Perinatal risk factors for adverse neurodevelopmental outcome after spontaneous preterm birth

Eur J Obstet Gynecol Reprod Biol. 2001 Dec 1;99(2):207-12. doi: 10.1016/s0301-2115(01)00383-9.

Abstract

Objective: The aim of this study was to investigate to what extend perinatal factors contribute to the neurodevelopmental outcome in a group neonates born after spontaneous preterm labour with or without prolonged rupture of the membranes (PROM).

Methods: In a cohort of neonates born after the spontaneous onset of labour with or without PROM before 34 weeks of gestation a stepwise forward logistic regression was performed to analyse the influence of antenatal and postnatal variables on adverse outcome. Adverse neurodevelopmental outcome was defined as a Griffith's developmental score <85, cerebral palsy, a major disability or perinatal death associated with severe cerebral damage.

Results: The study group consisted of 185 neonates. Seven neonates died with severe cerebral damage. After a forward logistic regression analysis three factors appeared to have an independent influence: gestational age protected against an adverse outcome (odds ratio (OR) per day increase 0.95, 95% confidence interval (CI) 0.90-0.97) while abnormal cranial ultrasound (intraventricular haemorrhage and periventricular leucomalacia) (OR 6.33, 95% CI 2.16-18.52) and the need for a second course of antibiotics (OR 1.85, 95% CI 1.02-3.33) increased the risk for adverse outcome. Comparing the group with a normal neurodevelopmental outcome with those with cerebral palsy, cranial ultrasound abnormalities were independently associated with cerebral palsy (OR 48.75, 95% CI 11.78-201.76).

Conclusion: The most important way of preventing neurological damage in infants is to increase gestational age at birth and to avoid the development of intraventricular haemorrhage and periventricular leucomalacia.

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Brain Diseases / diagnostic imaging
  • Brain Diseases / epidemiology
  • Brain Diseases / mortality
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / epidemiology
  • Cerebral Palsy / epidemiology
  • Female
  • Fetal Membranes, Premature Rupture
  • Gestational Age
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Infant, Premature*
  • Infections / drug therapy
  • Infections / epidemiology
  • Leukomalacia, Periventricular / diagnostic imaging
  • Leukomalacia, Periventricular / epidemiology
  • Logistic Models
  • Nervous System / growth & development*
  • Obstetric Labor, Premature*
  • Odds Ratio
  • Pregnancy
  • Risk Factors
  • Ultrasonography

Substances

  • Anti-Bacterial Agents