Predictors of cerebral palsy in very preterm infants: the EPIPAGE prospective population‐based cohort study

Abstract

IPHIntraparenchymal haemorrhage IVH Intraventricular haemorrhage PPROM Preterm premature rupture of membranes PTL Preterm labour PVL Periventricular leucomalacia AIM The aim of this study was to assess the independent role of cerebral lesions on ultrasound scan, and several other neonatal and obstetric factors, as potential predictors of cerebral palsy (CP) in a large population-based cohort of very preterm infants.METHOD As part of EPIPAGE, a population-based prospective cohort study, perinatal data and outcome at 5 years of age were recorded for 1812 infants born before 33 weeks of gestation in nine regions of France in 1997. RESULTSThe study group comprised 942 males (52%) and 870 females with a mean gestational age of 30 weeks (SD 2wks; range 24-32wks) and a mean birthweight of 1367g (SD 393g; range 450-2645g). CP was diagnosed at 5 years of age in 159 infants (prevalence 9%; 95% confidence interval [CI] 7-10%), 97 males and 62 females, with a mean gestational age of 29 weeks (SD 2wks; range 24-32wks) and a mean birthweight of 1305g (SD 386g; range 500-2480g). Among this group, 67% walked without aid, 14% walked with aid, and 19% were unable to walk. Spastic, ataxic, and dyskinetic CP accounted for 89%, 7%, and 4% of cases respectively. The prevalence of CP was 61% among infants with cystic periventricular leukomalacia, 50% in infants with intraparenchymal haemorrhage, 8% in infants with grade I intraventricular haemorrhage, and 4% in infants without a detectable cerebral lesion. After controlling for cerebral lesions and obstetric and neonatal factors, only male sex (odds ratio [OR] 1.52; 95% CI 1.03-2.25) and preterm premature rupture of membranes or preterm labour (OR 1.72; were predictors of the development of CP in very preterm infants.INTERPRETATION Cerebral lesions were the most important predictor of CP in very preterm infants. In addition, infant sex and preterm premature rupture of membranes or preterm labour were also independent predictors of CP.Very preterm infants (born before 33wks of gestation) are at high risk of developing motor deficiencies during childhood, particularly cerebral palsy (CP). 1 Cerebral lesions and several other neonatal and obstetric risk factors for CP have been described in the literature.2-4 These factors include, in particular, gestational age, low birthweight, multiple gestation, intrauterine infection, placental abruption, preterm labour or pre-labour rupture of membranes, respiratory distress syndrome, and neonatal sepsis.Since the early 1990s, advances in perinatal and neonatal care have improved the survival of very preterm infants. 5Although the incidence of severe cerebral lesions (i.e. white matter disease) has decreased significantly, 6,7 that of CP has not. 1,8 Indeed, in half of very preterm children who develop CP, no severe cerebral lesion is apparent on neonatal cranial ultrasound scans.9 Nevertheless, it is still strongly recommended that ultrasonography be performed in all infants born at a gestational age of less than 30 weeks and that it be used to p...

Neonatal brain microstructure correlates of neurodevelopment and gait in preterm children 18–22 mo of age: an MRI and DTI study

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The Instrumented Fetal Sheep as a Model of Cerebral White Matter Injury in the Premature Infant

“…Although major advances in the care of premature infants have resulted in striking improvements in the survival of very low birth weight infants (<1.5 kg), improved survival has been accompanied by a significant increase in the number of pre-term survivors with long-term neurological deficits [7]. The major consequences of this injury are permanent motor impairment (i.e., cerebral palsy [CP]) ranging from mild to profound spastic motor deficits [8][9][10][11][12][13], as well as a broad spectrum of cognitive, social behavioral, attentional, visual, and learning disabilities that manifest by school age in 25 to 50% of children [14][15][16][17][18]. In preterm survivors, magnetic resonance image (MRI)-defined WMI, but not gray matter injury manifests in the first months of life as abnormal movements that are predictive of CP [19][20][21].…”

Future Perspectives in the Treatment of Incurable Gastric Cancer

“…Recently, infant male sex was considered a risk factor for HIE (Wu et al, 2010) and was associated with an increased development of cerebral palsy in very preterm infants (Beaino et al, 2010). Although the biological basis of this increased risk of brain injury in male babies is not completely understood, several preclinical studies have demonstrated sex-dependent differences in the mechanisms of cell death after HIE.…”