Predictors of cerebral palsy in very preterm infants: the EPIPAGE prospective population‐based cohort study |
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| Authors: | GHADA BEAINO BABAK KHOSHNOOD MONIQUE KAMINSKI VÉRONIQUE PIERRAT STÉPHANE MARRET JACQUELINE MATIS BERNARD LEDÉSERT GÉRARD THIRIEZ JEANNE FRESSON JEAN‐CHRISTOPHE ROZÉ VÉRONIQUE ZUPAN‐SIMUNEK CATHERINE ARNAUD ANTOINE BURGUET BÉATRICE LARROQUE GÉRARD BRÉART PIERRE‐YVES ANCEL for the EPIPAGE Study Group |
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| Institution: | 1. INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women’s and Children’s Health, H?pital Tenon, Paris, France.;2. UMPC Univ Paris 06, UMR S 953, F‐75005, Paris, France.;3. UMPC Univ Paris 06, UMR S 953, F‐75005, Paris, France.;4. INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women’s and Children’s Health, H?pital Cochin, F‐75014, Paris, France.;5. INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women’s and Children’s Health, F‐94807, Villejuif, France.;6. Department of Neonatology, Jeanne de Flandre Hospital, Lille, France.;7. Department of Neonatal Medicine, Rouen University Hospital, and the INSERM Avenir Research Group, Institute for Biomedical Research, University of Rouen, Rouen, France.;8. Department of Neonatology, Strasbourg University Hospital, Strasbourg, France.;9. Observatoire régional de la Santé, Montpellier, France.;10. Paediatric Intensive Care Unit, Saint Jacques Hospital, Besan?on, France.;11. Regional Maternity University Hospital, Nancy, France.;12. Department of Neonatology, Children’s Hospital, Nantes, France.;13. Antoine Béclère Hospital, Clamart, France.;14. INSERM U558, Research Unit on Epidemiology and Public Health, Toulouse, France.;15. Department of Neonatology, Poitiers, France. |
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| Abstract: | 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 2wks; range 24–32wks) and a mean birthweight of 1367g (SD 393g; range 450–2645g). 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 2wks; range 24–32wks) and a mean birthweight of 1305g (SD 386g; range 500–2480g). 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. |
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