Decreasing Incidence and Severity of Cerebral Palsy in Prematurely Born Children

J Pediatr. 2011 Jul;159(1):86-91.e1. doi: 10.1016/j.jpeds.2010.12.053. Epub 2011 Mar 2.

Abstract

Objective: To examine incidence and severity of cerebral palsy (CP), and associated factors among preterm survivors (gestational age <34 weeks), admitted to a neonatal intensive care unit from 1990-2005.

Study design: Eighteen antenatal, perinatal and postnatal factors were analyzed. The cohort was divided in four birth periods: 1990-1993 (n=661), 1994-1997 (n=726), 1998-2001 (n=723), and 2002-2005 (n=850). The Gross Motor Function Classification System was used as primary outcome measure (mean age: 32.9 ± 5.3 months). Logistic regression analyses were used.

Results: CP incidence decreased from 6.5% in period I, to 2.6%, 2.9% and 2.2% (P<.001) in period II-IV, respectively. Simultaneously, cystic periventricular leukomalacia (c-PVL) decreased from 3.3% in period I to 1.3% in period IV (P=.004). Within the total cohort (n=3287), c-PVL grade III decreased from 2.3% in period I to 0.2% in period IV (P=.003). The number of children with Gross Motor Function Classification System levels III-V decreased from period I to IV (P=.035). Independent risk factors for CP were c-PVL and severe intraventricular hemorrhage, whereas antenatal antibiotics, presence of an arterial line, Caesarean section, and gestational age were independent protective factors.

Conclusion: CP incidence and severity decreased from 1990-1993 onward, which could be attributed to a reduction of 93% in severe c-PVL.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Birth Weight
  • Catheters, Indwelling
  • Cerebral Hemorrhage / epidemiology
  • Cerebral Palsy / classification
  • Cerebral Palsy / epidemiology*
  • Cesarean Section
  • Gestational Age
  • Humans
  • Incidence
  • Infant, Newborn
  • Infant, Premature*
  • Intensive Care Units, Neonatal
  • Leukomalacia, Periventricular / epidemiology
  • Netherlands / epidemiology
  • Prenatal Care
  • Prospective Studies
  • Risk Factors
  • Severity of Illness Index*

Substances

  • Anti-Bacterial Agents