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

Murphy, Deirdre J; Hope, Peter; Johnson, Ann

doi:10.1136/bmj.314.7078.404

Cited by 175 publications

(135 citation statements)

References 29 publications

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“…This process produced 16 article,s which appeared likely to provide information about the relationship between BP and ultrasound brain abnormalities in the neonatal period. 8,13,14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30] These articles are described in Table 1.…”

Section: Methodsmentioning

confidence: 99%

Treating hypotension in the preterm infant: when and with what: a critical and systematic review

2007

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A very large proportion of extremely preterm infants receive treatments for hypotension. There are, however, marked variations in indications for treatment, and in the interventions used, between neonatal intensive care units and between neonatologists.Methods: We performed systematic reviews of the literature in order to determine which preterm infants may benefit from treatment with interventions to elevate blood pressure (BP), and which interventions improve clinically important outcomes.Results: Our review was not able to define a threshold BP that was significantly predictive of a poor outcome, nor whether any interventions for hypotensive infants improved outcomes, nor which interventions were more likely to be beneficial. Conclusions:There is a distinct lack of prospective research of this issue, which prevents good clinical care. It is possible that a simple BP threshold that indicates the need for therapy does not exist, and other factors, such as the clinical status or systemic blood flow measurements, may be much more informative. Such a paradigm shift will also require careful prospective study.

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Section: Methodsmentioning

confidence: 99%

Treating hypotension in the preterm infant: when and with what: a critical and systematic review

2007

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“…At the same time, however, clinicians are commonly faced with critically ill infants who have cardiovascular insufficiency with hypotension, a condition that has also been associated with adverse consequences. [62][63][64][65][66][67] Current therapy for hypotension consists primarily of volume expanders and vasopressors, which only treat the symptom. If the etiology of the hypotension in some of these infants is relative adrenal insufficiency, treatment with hydrocortisone would be more appropriate.…”

Section: Should We Treat Relative Ai In Newborns?mentioning

confidence: 99%

Relative adrenal insufficiency in the preterm and term infant

2009

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Cortisol release in the face of illness or stress is vital for survival. Relative adrenal insufficiency occurs when a patient's cortisol response is inadequate for the degree of illness or stress. Numerous studies have documented the existence of relative adrenal insufficiency in critically ill adults, and its association with increased morbidity and mortality. There is increasing evidence that relative adrenal insufficiency may be an etiology for hemodynamic instability and hypotension in the critically ill newborn, but compared with the adult population, there is still a paucity of data in this population. Randomized controlled trials are needed to evaluate the efficacy and safety of glucocorticoids for the treatment of cardiovascular insufficiency due to relative adrenal insufficiency in ill preterm and term newborn infants. Keywords: adrenocorticotropin; ACTH; adrenal insufficiency; corticotrophin-releasing hormone; cortisol; critically ill infants hypothalamic-pituitary-adrenal axis; newborns-full term Introduction Activation of the hypothalamic-pituitary-adrenal (HPA) axis and ultimate release of cortisol are critical in maintaining homeostasis in response to stress. Relative adrenal insufficiency occurs when the HPA axis produces insufficient cortisol for the degree of illness or stress. In some critically ill adult populations, relative adrenal insufficiency is prevalent, 1-4 and is associated with increased morbidity and mortality. 2,3,5 Some studies of glucocorticoid treatment in critically ill adults have shown benefit, with faster reversal of shock and reduction in mortality. 3,[5][6][7][8] Recently, increasing evidence supports the existence of relative adrenal insufficiency in ill newborns, but, similar to other ill populations, there remains no general consensus on which patients should be tested, which tests to use and how to interpret them, which patients should be treated or how they should be treated. 9 The following discussion is an overview of corticosteroid physiology, relative adrenal insufficiency in critically ill populations and evidence of its existence in newborn infants, with proposed underlying

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“…More than 50% of extremely low birth weight infants (,1000 g) are treated for clinical or proven neonatal infection during their hospitalization, 12 and the associated mortality is high (20%-40%). [13][14][15] Follow-up studies of preterm infants have suggested an association between inflammation, cerebral white matter damage, and cerebral palsy, [16][17][18][19] but very few studies have directly addressed the possible links between neonatal infections and neurodevelopmental outcomes. 8,20 The objective of the current study was to evaluate the impact of neonatal infections on 5-year neurodevelopmental outcomes in a large population-based cohort of very preterm infants.…”

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confidence: 99%

Neonatal Infection and 5-year Neurodevelopmental Outcome of Very Preterm Infants

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Neonatal infections are frequent complications in very preterm infants, already at high risk of neurologic and cognitive disabilities. Few studies have linked neonatal infections and neurodevelopmental outcomes. Those that did evaluated children only to the age of 22 months. WHAT THIS STUDY ADDS:This study assessed the respective effects of early-and late-onset sepsis and their association with 5-year neurodevelopmental outcomes. We identified a significant and cumulative risk of cerebral palsy when episodes of early-and late-onset sepsis were associated. abstract OBJECTIVE: To determine whether neonatal infections are associated with a higher risk of adverse neurodevelopment at 5 years of age in a population-based cohort of very preterm children. METHODS:We included all live births between 22 and 32 weeks of gestation, from 9 regions in France, in 1997 (EPIPAGE study). Of the 2665 live births, 2277 were eligible for a follow-up evaluation at 5 years of age: 1769 had a medical examination and 1495 underwent cognitive assessment. Cerebral palsy and cognitive impairment were studied as a function of early-onset sepsis (EOS) and late-onset sepsis (LOS), after adjustment for potential confounding factors, in multivariate logistic regression models. RESULTS:A total of 139 (5%) of the 2665 live births included in the study presented with EOS alone (without associated LOS), 752 (28%) had LOS alone (without associated EOS), and 64 (2%) displayed both EOS and LOS. At 5 years of age, the frequency of cerebral palsy was 9% (157 of 1769) and that of cognitive impairment was 12% (177 of 1495). The frequency of cerebral palsy was higher in infants with isolated EOS (odds ratio [OR] CONCLUSIONS: Neonatal infections in these very preterm infants were associated with a higher risk of cerebral palsy at the age of 5 years, particularly in infants presenting with both EOS and LOS. Pediatrics 2013;132:e372-e380 AUTHORS:

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

Abstract: Objective: To assess decleration and acceleration in the disease process in the initial phase of epsilepsy in children with new onset tonic-clonic seizures.

Cited by 175 publications

References 29 publications

Treating hypotension in the preterm infant: when and with what: a critical and systematic review

Treating hypotension in the preterm infant: when and with what: a critical and systematic review

Relative adrenal insufficiency in the preterm and term infant

Neonatal Infection and 5-year Neurodevelopmental Outcome of Very Preterm Infants

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