Health, neurodevelopment and healthcare use at age 5 in the French very preterm birth cohort Epipage2

Abstract Background Children born very preterm (VPT) have increased risks of multiple, sometimes complex health and neurodevelopmental difficulties (NDD), requiring long-term care. It is imperative to assess their health service use to investigate both expected and potentially suboptimal care. We described the health services used by VPT children at age 5, by neurodevelopmental and health needs, compared to term-born children. Methods We used data from Epipage2, a prospective population-based cohort of births <32 weeks’ gestation (WG) in all maternity units in 25 French regions over 6 to 8 months in 2011. Data was collected from medical records at birth and parental questionnaires and clinical exams at age 5. A reference sample of 585 children born at term (37-41 WG) in metropolitan France was obtained from the contemporary ELFE cohort. We defined cut-offs for high care use, and compared the services used and frequency of visits by subgroups of children defined by their gestational age, presence of NDD and health problems. Results Out of 3099 eligible VPT children, 2262 participated at 5 years; 15% had moderate/severe NDD and 52% had health problems. Reliance on specialist and therapeutical/paramedical services was high compared to term-born peers, especially among children born extremely preterm, with moderate/severe NDD, or health problems. Health service use varied widely: 25% of children with moderate/severe NDD saw no specialists in the past year, while 46% had >21 visits (to any provider, vs. 10% of term-born peers with >21 visits). Differences in emergency department visits and hospital care were smaller across subgroups. Conclusions Health service use is high among VPT-born children overall, yet some of them have not consulted relevant care providers in the past year, despite having health problems or NDD. These contrasts in care among children with similar level of impairment raise questions about care adequacy and its costs and consequences for children and their families. Key messages • Children born very preterm use a wider range of health services and have more visits than their term-born peers, especially if they have neurodevelopmental or health difficulties. • Health service use in very preterm children varied from no specialist care to over 21 visits in total; these contrasts raise questions about care adequacy and its impact on children and families.