Preterm labour and delivery: psychological sequelae

[Medical, cognitive and affective status of four-year-old very premature babies without severe disability. A case-control study]

AIM

To determine cognitive performances and affective development of a cohort of very premature babies at the age of 4 years.

POPULATION AND METHODS

Longitudinal case-control study. Newborns less than 33 weeks gestation were included from 1992 to 1994 and were matched with two full-term newborns. At 4 years of age, they have been evaluated for medical status, cognitive functions with the K-ABC test and affective condition with the PSA and Conners' tests.

RESULTS

The preterm group was significantly different from the controls for: a smaller height, (P < 0.01), a lower socioeconomic level (P = 0.027), a lower nursery school level (44% versus 27,6%, P = 0.05), the incapacity to draw "a bonhomme" (55,3% versus 93%, P < 0.001), lower performances for the K-ABC and PSA tests, a pathologic Conners score (20.4% versus 2.4%, P < 0.001). Multivariate analysis by logistic regression showed a similar neuropsychological results: a lower score of K-ABC (< 80, P = 0.0006, odds-ratio = 33.2), and a lower social competence score of PSA (< 45, P = 0.004, odds-ratio = 35.9).

CONCLUSION

Follow-up of premature babies is required, and measures to prevent or minimize cognitive and social disabilities are mandatory.

New perspectives for the effective treatment of preterm labor

Preterm birth (before 37 completed weeks of gestation) continues to account for the vast majority of neonatal morbidity and mortality. The incidence of preterm birth can be reduced by appropriate social interventions and antenatal care. Currently available tocolytic agents suffer from low uterospecificity and prolong pregnancy only marginally, although postponement of birth by a few days may be of some value. Further progress is needed in at least four areas: prevention of preterm labor; identification of preterm labor; selection of candidates for tocolysis, and treatment of preterm labor. Effective, early treatment of vaginosis offers particular promise for the prevention of preterm labor and identification of specific biochemical markers will facilitate early detection of this process. Oxytocin antagonists offer greater specificity than current tocolytics and can be expected to show improved efficacy and risk profiles. Such compounds will allow more effective treatment of preterm labor with a lower risk of side effects.