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Pediatrics and Child Health

Special Care and School Difficulties in 8-Year-Old Very Preterm Children: The Epipage Cohort Study
Published: Friday, July 08, 2011
Author: Beatrice Larroque et al.

by Beatrice Larroque, Pierre-Yves Ancel, Laetitia Marchand-Martin, Gilles Cambonie, Jeanne Fresson, Véronique Pierrat, Jean-Christophe Rozé, Loic Marpeau, Gerard Thiriez, Corinne Alberge, Gérard Bréart, Monique Kaminski, Stéphane Marret, and the Epipage Study group


To investigate school difficulties, special care and behavioral problems in 8 year-old very preterm (VPT) children.

Patient and Methods

Longitudinal population-based cohort in nine regions of France of VPT children and a reference group born at 39–40 weeks of gestation (WG). The main outcome measures were information about school, special care and behavioral problems using Strengths and Difficulties Questionnaire from a questionnaire to parents.


Among the 1439 VPT children, 5% (75/1439) were in a specialised school or class, 18% (259/1439) had repeated a grade in a mainstream class and 77% (1105/1439) were in the appropriate grade-level in mainstream class; these figures were 1% (3/327) , 5% (16/327) and 94% (308/327) , respectively, for the reference group. Also, 15% (221/1435) of VPT children in a mainstream class received support at school versus 5% (16/326) of reference group. More VPT children between the ages of five and eight years received special care (55% (794/1436)) than children born at term (38% (124/325)); more VPT children (21% (292/1387)) had behavioral difficulties than the reference group (11% (35/319)). School difficulties, support at school, special care and behavioral difficulties in VPT children without neuromotor or sensory deficits varied with gestational age, socioeconomic status, and cognitive score at the age of five.


Most 8-year-old VPT children are in mainstream schools. However, they have a high risk of difficulty in school, with more than half requiring additional support at school and/or special care. Referral to special services has increased between the ages of 5 and 8 years, but remained insufficient for those with borderline cognitive scores.