Decreasing Incidence and Severity of Cerebral Palsy in Prematurely Born Children

• Published in: The Journal of pediatrics Vol. 159; no. 1; pp. 86 - 91.e1
• Main Authors: van Haastert, Ingrid C., MA, Groenendaal, Floris, MD, PhD, Uiterwaal, Cuno S. P.M., MD, PhD, Termote, Jacqueline U.M., MD, PhD, van der Heide-Jalving, Marja, MD, Eijsermans, Maria J.C., PPT, Gorter, Jan Willem, MD, PhD, Helders, Paul J.M., MSc, PhD, Jongmans, Marian J., MSc, PhD, de Vries, Linda S., MD, PhD
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Elsevier Inc 01.07.2011; Mosby, Inc; Elsevier
• Subjects: Anti-Bacterial Agents - therapeutic use; antibiotics; Biological and medical sciences; Birth Weight; Catheters, Indwelling; Cerebral Hemorrhage - epidemiology; cerebral palsy; Cerebral Palsy - classification; Cerebral Palsy - epidemiology; Cesarean Section; children; Epidemiology; General aspects; Gestational Age; hemorrhage; Humans; Incidence; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Leukomalacia, Periventricular - epidemiology; Medical sciences; Miscellaneous; Netherlands - epidemiology; Pediatrics; Prenatal Care; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; regression analysis; Risk Factors; Severity of Illness Index; Netherlands; Cystic periventricular leukomalacia; cUS; Cerebral palsy; Gross Motor Function Classification System; MRI; NICU; Cranial ultrasonography; Intraventricular hemorrhage; CP; Gestational age; c-PVL; Magnetic resonance imaging; BW; Neonatal intensive care unit; BPD; Bronchopulmonary dysplasia; Birth weight; GA; IVH; GMFCS; Human; Premature; Pediatrics; Nervous system diseases; Central nervous system disease; Birth; Child; Epidemiology; Public health; Cerebral disorder; Incidence
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2010.12.053

Objective To examine incidence and severity of cerebral palsy (CP), and associated factors among preterm survivors (gestational age <34 weeks), admitted to a neonatal intensive care unit from 1990–2005. Study design Eighteen antenatal, perinatal and postnatal factors were analyzed. The cohort was divided in four birth periods: 1990–1993 (n = 661), 1994–1997 (n = 726), 1998–2001 (n = 723), and 2002–2005 (n = 850). The Gross Motor Function Classification System was used as primary outcome measure (mean age: 32.9 ± 5.3 months). Logistic regression analyses were used. Results CP incidence decreased from 6.5% in period I, to 2.6%, 2.9% and 2.2% ( P < .001) in period II-IV, respectively. Simultaneously, cystic periventricular leukomalacia (c-PVL) decreased from 3.3% in period I to 1.3% in period IV ( P = .004). Within the total cohort (n = 3287), c-PVL grade III decreased from 2.3% in period I to 0.2% in period IV ( P  = .003). The number of children with Gross Motor Function Classification System levels III-V decreased from period I to IV ( P = .035). Independent risk factors for CP were c-PVL and severe intraventricular hemorrhage, whereas antenatal antibiotics, presence of an arterial line, Caesarean section, and gestational age were independent protective factors. Conclusion CP incidence and severity decreased from 1990–1993 onward, which could be attributed to a reduction of 93% in severe c-PVL.