Cerebral palsy in preterm infants: a population-based case-control study of antenatal and intrapartal risk factors (original) (raw)
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Cerebral palsy in preterm infants
The Lancet, 1994
Background/Aim. Cerebral palsy (CP) is one of the leading causes of neurological impairment in childhood. Preterm birth is a significant risk factor in the occurrence of CP. Clinical outcomes may include impairment of gross motor function and intellectual abilities, visual impairment and epilepsy. The aim of this study was to examine the relationships among gestational age, type of CP, functional ability and associated conditions. Methods. The sample size was 206 children with CP. The data were obtained from medical records and included gestational age at birth, clinical characteristics of CP and associated conditions. Clinical CP type was determined according to Surveillance of Cerebral Palsy in Europe (SCPE) and topographically. Gross motor function abilities were evaluated according to the Gross Motor Function Classification System (GMFCS). Results. More than half of the children with CP were born prematurely (54.4%). Statistically significant difference was noted with respect to the distribution of various clinical types of CP in relation to gestational age (p < 0.001). In the group with spastic bilateral CP type, there is a greater proportion of children born preterm. Statistically significant difference was noted in the functional classification based on GMFCS in terms of gestational age (p = 0.049), children born at earlier gestational age are classified at a higher GMFCS level of functional limitation. The greatest percentage of children (70.0%) affected by two or more associated conditions was found in the group that had extremely preterm birth, and that number declined with increasing maturity at birth. Epilepsy was more prevalent in children born at greater gestational age, and this difference in distribution was statistically significant (p = 0.032). Conclusion. The application of antenatal and postnatal protection of preterm children should be a significant component of the CP prevention strategy.
Preterm birth and cerebral palsy
Acta Obstetricia et Gynecologica Scandinavica, 1997
Actu 0h.rtrt Gynecol Scund 1997; 76: 843-848. 0 Acta Obstet Gynecol Scand 1997 ~u c k~r~~u~~. Preterm infants are at 8 times higher risk than term infants for pre-and perinatal brain damage, resulting in cerebral palsy. In this paper we have analysed the influence of prenatal and birth-related risk factors on cerebral palsy in preterm infants. Methods. In a register-based study, 175 preterm singleton infants with cerebral palsy, born in 1982-86, were compared with 687 controls matched by gestational age and year of birth. Results. Statistically significant higher rates in cases were found in parity 2 3 (22% vs. l6%,, p<0.05), Cesarean section (67% vs. 5654, p<O.Ol), and low Apgar scores at 1 minute (45%) vs. 36%. p<O.O5). By multivariate analyses, two variables remained statistically significant: parity 2 3 (adjusted OR= 1.53 (95% CI 1 .OO-2.34). p<O.O5) and Cesarean section (adjusted Conclusions. Pregnancy complications preceding preterm birth did not imply a higher risk of cerebral palsy. Delivery by Cesarean section was a prognostic factor for developing cerebral palsy, and the predictive value of Apgar scores was highly limited.
Early Human Development, 2005
Background: Preterm delivery is associated with an increased risk of cerebral palsy (CP). The greatest risk is for infants born b28 weeks' gestation. Aims: To identify significant neonatal risk factors for CP and explore the interactions between antenatal and neonatal risk factors, among extremely preterm infants of 27 weeks' gestation or less. Study Design: Nested case control design. Methods: Infants born between 1989 and 1996, at 24-27 weeks' gestation, were evaluated: 30 with CP at 2 years corrected age and 120 control infants matched for gestation age. Neonatal variables were compared using matched analyses with the interaction between antenatal and neonatal factors being examined using logistic regression analyses. Results: Risk factors for CP on matched analyses included patent ductus arteriosus requiring surgical ligation, peri-intraventricular haemorrhage, moderate to severe ventricular dilatation, periventricular leukomalacia (PVL) and need for home oxygen. Independent neonatal predictors were ventricular dilatation (OR 7.3; 95% CI 1.6, 32.3), PVL (OR 29.8; 95% CI 5.6, 159.1) and home oxygen use (OR 3.4; 95% CI 1.2, 9.4). No interaction terms in the logistic models were significant between the previously identified pregnancy risk factors of absence of antenatal steroids and intrauterine growth restriction and the neonatal risk factors.
Cerebral palsy among children born moderately and late preterm
Pediatrics, 2014
To compare the incidence of and risk factors for cerebral palsy (CP) in moderately preterm (MP) (32(+0)-33(+6) weeks) and late preterm (LP) (34(+0)-36(+6) weeks) infants with those in very preterm (VP) (<32(+0) weeks) and term infants (≥37 weeks). The national register study included all live-born infants in Finland from 1991 to 2008. Infants who died before the age of 1 year, had any major congenital anomaly, or had missing data were excluded. A total of 1 018 302 infants were included in the analysis and they were analyzed in 4 subgroups (VP, MP, LP, and term) and 3 time periods (1991-1995, 1996-2001, and 2002-2008). By the age of 7 years, 2242 children with CP were diagnosed (0.2%). CP incidence was 8.7% in the VP, 2.4% in the MP, 0.6% in the LP, and 0.1% in the term group. The risk of CP was highest in the study period 1991-1995 in all groups. Factors predictive of an increased CP risk in the MP and LP groups included resuscitation at birth (odds ratio 1.60; 95% CI 1.01-2.53 ...
Prenatal Risk Factors for Cerebral Palsy in Very Preterm Singletons and Twins
Obstetrics & Gynecology, 2005
for the Epipage Group* OBJECTIVE: To identify the main prenatal risk factors for cerebral palsy in very preterm singletons and twins. METHODS: The data were from the Epipage study, which included all very preterm children (< 33 weeks) born in 1997 in 9 regions of France. The analysis included 1,954 children for whom a medical questionnaire was completed at the age of 2 years (83% of the surviving children). The risk factors studied were pregnancy complications and specific factors in twins (type of placenta and death of cotwin). Logistic regression analysis was carried out for singletons and generalized estimating equation models used for twins. RESULTS: The proportion of cerebral palsy was 8% in singletons and 9% in twins. For singletons, spontaneous preterm labor (adjusted odds ratio ͓OR͔ 3.4, 95% confidence interval ͓CI͔ 1.7-6.7), preterm premature rupture of membranes (PPROM) with short latency (adjusted OR 4.9, 95% CI 2.0-11.8), and prolonged PPROM (adjusted OR 2.7, 95% CI 1.4-5.3) were associated with a higher risk of cerebral palsy than was hypertension. No such link was found between these pregnancy complications and cerebral palsy in twins. For twins, a monochorionic placenta (OR 1.9, 95% CI 1.0-3.6) increased the risk of cerebral palsy, but the OR became nonsignificant after adjustment (OR 1.7, 95% CI 0.8-3.4). CONCLUSION: In very preterm singletons, spontaneous preterm labor and PPROM increased the risk of cerebral palsy compared with hypertension.