Neurodevelopmental Disabilities in Neonates

Dear Colleagues,

Large population-based studies reporting on the fate of prematurely born children have mainly focused on children born extremely preterm and less on children born very or moderately preterm. However, changes in care have been substantial for all groups of preterm infants, and infants born very or moderately preterm represent a large proportion of those with developmental difficulties. Since the advent of neuroprotective therapies and surfactants, neonatal mortality has decreased, and severe disabilities such as mental retardation, autism, and cerebral palsy have stabilized. This is why low-severity dysfunctions are increased, persist, and worsen throughout school years and in young preterm adults with an impact on quality of life.

Premature birth is associated with a significantly increased risk of infantile and adolescent psychopathology, with social adjustment disorders, compared to full-term birth. These social adjustment disorders are correlated with language disorders and/or dysexecutive syndrome and/or behavioral disorders. Thus, neurobehavioral disorders currently dominate the fate of long-term prematurity. Recently, in the French Epipage 2 cohort, the rates of moderate neurodevelopmental impairment are high (approximately 30%) regardless of gestational age. The persistence and worsening of these neurobehavioral disorders in adulthood for those born preterm (e.g., introverted personality, anxiety disorders) leads to withdrawal and social distancing, making it a public health problem.

Comprehensive research over the past three decades has profiled the neurodevelopmental consequences of preterm birth. Nonetheless, relative to our understanding of the motor and cognitive outcomes, robust conclusions regarding the true nature of childhood psychopathology remain a major challenge, spanning from subclinical to clinical presentations. To a reasonable degree, this ambiguity is due to substantial variability in outcome measures, an over-reliance on single informants, limited longitudinal investigations, and a primary focus on broad mental health classifications rather than individual clinical diagnostic criteria.

The aim of this review is to provide a complete characterization of the neurobehavioral phenotype and to highlight the main gaps in knowledge, mainly with regard to the evolution of symptoms, the co-occurrence of disorders, and associations with chronological age and degree of prematurity. Hypotheses which suggest that this neurobehavioral phenotype of prematurity is due to brain hypo-connectivity, thus leading to diffuse structural abnormalities similar to autism spectrum disorders but with reduced severity, will be discussed based on brain imaging of the newborn term-corrected age. 

Research on preventive interventions, with more individualized approaches capable of mitigating the long-term effects of a premature birth, as well as the identification of risk factors and resilience, will be described. To alleviate mental health problems and parenting disorders leading to impaired brain development which are linked to premature birth, we will talk about the development of “family-centered care” devices in neonatal care and the concept of parental resources with their participation in various projects in partnership with professionals in the field.

To finish we will develop hypotheses on the clinical phenotype of children having presented an encephalopathy anoxo-ischemic to the hypothermia treatment area. 

Dr. Gire Catherine
Guest Editor

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• preterm long term outcome
• neurobehavioural phenotype
• dysexecutive syndrome
• neonatal brain imaging
• development care
• family-centered care