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Medical care for former premature babies
Nearly 180 babies are born prematurely every day in France. If the first fight for the medical teams is to keep these children alive, another major challenge quickly becomes obvious: the long-term follow-up of these children born too early.
The majority of premature babies surviving the neonatal period develop well. But this is not the case for all. Smaller, more fragile… Babies who are born too early sometimes have difficulty after discharge from the hospital. Still very vulnerable on the pulmonary level, they are also more susceptible to infections of all kinds. Developmentally, premature babies most often have delay in the various acquisitions (sitting, walking, speaking), compared to term infants. Other sequelae may appear later.
« At the time of schooling, we can discover learning, behavior and emotional disorders, even though all the exams were reassuring until then. », Explains Dr Chantegeret, pediatrician neonatologist, responsible for the consultation of follow-up of very premature babies (CHU Dijon). Hence the interest of a follow-up adapted to the needs of each one and especially prolonged in time.
Prematurity: focus on the notion of “corrected” age
Until the child is two years old, two notions of age coexist: that ofcivil age, the one based on the date of birth of the child, and that of“corrected” age, which takes prematurity into account.
Thus, for example, when a baby born premature at 7 months of pregnancy is 12 months of calendar age, it can be considered that he is only 10 months of “corrected” age. It is therefore necessary “to compare what is comparable”, and to take into account the corrected age rather than the civil age to judge its psychomotor development, language etc.
Premature baby: a structured and prolonged medical protocol
Currently, medical monitoring is coordinated at the regional level by the perinatal networks. It is divided between different actors: the hospital pediatrician, Maternal and Child Protection (PMI) and the Early Medico-Social Action Center (CAMSP). The child is followed by a referring doctor, most often a pediatrician from the neonatal department, upon leaving the maternity ward. Consultations take place every two to four months during the first two years and annually until the sixth year. But the duration is variable according to the state of health of the child. These consultations are intended for monitor psychomotor development of the former premature baby and to identify any deficiencies. But they do not replace the classic consultations with the city pediatrician. In principle, families can also rely on the PMI which is informed of the release of the child. The medical follow-up is not addressed in theory than very premature babies, that is, babies born before 32 weeks of gestation. But it can however be offered to a child born later but having encountered difficulties in neonatology.
Pediatricians and other professionals: the CAMPS network
The early medico-social action centers (CAMPS) are responsible for dealing with disability issues in children aged 0 to 6 years. Often attached to level III maternity hospitals, these organizations take in premature infants, primarily the most fragile. The peculiarity of these structures is that the follow-up is global and multidisciplinary. Each child has the opportunity to be followed by several professionals (pediatricians, psychomotor therapists, physiotherapists, child psychiatrists, nursery nurses, etc.), each authorized to intervene in developmental neurology.
« Today we favor a increasingly early detection, in order to implement targeted actions without delay, underlines Dr Valleur, director of CAMPS at the Institut de périculture de Paris (IPP). It’s a fact: the sooner we act, the more we limit the consequences. »
This work is done in close collaboration with the families. Thus, parents can be seen as soon as they leave neonatal care for a first screening. When a deficiency diagnosis is made, the CAMPS teams then offer specific treatment. Some children benefit from two to three consultations per week, until they are 6 years old.
A follow-up still uneven with regard to the recommendations
The latest Euro-peristat report pointed to the shortcomings of perinatal policy in France. It is clear that the management of prematurity is no exception to the rule … Despite the goodwill of professionals, the follow-up of premature infants is still insufficient and very uneven depending on the region. ” Some families fall through the cracks and find themselves asking for help because they haven’t seen anyone and their 2 year old is not doing well. », Deplores Charlotte Bouvard, President of the SOS Préma association. Through the Prematurity Collective, it campaigns for a harmonization of the long-term follow-up of children born prematurely and more generally of the aid granted to parents. the lack of means shortage of professionals partly explain these shortcomings. In the CAMPS, the waiting lists are constantly growing.
« It is true that we are not in sufficient number, recognizes Dr Valleur. Once the first screening assessment has passed, families often have to wait for a consultation with a specialist. It is not easy for them. To overcome these weaknesses, parents can be referred to professionals in the private sector. But the price is not the same. For example, a consultation with a psychomotor therapist is not covered by health insurance.