Moderate and late preterm birth increases cerebral palsy risk

1. Resuscitation at birth, antibiotic treatment during the first hospitalization, small for gestational age (SGA), 1-minute Apgar score <7, and intracranial hemorrhage were predictive of cerebral palsy (CP) in moderately preterm and late preterm infants in Finland.

2. The incidence of CP was highest in all preterm groups and decreased nonlinearly after 28 weeks of gestation.

Evidence Rating Level: 1 (Excellent) 

Study Rundown: CP is a neurological disorder resulting from abnormalities in fetal and infant brain development. Preterm birth has been found to be the strongest risk factor for CP, with moderately preterm (MP; 32-33 weeks) and late preterm (LP; 34-36 weeks) infants comprising over 80% of all preterm births. This study explored additional risk factors contributing to the development of CP in MP and LP infants. Results indicated that birth between 1991 and 1995, 1-minute Apgar <7, small size for gestational age, resuscitation at birth, and intracranial hemorrhage all predicted CP in MP and LP infants.. In addition, the incidence of CP decreased in a nonlinear fashion over time, with the greatest drop among very preterm (VP; <32 weeks) infants. This study is limited by possible discrepancies in recording habits among the institutions involved. Nonetheless, a better understanding of risk factors may help improve the prenatal and post-partum care, diagnosis, and treatment of infants at risk for CP.

Click to read the study in Pediatrics

Relevant Reading: Long-term outcomes of moderately preterm, late preterm, and early term infants

Study Author, Dr. Mikko Hirvonen, MD, talks to 2 Minute Medicine: Department of Pediatrics, Tampere Center for Child and Health Research, Central Finland Health Care District, Jyvaskyla, Finland.

“Moderately and late preterm infants comprise the largest group of all prematurely born infants. According to our study these groups have a greater risk for CP compared to full-term born children. Factors indicating asphyxia and brain damage were most prominently associated with an increased risk of CP.” 

In-Depth [case control study]: Study participants included 1,018,302 infants from the Medical Birth Register, maintained by the National Institutes of Health and Welfare Finland. Participants were divided into VP (<32 weeks), MP (32-32 weeks), LP (34-36 weeks), and term infants (>37 weeks). Three time periods were compared: 1991 to 1995, 1996 to 2001, and 2002 to 2008. Of all births recorded, preterm births made up 5.02% in 1991 to 1995, 5.43% in 1996 to 2001, and 5.18% in 2002 to 2008. Of all premature births, LP and MP infants comprised 88%. The incidence of CP among all births was 0.22% in 1991 and decreased with increasing gestational age and over time, with the biggest decrease in the VP group. Compared to the full term group, the odds of developing CP were 9.37, 5.12, and 2.35 in the VP, MP, and LP groups, respectively (95% CI 7.34-11.96, 4.13-6.34 and 1.99-2.77, respectively). Furthermore, premature rupture of membranes (PROM) was associated with increased risk of CP in the MP group, while antenatal steroid use was linked to decreased CP risk in the same group (OR 3.05 95% CI 1.02-9.12 and 0.27 95% CI 0.09-0.80, respectively).

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