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Prediction of Cerebral Palsy or Death among Preterm Infants Who Survive the Neonatal Period
Alan M Peaceman1, Lisa Mele2, Dwight J Rouse3
1Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
Insights
Neonatal morbidities like intraventricular hemorrhage and periventricular leukomalacia at hospital discharge predict subsequent cerebral palsy (CP) or death. A validated model can now calculate individual infant risk for better counseling.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Clinical prediction modeling
Background:
- Cerebral palsy (CP) and neonatal death are significant concerns for preterm infants.
- Identifying early risk factors is crucial for timely intervention and parental counseling.
- Previous studies have explored various neonatal outcomes, but a comprehensive model for discharge-based prediction is needed.
Purpose of the Study:
- To determine if neonatal morbidities present at hospital discharge are associated with subsequent cerebral palsy (CP) or death.
- To develop and validate a predictive model for CP or death using factors known at discharge.
- To provide a tool for calculating individual infant risk to aid in parental counseling.
Main Methods:
- Secondary analysis of a multicenter, placebo-controlled trial of magnesium sulfate for CP prevention.
- Examined associations between 11 prespecified neonatal outcomes and 10 demographic/clinical factors at discharge.
- Developed a prediction model for death or moderate/severe CP by age 2 in surviving infants (n=1889).
Main Results:
- Gestational age at delivery, grade III/IV intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), and male gender were significantly associated with death or CP by age 2.
- Respiratory distress syndrome, bronchopulmonary dysplasia, seizures, necrotizing enterocolitis, neonatal hypotension, Apgar score, sepsis, and retinopathy of prematurity were not significantly associated.
- The final prediction model demonstrated strong predictive accuracy with an area under the receiver operating characteristic curve of 0.84 (95% CI: 0.78-0.89).
Conclusions:
- Intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) are the primary neonatal complications at discharge predicting long-term risk of death or CP.
- A predictive model incorporating gestational age, gender, IVH, and PVL can accurately estimate an infant's risk for subsequent neurologic sequelae.
- This model allows for the calculation of individual infant risk at hospital discharge, facilitating informed parental counseling.
Objective:
To assess whether neonatal morbidities evident by the time of hospital discharge are associated with subsequent cerebral palsy (CP) or death.
Study Design:
This is a secondary analysis of data from a multicenter placebo-controlled trial of magnesium sulfate for the prevention of CP. The association between prespecified intermediate neonatal outcomes (n = 11) and demographic and clinical factors (n = 10) evident by the time of discharge among surviving infants (n = 1889) and the primary outcome of death or moderate/severe CP at age 2 (n = 73) was estimated, and a prediction model was created.
Results:
Gestational age in weeks at delivery (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.67-0.83), grade III or IV intraventricular hemorrhage (IVH) (OR: 5.3, CI: 2.1-13.1), periventricular leukomalacia (PVL) (OR: 46.4, CI: 20.6-104.6), and male gender (OR: 2.5, CI: 1.4-4.5) were associated with death or moderate/severe CP by age 2. Outcomes not significantly associated with the primary outcome included respiratory distress syndrome, bronchopulmonary dysplasia, seizure, necrotizing enterocolitis, neonatal hypotension, 5-minute Apgar score, sepsis, and retinopathy of prematurity. Using all patients, the receiver operating characteristic curve for the final prediction model had an area under the curve of 0.84 (CI: 0.78-0.89). Using these data, the risk of death or developing CP by age 2 can be calculated for individual surviving infants.
Conclusion:
IVH and PVL were the only neonatal complications evident at discharge that contributed to an individual infant's risk of the long-term outcomes of death or CP by age 2. A model that includes these morbidities, gestational age at delivery, and gender is predictive of subsequent neurologic sequelae.
Key Points:
· Factors known at hospital discharge are identified which are independently associated with death or CP by age 2.. · A model was created and validated using these findings to counsel parents.. · The risk of death or CP can be calculated at the time of hospital discharge..
