Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks’ gestation in France in 2011: EPIPAGE-2 cohort studyBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3448 (Published 16 August 2017) Cite this as: BMJ 2017;358:j3448
All rapid responses
Pierrat et al must be commended for their concerns about the neurodevelopment of children born prematurely in France.(1) Nevertheless, the timid conclusion that "parental questionnaires may represent a promising alternative for early identification of children at risk of later difficulties”(1) may be “too little, too late”. There was a missed opportunity to report and highlight means of tackling avoidable social determinants of children’s health.
The authors did not provide data about smoking and alcohol despite: smoking prevalence of 35% (http://invs.santepubliquefrance.fr/beh/2016/30-31/2016_30-31_0.html) and no public policy targeting pregnant women;(2) adult per-capita annual consumption of pure alcohol of 12 L (20% higher than in the UK) and 8% of women reporting binge drinking during early pregnancy.(3) It is disappointing these two main avoidable causes of pre-term birth and poor neurodevelopmental outcomes are frequently neglected in medical literature.(4,5)
Although some explanatory variables from parental questionnaires such as parents’ socioeconomic status are significantly associated with Ages and Stages Questionnaire scores below threshold at 2 years corrected age (Supplemental Table 6 in 1) the five category classification is too crude to provide adequate sensitivity and specificity for meaningful clinical application.
France is one of the few high-income countries where child wellbeing (20 indicators not including poverty) declined between 2000 and 2010, along with Sweden, Switzerland, Canada, and Japan.(6) In 2015, Michele Barzach, head of UNICEF France, warned about an alarming increase in child poverty.(7) A national comprehensive policy inspired by good practices, with monitoring by the popular balanced scorecard strategy performance management tool (8), must be used if France is to demonstrate concern for its future citizens.(9)
1 Pierrat V, Marchand-Martin L, Arnaud C et al. Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks’ gestation in France in 2011: EPIPAGE-2 cohort study. BMJ 2017;358:j3448.
2 Braillon A, Lansac J, Delcroix M, Gomez C, Dubois G. [Tobacco and pregnancy: France always bad pupil]. J Gynecol Obstet Biol Reprod (Paris) 2010;39:1-2.
3 Dumas A, Toutain S, Simmat-Durand L. Alcohol use during pregnancy or breastfeeding: A national survey in France. J Womens Health (Larchmt) 2017;26:798-805.
4 Braillon A, Bewley S. The enigma of spontaneous preterm birth. N Engl J Med 2010;362:2032.
5 Braillon A. Practice parameter: evaluation of the child with microcephaly (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology and the Practice Committee of The Child Neurology Society. Neurology 2010;74:1079-8.
6 Wickham, S, Anwar, E, Barr, B, Law, C, and Taylor-Robinson, D. Poverty and child health in the UK: using evidence for action. Arch Dis Child 2016; 101: 759–766.
7 The Lancet. Child poverty in France: alarming trends. Lancet 2015;385:2434.
8 Kaplan RS, Norton DP. "The Balanced Scorecard – Measures That Drive Performance". Harvard Business Review 1992;70:71–79.
9 Braillon A. Child poverty: no future? Lancet 2017;389:1882.
Competing interests: No competing interests