Children born prematurely in France continue to experience significant behavioral and school difficulties at ten years old, according to a study published Thursday by Inserm.
While a large majority of parents report that their ten-year-old children are in good health, researchers found that 16 percent of premature children experience behavioral problems such as emotion management and attention disorders, compared to 12 percent of children born at full term.
The report, published in the medical journal eClinicalMedicine, compared telephone interview data from 2,181 children born prematurely with data from 7,286 full-term children belonging to another cohort. The research team from the Center for Research in Epidemiology and Statistics, a joint institution of the French National Institute of Health and Medical Research and Université Paris Cité, has been tracking the long-term impact of early births since 2011. In France, approximately seven percent of babies are born before eight and a half months of pregnancy.
Developmental Support and Degree of Prematurity
The degree of prematurity plays a vital role in long-term neurodevelopment. Nearly half of children born extremely premature, between 24 and 26 weeks of gestation, receive at least one healthcare service for developmental challenges, including speech therapy, psychomotor therapy, and psychological support. For children born moderately premature, between 32 and 34 weeks, nearly one-third require such specialized care.
Researchers noted that about half of the premature infants initially included in the long-term survey were lost to follow-up ten years later. Among those tracked, daily activity limitations linked to neurodevelopmental disorders affected 14 percent of extremely premature children and four percent of moderately premature children.
Academic performance is also heavily impacted by early birth. Nearly one in four premature children, or 23 percent, requires formal educational support at school in the form of an accompanying worker for students with disabilities, known in France as an AESH. That figure is almost double the rate seen among children born at term. Former premature infants also repeat a school grade more frequently than their peers.
Social Life and Physical Activity Differences
The study highlights noticeable differences in social participation and leisure activities between premature children and those born at term. Only 69 percent of ten-year-olds born prematurely play a sport, compared to 77 percent of full-term children. Furthermore, 55 percent celebrated their birthday with friends compared to 60 percent of term peers, and 54 percent were invited to a sleepover in the preceding twelve months compared to 63 percent of children born at term.
Stéphane Marret, a pediatrician at Rouen University Hospital and Inserm researcher, said that the persistent vulnerability of premature children long after birth justifies France's national strategy on neurodevelopmental disorders. Marret stressed the critical importance of early screening and detection. He added that while premature birth is an initial disruption in a child's life, it is not the sole cause of later difficulties, citing psychosocial factors and family financial instability as contributing elements.
Healthcare Access and Regional Disparities
Charlotte Bouvard, founder of the charity SOS Préma, emphasized that prematurity does not end when a baby leaves the hospital. Describing a domino effect on families, Bouvard criticized out-of-pocket health expenses that push households into poverty, as well as regional inequalities in access to care. She cited examples of families who suspect developmental issues and contact an early medico-social action center, known as a CAMSP, only to be offered an appointment thirteen months later, noting that the most disadvantaged families suffer the most.
Véronique Pierrat, a neonatologist and the lead author of the study, said the findings reinforce the need for personalized follow-up care for families. Pierrat noted to reporters that these results match findings from international studies. She explained that France's current follow-up framework is recommended only until age seven, varies considerably depending on regional resources, and completely excludes children born moderately premature.
