Neonatal risk factors for cerebral palsy in very preterm babies: case-control study

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Abstract
Objective: To identify neonatal risk factors for cerebral palsy among very preterm babies and in particular the associations independent of the coexistence of antenatal and intrapartum factors. Design: Case-control study. Setting: Oxford health region. Subjects: Singleton babies born between 1984 and 1990 at less than 32 weeks' gestation who survived to discharge from hospital: 59 with cerebral palsy and 234 randomly selected controls without cerebral palsy. Main outcome measures: Adverse neonatal factors expressed as odds ratios and 95% confidence intervals. Results: Factors associated with an increased risk of cerebral palsy after adjustment for gestational age and the presence of previously identified antenatal and intrapartum risk factors were patent ductus arteriosus (odds ratio 2.3; 95% confidence interval 1.2 to 4.5), hypotension (2.3; 1.3 to 4.7), blood transfusion (4.8; 2.5 to 9.3), prolonged ventilation (4.8; 2.5 to 9.0), pneumothorax (3.5; 1.6 to 7.6), sepsis (3.6; 1.8 to 7.4), hyponatraemia (7.9; 2.1 to 29.6) and total parenteral nutrition (5.5;2.8 to 10.5). Seizures were associated with an increased risk of cerebral palsy (10.0; 4.1 to 24.7), as were parenchymal damage (32; 12.4 to 84.4) and appreciable ventricular dilatation (5.4; 3.0 to 9.8) detected by cerebral ultrasound. Conclusion: A reduction in the rate of cerebral palsy in very preterm babies requires an integrated approach to management throughout the antenatal, intrapartum, and neonatal periods. Preterm birth is associated with an increased risk of cerebral palsy Antenatal, intrapartum, and neonatal factors have all been associated with cerebral palsy in preterm babies Neonatal pneumothorax, sepsis, and transfusion are associated with preterm cerebral palsy independently of adverse antenatal factors and mode of delivery Intrauterine infection followed by neonatal sepsis is associated with a very high risk of cerebral palsy among preterm babies The prevention of cerebral palsy among very preterm babies requires an integrated approach throughout the antenatal, intrapartum, and neonatal periods