Marlow N Costeloe K Gibson AT Wilkinson AR Neurologic and developmental disability after extremely preterm birth. EPICure Study Group.N Engl J Med. 2000; 343: 378-384Crossref PubMed Scopus (1155) Google Scholar should be integrated in a teleological perspective beyond merely neonatal care, for these investigations provide essential arguments for preventing prematurity, which is feasible only with a two-pronged, biomedical and psychosocial approach. Indeed, women and practitioners should be reminded that, despite medical advances, the morbid outcomes of pregnancy, especially prematurity, are partly linked to psychosocial determinants4Ancel PY Saurel-Cubizolles MJ Di Renzo GC Papiernik E Bréart G Social differences of very preterm birth in Europe: interaction with obstetric history. Europop Group.Am J Epidemiol. 1999; 149: 908-915Crossref PubMed Scopus (61) Google Scholar such as pregnancy denial and precarious social situations. Advances in neonatal intensive care must not mask the need for, or be made to the detriment of, the means adopted to develop primary psychosocial prevention measures, especially since Larroque and colleagues' study found that loss to follow-up was more common in socially disadvantaged children. We declare that we have no conflict of interest.