Risk factors for cerebral palsy and movement difficulties in 5-year-old children born extremely preterm

Abstract

BackgroundMotor impairment is common after extremely preterm (EPT, <28 weeks' gestational age (GA)) birth, with cerebral palsy (CP) affecting about 10% of children and non-CP movement difficulties (MD) up to 50%. This study investigated the sociodemographic, perinatal and neonatal risk factors for CP and non-CP MD. MethodsData come from a European population-based cohort of children born EPT in 2011-2012 in 11 countries. We used multinomial logistic regression to assess risk factors for CP and non-CP MD (Movement Assessment Battery for Children-2 nd edition ≤5 th percentile) compared to no MD (>15 th percentile) among five-year-old children. ResultsCompared to children without MD (n=366), young maternal age, male sex and bronchopulmonary dysplasia were similarly associated with CP (n=100) and non-CP MD (n=224) with Relative Risk Ratios (RRR) ranging from 2.3 to 3.6. CP was strongly related to severe brain lesions (RRR>10), other neonatal morbidities, congenital anomalies and low Apgar score (RRR: 2.4 to 3.3), while non-CP MD was associated with primiparity, maternal education, small for GA (RRR: 1.6 to 2.6) and severe brain lesions, but at a much lower order of magnitude. ConclusionCP and non-CP MD have different risk factor profiles, with fewer clinical but more sociodemographic risk factors for non-CP MD.

Apgar Score and Neurodevelopmental Outcomes at Age 5 Years in Infants Born Extremely Preterm

“…previously in our cohort, 23,29,50 and may overshadow outcomes associated with perinatal risk factors.…”

“…We constructed 4 models: (1) no adjustments except for country as a fixed effect (termed unadjusted), (2) adjustments for country and additionally on sociodemographic factors, (3) adjustments for country and sociodemographic factors from models 1 and 2 plus adjustment on perinatal factors, and (4) a full model with adjustments for country, sociodemographic factors, JAMA Network Open | Pediatrics perinatal factors, and additionally on severe neonatal morbidities to take into consideration postnatal factors. 23,[26][27][28][29] To avoid collinearity in adjusted models, we included maternal age, education, and country of birth as sociodemographic factors; gestational age, SGA, child sex, and multiplicity as perinatal factors; and a composite of severe morbidity and BPD as neonatal factors. We applied inverse probability weighting (IPW) to account for loss to follow-up as done previously on this population.…”

“…We also used information on whether the child had a diagnosis of CP as reported by caregivers in the parental questionnaire, except in France, where this information came from a clinical assessment of CP by the study team. Training of assessors and strategies for reporting consistent results and managing missing or incomplete data were reported previously . Additionally, 2 domains of the ASQ-3, with questions selected from 60- and 72-month tests, were used to assess communication and problem-solving skills.…”

“…To avoid collinearity in adjusted models, we included maternal age, education, and country of birth as sociodemographic factors; gestational age, SGA, child sex, and multiplicity as perinatal factors; and a composite of severe morbidity and BPD as neonatal factors. We applied inverse probability weighting (IPW) to account for loss to follow-up as done previously on this population . Missing data for most covariates was less than 4% (eg, mother’s age: 4 of 996 individuals [0.4%] or any antenatal steroids: 7 individuals [0.7%]); those with missing data greater than 4% included maternal education (40 individuals [4.0%]), parents’ cohabiting (59 individuals [5.8%]) and employment (66 individuals [6.6%]) status, and Apgar score (78 individuals [7.8%]).…”

Major Morbidity and Survival of Extremely Preterm Infants in Tertiary Hospital

“…Infants born at 22-23 weeks had more than one major morbidity. RoP, sepsis, NEC, BPD, PVL, and IVH cause neurodevelopmental impairment (Aubert et al, 2023). Previous studies show that extremely preterm infants are at risk of major morbidities, including cognitive and behavioral impairment and cerebral palsy, significantly hindering normal life activities later (O'Reilly et al, 2020).…”