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Published on: November 20, 2015
Incidence and risk factors for cerebral palsy in infants with perinatal problems: a 15-year review
A Drougia1, V Giapros, N Krallis
1Neonatal Intensive Care Unit (NICU), University Hospital of Ioannina, Greece.
Insights
Cerebral palsy (CP) risk factors vary by gestational age and study period, with improved survival in preterm infants during the later study phase. Key predictors included small for gestational age (SGA), patent ductus arteriosus (PDA), periventricular leucomalacia (PVL), and sepsis.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Public Health
Background:
- Cerebral palsy (CP) is a complex condition influenced by prenatal, perinatal, and postnatal factors.
- Understanding CP's incidence and risk factors in Neonatal Intensive Care Unit (NICU) populations is crucial for improving outcomes.
Purpose of the Study:
- To determine the frequency of cerebral palsy (CP) in infants admitted to a NICU in Northwest Greece.
- To examine the risk factors associated with CP development in relation to gestational age and study period.
Main Methods:
- A retrospective case-control study involving neonates admitted to the NICU between 1989 and 2003.
- Infants were categorized by gestational age (<34 weeks and >34 weeks) and study period (1989-1996 and 1997-2003).
Main Results:
- CP incidence increased with decreasing gestational age.
- Survival without CP improved significantly for infants with gestational age <34 weeks during the later study period (1997-2003).
- Identified risk factors included small for gestational age (SGA), patent ductus arteriosus (PDA), periventricular leucomalacia (PVL), prolonged rupture of membranes (PROM), mechanical ventilation duration, neonatal transfer, and sepsis/meningitis.
Conclusions:
- Improved survival without CP was observed in preterm infants during the later study period.
- Risk factors for CP in preterm infants were dependent on the study period, with PVL, PROM, and PDA being significant predictors for those with gestational age <34 weeks.
- SGA, neonatal transfer, and sepsis/meningitis were key predictors for infants with gestational age >34 weeks.
Objective:
Cerebral palsy (CP) is associated with prenatal, perinatal and postnatal factors. This is a retrospective case-control study aiming to determine the frequency of CP and examine risk factors for CP among infants cared for in the Neonatal Intensive Care Unit (NICU) covering Northwest Greece.
Design And Patients:
All neonates who were admitted to the NICU during the period 1989-2003 inclusive, and subsequently developed CP, were enrolled in the study, with matched controls. The incidence of CP was evaluated according to gestational age (GA): GA<34 weeks (group A) and GA>34 (group B), and study period: 1989-1996 (period I) and 1997-2003 (period II, during which intrauterine transfer and prenatal steroids were used).
Results:
CP was diagnosed in 78 children, 55 in group A and 23 in group B. The incidence of CP increased significantly with decreasing GA. Survival without CP increased significantly in children of GA<34 weeks during period II. The main factors associated with CP, identified by multivariate analysis, were (odds ratios, confidence interval), for group A: being small for gestational age (SGA) (2.5, 1.2-4.5) and patent ductus arteriosus (PDA) (3.4, 1.3-9.2) in period I, periventricular leucomalacia (PVL) (27, 4.8-209), prolonged rupture of membranes (PROM) (5.6, 1.8-18) and duration of mechanical ventilation (1.1, 1.05-1.2) in period II, and for group B: SGA (3.6, 1.3-9.9), neonatal transfer (3.06, 1.2-7.6), duration of mechanical ventilation (1.1, 1.06-1.25) and sepsis-meningitis (4.3, 1.2-16).
Conclusion:
Improvement in survival without CP was observed in infants of GA<34 weeks during the later period of the study, and risk factors for CP in preterm infants depended on the study period. PVL, PROM and PDA were the most powerful independent predictors of CP in children of GA<34 weeks and SGA, neonatal transfer and sepsis/meningitis in children of GA>34 weeks.
