Outcome at ten years of childrenborn preterm: the Epipage-2 and Elfe cohort studies

In France, approximately 7% of all annual births occur before the standard gestational term of 37 weeks of amenorrhea, a medical threshold that defines prematurity. While modern neonatal intensive care units have dramatically improved the immediate survival rates of preterm infants over the past several decades, the long-term developmental trajectories of these children remain a subject of intense scientific inquiry. New findings published in the esteemed medical journal eClinicalMedicine offer a comprehensive look into the lives of these children as they reach pre-adolescence. Led by researchers from the National Institute of Health and Medical Research (Inserm) and Université Paris Cité, the study evaluates the health, behavioral patterns, educational paths, and social integration of 10-year-olds who were born prematurely, comparing them against their peers born at full term.

The results present a nuanced portrait of a vulnerable yet resilient population. While the vast majority of parents report that their children are in overall good health and fully integrated into standard schooling systems, a significant subset of preterm children faces persistent hurdles. These challenges manifest as emotional and behavioral difficulties, a higher reliance on specialized developmental healthcare and educational support, and slightly more restricted participation in social and extracurricular activities. The study underscores the necessity for sustained, personalized medical and educational follow-up as these children navigate the critical transition from childhood to adolescence.

A Decade of Tracking: The Chronology and Methodology of Epipage-2

To understand the long-term impacts of premature birth, researchers from the Oppale team within the Center for Research in Epidemiology and Statistics (Inserm/Université Paris Cité) have been closely tracking a cohort of children born prematurely in France since 2011. This continuous research builds directly upon the foundational framework of the nationwide Epipage-2 study, a comprehensive epidemiological project designed to map the health and developmental outcomes of preterm births.

The timeline of this large-scale scientific tracking began between April and December 2011, when Epipage-2 initially enrolled 7,819 infants born at gestational ages ranging from 24 to 34 weeks. These births were categorized into distinct clinical tiers: extreme prematurity (birth between 24 and 26 completed weeks of amenorrhea), great prematurity (27 to 31 weeks), and moderate prematurity (32 to 34 weeks). An earlier milestone in this longitudinal study evaluated the children at five and a half years of age, providing critical early childhood data on neuro-motor, sensory, and cognitive development.

The latest data release marks a major milestone at the 10-year mark. Researchers analyzed data from 2,181 children born prematurely and contrasted these metrics against a control group of 7,286 children born at full term, drawn from the separate, nationally representative Elfe cohort. The Elfe study, jointly managed by Inserm and the French National Institute for Demographic Studies (Ined), follows nearly 18,000 children born in 2011 from birth through adulthood to examine how environmental, social, and familial factors shape development. By leveraging structured telephone interviews with parents, the research team gathered extensive comparative data regarding behavioral traits, developmental healthcare utilization, academic performance, and social engagement at age 10.

Behavioral Patterns and Healthcare Utilization at Age 10

The quantitative analysis of the 10-year data reveals clear disparities in behavioral health between children born prematurely and those born at full term. Specifically, 16% of children born prematurely exhibit behavioral difficulties at age 10, compared to 12% of children born at full term. Among the various behavioral challenges reported by parents, difficulties related to emotional regulation emerge as the most frequent obstacle for pre-teens with a history of prematurity.

Furthermore, the data highlights a direct correlation between gestational age at birth and the subsequent need for specialized developmental healthcare services. These services typically encompass consultations and therapies with speech-language pathologists, psychologists, and child psychiatrists aimed at managing learning disabilities, speech impediments, and behavioral disorders. At age 10, nearly half of all children born extremely premature continue to benefit from at least one form of developmental healthcare. This proportion decreases as gestational age increases, though even among moderately preterm children, the utilization rates remain notable. Conversely, the study also notes that while the statistical risk is elevated across all premature groups compared to full-term peers, the baseline utilization of healthcare services among full-term children is itself non-negligible, reflecting broader societal trends in pediatric mental health support.

