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Intrauterine growth and gestational age in preterm infants with cerebral palsy
M Topp1, J Langhoff-Roos, P Uldall
1Department of Obstetrics and Gynecology, University of Copenhagen, Denmark.
Insights
Preterm infants with cerebral palsy are born earlier. Small for gestational age (SGA) increases cerebral palsy risk in preterm infants over 33 weeks, but not earlier.
Area of Science:
- Perinatal Medicine
- Neonatology
- Developmental Neurology
Background:
- Cerebral palsy (CP) is a significant concern in preterm infants.
- Understanding risk factors like gestational age and intrauterine growth is crucial for prevention and management.
Purpose of the Study:
- To investigate the relationship between gestational age, intrauterine growth, and the risk of cerebral palsy in preterm infants.
- To determine if being small for gestational age (SGA) modifies the risk of CP in relation to gestational age.
Main Methods:
- A case-control study comparing 191 preterm infants with CP to 2203 preterm controls.
- Analysis of gestational age distribution and birth weight deviation from the mean for gestational age.
- Assessment of the odds ratio (OR) for CP associated with SGA across different gestational age groups.
Main Results:
- The distribution of gestational age among preterm CP cases showed peaks at 29 and 32 weeks.
- The highest risk for CP was observed in infants born between 28-30 weeks gestation (OR = 5.6).
- Small for gestational age (SGA) was associated with increased CP risk only in preterm infants born after 33 weeks gestation (OR = 5.2 for 34-36 weeks).
Conclusions:
- Preterm infants diagnosed with cerebral palsy tend to be born at earlier gestational ages compared to other preterm infants.
- The association between being small for gestational age and cerebral palsy is significant only for preterm infants born later (above 33 weeks gestation).
Abstract:
In a case-control study, gestational age and intrauterine growth of 191 preterm singleton infants 1971-82 with cerebral palsy were compared to all preterm live-born singletons in Denmark in 1982 (N = 2203). The distribution of gestational age among preterm cases was slightly bimodal with maximum values at 29 and 32 weeks. The risk for cerebral palsy was highest in the infants with gestational age 28-30 weeks (OR = 5.6 (4.0-7.8), 95% confidence interval). Birth weight deviation, in the 34-36 weeks infants, expressed as the number of standard deviations from the mean birth weight for gestational age, was more negative in cases than in controls (P < 0.001). The frequency of small for gestational age (SGA) was 13% in cases and 9% in controls (OR = 1.5 (0.96-2.3), 95% confidence interval). The odds for cerebral palsy being SGA, was lower in 28-30 weeks (OR = 0.22 (0.06-0.86), 95% confidence interval), the same in 31-33 weeks (OR = 0.83 (0.35-2.0), 95% confidence interval) and higher in 34-36 weeks (OR = 5.2 (2.9-9.5), 95% confidence interval). In conclusion, preterm infants with cerebral palsy are born earlier than other preterm infants. Small for gestational age is associated with cerebral palsy in preterm infants only above 33 weeks.