Respiratory distress syndrome in moderately late and late preterm infants and risk of cerebral palsy: a population-based cohort study

Abstract

ObjectivesInfant respiratory distress syndrome (IRDS) is a known risk factor for intracerebral haemorrhage/intraventricular haemorrhage (ICH/IVH) and periventricular leucomalacia. These lesions are known to increase the risk of cerebral palsy (CP). Thus, we wanted to examine the long-term risk of CP following IRDS in moderately late and late preterm infants.DesignPopulation-based cohort study.SettingAll hospitals in Denmark.ParticipantsWe used nationwide medical registries to identify a cohort of all moderately and late preterm infants (defined as birth during 32–36 full gestational weeks) born in Denmark in 1997–2007 with and without hospital diagnosed IRDS.Main outcomes measuresWe followed study participants from birth until first diagnosis of CP, emigration, death or end of follow-up in 2014. We computed the cumulative incidence of CP before age 8 years and used Cox's regression analysis to compute HRs of IRDS, comparing children with IRDS to those without IRDS. HRs were adjusted for multiple covariates.ResultsWe identified 39 420 moderately late and late preterm infants, of whom 2255 (5.7%) had IRDS. The cumulative incidence of CP was 1.9% in infants with IRDS and 0.5% in the comparison cohort. The adjusted HR of CP was 2.0 (95% CI 1.4 to 2.9). The adjusted HR of CP was 12 (95% CI 4.5 to 34) in children with IRDS accompanied by a diagnosis of ICH/IVH. After restriction to children without diagnoses of perinatal breathing disorders other than IRDS, congenital heart disease and viral or bacterial infections occurring within 4 days of birth, the overall adjusted HR was 2.1 (95% CI 1.4 to 3.1).ConclusionsThe risk of CP was increased in moderately late and late preterm infants with IRDS compared with infants without IRDS born during the same gestational weeks.

Is it possible to safely prevent late preterm and early term births?

“…Not all of this increase in adverse perinatal outcomes is related to the cause of the preterm birth rather than the prematurity itself [2]. Respiratory complications, especially, appear to relate more directly to prematurity regardless of the underlying cause and, importantly, those neonates suffering respiratory distress syndrome are at greater risk of long-term neurodevelopmental morbidity than are those without [3,4]…”

The impact of preterm birth <37 weeks on parents and families: a cross-sectional study in the 2 years after discharge from the neonatal intensive care unit

“…All preterm infants are at risk for re-hospitalization, as well as medical and neurodevelopmental complications, even moderate to late preterm infants (born at 32 to <37 weeks’ gestation) [ 6 ]. A particularly challenged sub-group is very low birth weight (VLBW) infants or those born < 1500 g. More than 90% of VLBW infants are discharged home from the neonatal intensive care unit (NICU).…”

Pulmonary Surfactant Replacement Therapy for Respiratory Distress Syndrome in Neonates: a Nationwide Epidemiological Study in Korea

“…The Danish Medical Birth Registry Cohort showed that the incidence of RDS in infants born at 32–36 weeks of gestation was approximately 5.7%. 26 In the same study, the incidence of intracranial or IVH was 2.0% and of PDA was 3.4% in the RDS group. In our study, the incidence of IVH or PDA is higher than previous study, it is necessary to take careful consideration for preventing complication among the late preterm infants.…”