Objective To assess the joint effects of prognostic factors for cerebral palsy in very preterm infants.
Methods All infants born before 33 weeks of gestation in nine regions of France in 1997 were included. Perinatal data were recorded. Cerebral lesions detected on neonatal cranial ultrasound scan were cystic periventricular leukomalacia (PVL), intraparenchymal hemorrhage (IPH), persistent echodensities, ventricular dilatation and intraventricular hemorrhages (IVH). Of 2357 eligible survivors, 1812 were assessed for cerebral palsy at five years of age. We estimated the prevalence of cerebral palsy in relation to cerebral lesions and studied prognostic factors for cerebral palsy using multiple logistic regression.
Results Very preterm infants with cystic PVL or IPH were at high risk of cerebral palsy (60%) independently of other perinatal factors. In infants without cystic PVL or IPH, prognostic factors for cerebral palsy were the presence of persistent echodensities or ventricular dilatation or grade III IVH (OR, 3.26; 95% CI, 2.04 to 5.24), grade II IVH (OR, 2.46; 95% CI, 1.27 to 4.79), decreasing gestational age (31–32 weeks: reference group/29–30 weeks: OR: 1.28; 95% CI, 1.01 to 1.63/24–28 weeks: OR, 1.64; 95% CI, 1.02 to 2.66), male sex (OR, 1.78; 95% CI, 1.18 to 2.67) and preterm premature rupture of membranes or preterm labor (OR, 2.10; 95% CI, 1.28 to 3.45). In these infants, predicted probabilities of cerebral palsy varied from 2% to 24% depending on the four previous prognostic factors.
Conclusions Motor prognosis of very preterm infants depends primarily on cerebral lesions, but also on several obstetric factors in the absence of cystic PVL or IPH.
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