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Predictors of cerebral palsy in very preterm infants: the EPIPAGE prospective population-based cohort study
Ghada Beaino1, Babak Khoshnood, Monique Kaminski
1INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Hôpital Tenon, and UMPC University Paris, Paris, France. ghbeaino@chusa.jussieu.fr
Insights
Cerebral lesions on ultrasound are the primary predictor of cerebral palsy (CP) in very preterm infants. Male sex and preterm birth complications also independently increase CP risk.
Area of Science:
- Neonatal Neurology
- Developmental Pediatrics
- Medical Ultrasound Imaging
Background:
- Cerebral palsy (CP) is a significant concern in very preterm infants.
- Identifying reliable predictors of CP is crucial for early intervention and improved outcomes.
- Ultrasound findings of cerebral lesions are suspected contributors to CP development.
Purpose of the Study:
- To evaluate the independent predictive value of cerebral lesions detected via ultrasound.
- To assess other neonatal and obstetric factors as predictors of CP.
- To analyze CP development in a large, population-based cohort of very preterm infants.
Main Methods:
- Prospective, population-based cohort study (EPIPAGE) involving 1812 infants born before 33 weeks gestation.
- Perinatal data and 5-year outcomes were collected for infants born in 1997 across nine French regions.
- Cerebral lesions were assessed using ultrasound scans; CP diagnosis was made at 5 years of age.
Main Results:
- CP prevalence was 9% (159/1812 infants) at 5 years. Infants with cystic periventricular leukomalacia had a 61% CP rate, and intraparenchymal hemorrhage had a 50% rate.
- Prevalence of CP was significantly lower (4%) in infants without detectable cerebral lesions.
- Male sex (OR 1.52) and preterm premature rupture of membranes or preterm labor (OR 1.72) were independent predictors of CP after controlling for lesions.
Conclusions:
- Cerebral lesions identified on ultrasound are the most significant predictor of cerebral palsy in very preterm infants.
- Infant sex and specific preterm birth complications (PROM or preterm labor) are also independent risk factors for CP.
- These findings underscore the importance of early detection of brain abnormalities and consideration of obstetric history in predicting CP risk.
Aim:
The aim of this study was to assess the independent role of cerebral lesions on ultrasound scan, and several other neonatal and obstetric factors, as potential predictors of cerebral palsy (CP) in a large population-based cohort of very preterm infants.
Method:
As part of EPIPAGE, a population-based prospective cohort study, perinatal data and outcome at 5 years of age were recorded for 1812 infants born before 33 weeks of gestation in nine regions of France in 1997.
Results:
The study group comprised 942 males (52%) and 870 females with a mean gestational age of 30 weeks (SD 2 wks; range 24-32 wks) and a mean birthweight of 1367 g (SD 393 g; range 450-2645 g). CP was diagnosed at 5 years of age in 159 infants (prevalence 9%; 95% confidence interval [CI] 7-10%), 97 males and 62 females, with a mean gestational age of 29 weeks (SD 2 wks; range 24-32 wks) and a mean birthweight of 1305 g (SD 386 g; range 500-2480 g). Among this group, 67% walked without aid, 14% walked with aid, and 19% were unable to walk. Spastic, ataxic, and dyskinetic CP accounted for 89%, 7%, and 4% of cases respectively. The prevalence of CP was 61% among infants with cystic periventricular leukomalacia, 50% in infants with intraparenchymal haemorrhage, 8% in infants with grade I intraventricular haemorrhage, and 4% in infants without a detectable cerebral lesion. After controlling for cerebral lesions and obstetric and neonatal factors, only male sex (odds ratio [OR] 1.52; 95% CI 1.03-2.25) and preterm premature rupture of membranes or preterm labour (OR 1.72; 95% CI 0.95-3.14) were predictors of the development of CP in very preterm infants.
Interpretation:
Cerebral lesions were the most important predictor of CP in very preterm infants. In addition, infant sex and preterm premature rupture of membranes or preterm labour were also independent predictors of CP.
