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Risk factors for cerebral palsy in very low-birthweight infants in the 1980s and 1990s
D Dunin-Wasowicz1, K Rowecka-Trzebicka, B Milewska-Bobula
1Infant Department, Children's Memorial Health Institute, Warsaw, Poland.
Insights
Periventricular leukomalacia is a better predictor of cerebral palsy in very low-birthweight infants than intraventricular hemorrhage. Risk factors like complicated pregnancies and severe asphyxia did not significantly increase cerebral palsy risk.
Area of Science:
- Neonatal care
- Neurodevelopmental outcomes
- Pediatric neurology
Background:
- Very low-birthweight infants face significant neurodevelopmental challenges.
- Understanding predictors of cerebral palsy is crucial for early intervention in this vulnerable population.
Purpose of the Study:
- To compare the predictive value of periventricular leukomalacia and intraventricular hemorrhage for cerebral palsy in very low-birthweight infants.
- To identify risk factors associated with cerebral palsy in very low-birthweight infants.
Main Methods:
- Retrospective analysis of 129 very low-birthweight infants treated between 1985-1994.
- Neurodevelopmental follow-up assessments at 2-11 years of age.
- Comparison of cerebral palsy rates and associated risk factors between two treatment periods (1985-1989 vs. 1990-1994).
Main Results:
- Cerebral palsy occurred in 28.9% of infants in the earlier group and 35.2% in the later group (no significant difference).
- Periventricular leukomalacia demonstrated a higher predictive value for cerebral palsy compared to intraventricular hemorrhage.
- Complicated pregnancies, cesarean sections, severe asphyxia, and respiratory distress syndrome did not significantly increase cerebral palsy risk.
Conclusions:
- Periventricular leukomalacia is a more reliable indicator for predicting cerebral palsy in very low-birthweight infants.
- While certain complications were more frequent in later treatment periods, they did not correlate with increased cerebral palsy risk.
- Further research into the specific mechanisms linking periventricular leukomalacia to cerebral palsy is warranted.
Abstract:
One-hundred twenty-nine very low-birthweight infants were treated in Newborn and Infant Care Department of Children's Memorial Health Institute between 1985 and 1994; 89 were taken to prospective neurodevelopmental care. The newborns were divided into two groups. Group I had 38 preterm infants born from 1985 to 1989 and followed up at 7 to 11 years of age. Group II had 51 very low-birthweight infants treated from 1990 to 1994 and followed up at 2 to 5 years of age. Complicated, multiple pregnancy, normal delivery, and extremely low birthweight were significantly more frequent in group II. Very low-birthweight infants were frequently born by cesarean section in severe asphyxia. Only four (7.8%) newborns received surfactant therapy. From 1990 to 1994, respiratory distress syndrome III and IV, and a longer respiratotherapy period were significantly more frequent. From 1985 to 1994, the frequency of sepsis, periventricular leukomalacia, and normal ultrasonography was constant. Intraventricular hemorrhage I, II, and IV were frequently present in the 1990s, and intraventricular hemorrhage III was frequent in the 1980s. Cerebral palsy was diagnosed in 11 (28.9%) children in group I and 18 (35.2%) in group II (not statistically different). Multiple and complicated pregnancy, cesarean section, severe asphyxia, and respiratory distress syndrome did not increase the risk of cerebral palsy in very low-birthweight infants. Periventricular leukomalacia has a more predictive value for cerebral palsy in these infants than did intraventricular hemorrhage.
