Decreasing Incidence and Severity of Cerebral Palsy in Prematurely Born Children

作     者：van Haastert, Ingrid C. Groenendaal, Floris Uiterwaal, Cuno S. P. M. Termote, Jacqueline U. M. van der Heide-Jalving, Marja Eijsermans, Maria J. C. Gorter, Jan Willem Helders, Paul J. M. Jongmans, Marian J. de Vries, Linda S. 

作者机构：Univ Med Ctr Utrecht Dept Neonatol Wilhelmina Childrens Hosp NL-3584 EA Utrecht Netherlands Univ Med Ctr Utrecht Julius Ctr Hlth Sci & Primary Care NL-3584 EA Utrecht Netherlands Univ Med Ctr Utrecht Dept Paediat Phys Therapy & Clin Exercise Physiol Wilhelmina Childrens Hosp Div Paediat NL-3584 EA Utrecht Netherlands McMaster Univ CanChild Ctr Childhood Disabil Res Hamilton ON Canada 

出 版 物：《JOURNAL OF PEDIATRICS》 (儿科学杂志)

年 卷 期：2011年第159卷第1期

页      面：86-U112页

核心收录：

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学] 

主　　题：BPD Bronchopulmonary dysplasia BW Birth weight c-PVL Cystic periventricular leukomalacia CP Cerebral palsy cUS Cranial ultrasonography GA Gestational age GMFCS Gross Motor Function Classification System IVH Intraventricular hemorrhage MRI Magnetic resonance imaging NICU Neonatal intensive care unit 

摘      要：Objective To examine incidence and severity of cerebral palsy (CP), and associated factors among preterm survivors (gestational age 34 weeks), admitted to a neonatal intensive care unit from 1990-2005. Study design Eighteen antenatal, perinatal and postnatal factors were analyzed. The cohort was divided in four birth periods: 1990-1993 (n = 661), 1994-1997 (n = 726), 1998-2001 (n = 723), and 2002-2005 (n = 850). The Gross Motor Function Classification System was used as primary outcome measure (mean age: 32.9 +/- 5.3 months). Logistic regression analyses were used. Results CP incidence decreased from 6.5% in period I, to 2.6%, 2.9% and 2.2% (P.001) in period II-IV, respectively. Simultaneously, cystic periventricular leukomalacia (c-PVL) decreased from 3.3% in period I to 1.3% in period IV (P = .004). Within the total cohort (n = 3287), c-PVL grade III decreased from 2.3% in period I to 0.2% in period IV (P = .003). The number of children with Gross Motor Function Classification System levels III-V decreased from period I to IV(P = .035). Independent risk factors for CP were c-PVL and severe intraventricular hemorrhage, where as antenatal antibiotics, presence of an arterial line, Caesarean section, and gestational age were independent protective factors. Conclusion CP incidence and severity decreased from 1990-1993 onward, which could be attributed to a reduction of 93% in severe c-PVL. (J Pediatr 2011;159:86-91).