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Am J Perinatol 2024; 41(06): 783-789
DOI: 10.1055/a-1788-6281
Original Article

Prediction of Cerebral Palsy or Death among Preterm Infants Who Survive the Neonatal Period

Alan M. Peaceman
1   Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Lisa Mele
2   Department of Biostatistics and Bioinformatics, The George Washington University, Washington, District of Columbia
,
Dwight J. Rouse
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Kenneth J. Leveno
4   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Brian M. Mercer
5   Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
6   Department of Obstetrics and Gynecology, University of Tennessee, Memphis, Tennessee
,
Michael W. Varner 
7   Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
Uma M. Reddy
8   Pregnancy and Perinatology Branch, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Ronald J. Wapner
9   Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
10   Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania
,
Yoram Sorokin
11   Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
,
John M. Thorp
12   Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Susan M. Ramin
13   Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas
,
Fergal D. Malone
14   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Mary J. O'Sullivan
15   Department of Obstetrics and Gynecology, University of Miami, Miami, Florida
,
Donald J. Dudley
16   Department of Obstetrics and Gynecology, University of Texas at San Antonio, San Antonio, Texas
,
Steve N. Caritis
17   Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
,
for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network › Institutsangaben Funding The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [HD27869, HD34208, HD34116, HD40544, HD27915, HD34136, HD21414, HD27917, HD27860, HD40560, HD40545, HD40485, HD40500, HD27905, HD27861, HD34122, HD40512, HD53907, HD34210, HD21410, HD36801, HD19897], MO1-RR-000080, and by the National Institute of Neurological Disorders and Stroke (NINDS). Comments and views of the authors do not necessarily represent views of the NICHD and NINDS.
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Abstract

Objective To assess whether neonatal morbidities evident by the time of hospital discharge are associated with subsequent cerebral palsy (CP) or death.

Study Design This is a secondary analysis of data from a multicenter placebo-controlled trial of magnesium sulfate for the prevention of CP. The association between prespecified intermediate neonatal outcomes (n = 11) and demographic and clinical factors (n = 10) evident by the time of discharge among surviving infants (n = 1889) and the primary outcome of death or moderate/severe CP at age 2 (n = 73) was estimated, and a prediction model was created.

Results Gestational age in weeks at delivery (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.67–0.83), grade III or IV intraventricular hemorrhage (IVH) (OR: 5.3, CI: 2.1–13.1), periventricular leukomalacia (PVL) (OR: 46.4, CI: 20.6–104.6), and male gender (OR: 2.5, CI: 1.4–4.5) were associated with death or moderate/severe CP by age 2. Outcomes not significantly associated with the primary outcome included respiratory distress syndrome, bronchopulmonary dysplasia, seizure, necrotizing enterocolitis, neonatal hypotension, 5-minute Apgar score, sepsis, and retinopathy of prematurity. Using all patients, the receiver operating characteristic curve for the final prediction model had an area under the curve of 0.84 (CI: 0.78–0.89). Using these data, the risk of death or developing CP by age 2 can be calculated for individual surviving infants.

Conclusion IVH and PVL were the only neonatal complications evident at discharge that contributed to an individual infant's risk of the long-term outcomes of death or CP by age 2. A model that includes these morbidities, gestational age at delivery, and gender is predictive of subsequent neurologic sequelae.

Key Points

  • Factors known at hospital discharge are identified which are independently associated with death or CP by age 2.

  • A model was created and validated using these findings to counsel parents.

  • The risk of death or CP can be calculated at the time of hospital discharge.

Keywords

cerebral palsy - magnesium sulfate - premature rupture

Note

Presented at the 32nd Annual Meeting of the Society for Maternal-Fetal Medicine, Dallas, Texas, February 6–11, 2012. The parent trial for this study was registered on ClinicalTrials.gov Web site with number NCT00014989.




Publikationsverlauf

Eingereicht: 07. Oktober 2021

Angenommen: 18. Februar 2022

Accepted Manuscript online:
04. März 2022

Artikel online veröffentlicht:
12. Mai 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

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