Neurodevelopment and healthcare utilisation at age 5–6 years in bronchopulmonary dysplasia: an EPIPAGE-2 cohort study

Abstract

ObjectiveWe aimed to study neurodevelopmental outcomes and healthcare utilisation at age 5–6 years in very preterm children with bronchopulmonary dysplasia (BPD).DesignProspective and national population-based study.SettingAll the neonatal units in 25 French regions (21 of the 22 metropolitan regions and 4 overseas regions).PatientsChildren born before 32 weeks’ gestation in 2011.InterventionsBlind, comprehensive and standardised assessment by trained neuropsychologists and paediatricians at age 5–6 years.Main outcome measuresOverall neurodevelopmental disabilities, behavioural difficulties, developmental coordination disorders, full-scale IQ, cerebral palsy, social interaction disorders, rehospitalisation in the previous 12 months and detailed developmental support.ResultsOf the 3186 children included, 413 (11.7%) had BPD. The median gestational age of children with BPD was 27 weeks (IQR 26.0–28.0) and without BPD was 30 weeks (28.0–31.0). At age 5–6 years, 3150 children were alive; 1914 (60.8%) had a complete assessment. BPD was strongly associated with mild, moderate and severe overall neurodevelopmental disabilities (OR 1.49, 95% CI 1.05 to 2.20; 2.20, 1.41 to 3.42 and 2.71, 1.67 to 4.40). BPD was associated with developmental coordination disorders, behavioural difficulties, lower IQ score as well as rehospitalisation in the last 12 months and developmental support. The association between BPD and cerebral palsy was statistically significant before adjustment but not in adjusted analyses.ConclusionsBPD was strongly and independently associated with many neurodevelopmental disabilities. Improving medical and neurodevelopmental management of BPD in very preterm children should be a priority to reduce its long-term consequences.