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. 1999 Mar;80(2):F115–F117. doi: 10.1136/fn.80.2.f115

Trends in incidence of cranial ultrasound lesions and cerebral palsy in very low birthweight infants 1982-93

R Cooke
PMCID: PMC1720893  PMID: 10325787

Abstract

AIM—To evaluate the effects of changing perinatal practice on outcome in terms of cranial ultrasound appearances and subsequent cerebral palsy rates in survivors.
METHODS—A tertiary neonatal centre based prospective cohort study was undertaken of very low birthweight infants, in three 4 year periods: 1982-5, 1986-9, 1990-3. Rates of survival, parenchymal cerebral haemorrhage (PH), and leucomalacia on cerebral ultrasound scans, and cerebral palsy (CP) at the age of 3 years were compared. Antenatal steroid prophylaxis and postnatal surfactant use were also compared.
RESULTS—VLBW infants (1722) were admitted over the 12 years, of whom 1268 (73.6%) were discharged home. Neonatal survival increased significantly over the three periods (69.2%, 72.9%, 79.7%; p<0.0001). PH declined from 14.9% to 10.5% (p=0.032) after 1990 as did CP rate (10.9% to 7.3%; p=0.046). The use of antenatal steroids and postnatal surfactant greatly increased during this period. Steroid use was significantly associated with increased survival (OR 3.34,2.31-4.79), decreased PH (OR 0.44, 0.28-0.71), and decreased risk of CP in survivors (OR 0.47, 0.27-0.81) after standardising for gestation, birthweight, sex, place and mode of delivery. Similar effects for surfactant did not remain significant after steroid use had been accounted for.
CONCLUSION—Improved survival in VLBW infants since 1990 has been accompanied by a fall in PH and subsequent CP rates in survivors. This change is most likely to be due to the greater use of antenatal steroid prophylaxis.



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Selected References

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  1. Allan W. C., Dransfield D. A., Kessler D. L. Cerebral palsy in preterm infants. Lancet. 1994 Apr 23;343(8904):1048–1048. [PubMed] [Google Scholar]
  2. BAX M. C. TERMINOLOGY AND CLASSIFICATION OF CEREBRAL PALSY. Dev Med Child Neurol. 1964 Jun;6:295–297. doi: 10.1111/j.1469-8749.1964.tb10791.x. [DOI] [PubMed] [Google Scholar]
  3. Cooke R. W. Annual audit of three year outcome in very low birthweight infants. Arch Dis Child. 1993 Sep;69(3 Spec No):295–298. doi: 10.1136/adc.69.3_spec_no.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cooke R. W. Cerebral palsy in very low birthweight infants. Arch Dis Child. 1990 Feb;65(2):201–206. doi: 10.1136/adc.65.2.201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cooke R. W. Early and late cranial ultrasonographic appearances and outcome in very low birthweight infants. Arch Dis Child. 1987 Sep;62(9):931–937. doi: 10.1136/adc.62.9.931. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cooke R. W. Survival and cerebral morbidity in preterm infants. Lancet. 1994 Jun 18;343(8912):1578–1578. doi: 10.1016/s0140-6736(94)92984-x. [DOI] [PubMed] [Google Scholar]
  7. Hagberg B., Hagberg G., Olow I. The changing panorama of cerebral palsy in Sweden. IV. Epidemiological trends 1959-78. Acta Paediatr Scand. 1984 Jul;73(4):433–440. doi: 10.1111/j.1651-2227.1984.tb09951.x. [DOI] [PubMed] [Google Scholar]
  8. Kuban K. C., Leviton A. Cerebral palsy. N Engl J Med. 1994 Jan 20;330(3):188–195. doi: 10.1056/NEJM199401203300308. [DOI] [PubMed] [Google Scholar]
  9. Meberg A., Broch H. A changing pattern of cerebral palsy. Declining trend for incidence of cerebral palsy in the 20-year period 1970-89. J Perinat Med. 1995;23(5):395–402. doi: 10.1515/jpme.1995.23.5.395. [DOI] [PubMed] [Google Scholar]
  10. O'Shea T. M., Preisser J. S., Klinepeter K. L., Dillard R. G. Trends in mortality and cerebral palsy in a geographically based cohort of very low birth weight neonates born between 1982 to 1994. Pediatrics. 1998 Apr;101(4 Pt 1):642–647. doi: 10.1542/peds.101.4.642. [DOI] [PubMed] [Google Scholar]
  11. Pharoah P. O., Cooke T., Cooke R. W., Rosenbloom L. Birthweight specific trends in cerebral palsy. Arch Dis Child. 1990 Jun;65(6):602–606. doi: 10.1136/adc.65.6.602. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Pharoah P. O., Cooke T., Rosenbloom I., Cooke R. W. Trends in birth prevalence of cerebral palsy. Arch Dis Child. 1987 Apr;62(4):379–384. doi: 10.1136/adc.62.4.379. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Robertson C. M., Hrynchyshyn G. J., Etches P. C., Pain K. S. Population-based study of the incidence, complexity, and severity of neurologic disability among survivors weighing 500 through 1250 grams at birth: a comparison of two birth cohorts. Pediatrics. 1992 Nov;90(5):750–755. [PubMed] [Google Scholar]
  14. Tudehope D., Burns Y. R., Gray P. H., Mohay H. A., O'Callaghan M. J., Rogers Y. M. Changing patterns of survival and outcome at 4 years of children who weighted 500-999 g at birth. J Paediatr Child Health. 1995 Oct;31(5):451–456. doi: 10.1111/j.1440-1754.1995.tb00856.x. [DOI] [PubMed] [Google Scholar]

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