Educational Trajectories and Academic Support

In terms of formal education, the findings demonstrate a high degree of integration. School enrollment in standard educational establishments and regular classrooms is virtually universal across all groups, regardless of gestational age. However, a deeper look into academic progression reveals clear markers of strain. Grade retention—commonly known as repeating a year—is significantly more prevalent among children born prematurely. Specifically, redoublement is observed in 16% of children born between 24 and 26 weeks, 11% of those born between 27 and 31 weeks, and 4% of those born between 32 and 34 weeks, compared to just 3% of children born at full term who attend regular classes.

Support mechanisms extend beyond mere grade retention. Overall, 23% of children born prematurely receive targeted academic support. This assistance ranges from 35% for the most prematurely born children to 20% for those in the moderately preterm group, while only 12% of full-term children receive equivalent support. Longitudinal tracking reveals a strong continuity in these needs: a solid majority—57%—of preterm children who required developmental healthcare or academic support at age 5 still required such interventions at age 10. Meanwhile, 27% of children who required no support at age 5 developed needs that emerged by the time they reached pre-adolescence.

Social Integration and Extracurricular Participation

Beyond the classroom, the study investigated how prematurity influences social life, peer interactions, and participation in leisure activities. The data shows that 69% of children born prematurely participate in organized sports, compared to 77% of their full-term peers. Milestone events also reflect slight variations in social breadth: 55% of 10-year-olds born prematurely celebrated a birthday party with friends over the preceding year, compared to 60% of full-term children. A more pronounced gap appeared in overnight peer interactions, with 54% of preterm children having been invited to sleep over at a friend’s house in the past 12 months, versus 63% of full-term children.

Statistical cross-analysis indicates that participation in these extracurricular and social activities is heavily mediated by the presence of behavioral difficulties and the receipt of academic support. Children facing behavioral hurdles or requiring specialized educational assistance uniformly exhibited lower participation rates in social activities, regardless of whether their birth was preterm or full-term.

Parental Perceptions and Family Impact

When surveyed about their overall perception of their child’s health, the vast majority of parents expressed a positive view, considering their children to be in good general health. Nevertheless, granular disclosures reveal specific limitations. Approximately 14% of parents of children born between 24 and 26 weeks, and 4% of parents of those born between 32 and 34 weeks, report that their children experience tangible limitations in daily activities, largely driven by underlying neurodevelopmental disorders.

Furthermore, roughly 20% of parents of preterm children explicitly reported that their offspring face substantial emotional, behavioral, or relational hurdles. Parental feedback also suggests that preterm children are statistically more likely to report having no close friends, to express dissatisfaction with their peer networks, and to spend less face-to-face time interacting with peers. Academically, among children placed in regular classrooms matching their expected grade level, roughly 70% of parents of preterm children reported that their child encountered no major difficulties in French or mathematics, compared to 80% of parents of full-term children.

Expert Perspectives and Clinical Implications

The implications of these findings extend far beyond individual medical charts, offering critical guidance for public health policy and pediatric care frameworks. Dr. Véronique Pierrat, the lead author of the study, an Inserm researcher, and a neonatologist at the Intercommunal Hospital Center of Créteil, emphasizes the ongoing vulnerability of this demographic.

"The results of our study show that children born prematurely still constitute, at 10 years of age, a vulnerable population," Dr. Pierrat stated. "They reinforce the importance of offering families a personalized follow-up for these children, particularly concerning those born extremely prematurely. These recommendations should cover the transition period between childhood and adolescence, in order to promote health, education, and social inclusion."

Complementing this clinical perspective, Professor Pierre-Yves Ancel, the senior author of the study, head of the Oppale team, and professor at Université Paris Cité, highlights the broader societal and familial toll associated with long-term developmental challenges.

"Beyond the difficulties encountered by children born prematurely, these results raise questions about the repercussions they can have on the well-being of families," Professor Ancel noted. "The frequency of behavioral, school, or daily activity difficulties and the significant use of specialized support can indeed weigh heavily on the daily lives of parents."

As the Epipage-2 cohort continues to age into adolescence and young adulthood, researchers stress that healthcare systems must adapt to provide continuous, multidisciplinary support networks. By bridging the gap between neonatal intensive care and adolescent medicine, policymakers and clinicians can better equip preterm children and their families to overcome structural and functional developmental hurdles, ensuring improved life outcomes well into adulthood.