Some Risk Factors for Cerebral Palsy in Very Premature Infants: Importance of Premature Rupture of Membranes and Monochorionic Twin Placentation

Burguet, A.; Monnet, Élisabeth; Pauchard, Jean-Yves; Roth, P.; Fromentin, Clément; Dalphin, M.L.; Allemand, H.; Maillet, R; Menget, A.

doi:10.1159/000014094

Cited by 47 publications

(14 citation statements)

References 28 publications

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“…Duration of intensive care showed a trend towards worse outcome. These findings were similar to those reported in other studies where NEC [24-28], gender [7,26,29-33], chronic lung disease [3,7,32,34], respiratory distress [35,36], multiple birth [7], HIV infection [37], cranial sonar findings [29,38-41], particularly PVL [15,26,31,42,43] and intraventricular haemorrhage, [26,44,45]), neonatal seizures [26,44], perinatal asphyxia [41,44,45], neonatal sepsis [27,41], postnatal steroids [31,33,34] and the duration of assisted ventilation [24,26,30] have all been associated with adverse neurodevelopmental outcome in VLBW infants. Gestational age [3,35,46] and birth weight [10,30,46] have both been reported as predictors of poor neurodevelopmental outcome.…”

Section: Discussionsupporting

confidence: 92%

Developmental outcome of very low birth weight infants in a developing country

et al. 2012

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BackgroundAdvances in neonatal care allow survival of extremely premature infants, who are at risk of handicap. Neurodevelopmental follow up of these infants is an essential part of ongoing evaluation of neonatal care. The neonatal care in resource limited developing countries is very different to that in first world settings. Follow up data from developing countries is essential; it is not appropriate to extrapolate data from units in developed countries. This study provides follow up data on a population of very low birth weight (VLBW) infants in Johannesburg, South Africa.MethodsThe study sample included all VLBW infants born between 01/06/2006 and 28/02/2007 and discharged from the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Bayley Scales of Infant and Toddler Development Version 111 (BSID) 111 were done to assess development. Regression analysis was done to determine factors associated with poor outcome.Results178 infants were discharged, 26 were not available for follow up, 9 of the remaining 152 (5.9%) died before an assessment was done; 106 of the remaining 143 (74.1%) had a BSID 111 assessment. These 106 patients form the study sample; mean birth weight and mean gestational age was 1182 grams (SD: 197.78) and 30.81 weeks (SD: 2.67) respectively. The BSID (111) was done at a median age of 16.48 months. The mean cognitive subscale was 88.6 (95% CI: 85.69 - 91.59), 9 (8.5%) were < 70, mean language subscale was 87.71 (95% CI: 84.85 - 90.56), 10 (9.4%) < 70, and mean motor subscale was 90.05 (95% CI: 87.0 - 93.11), 8 (7.6%) < 70. Approximately one third of infants were identified as being at risk (score between 70 and 85) on each subscale. Cerebral palsy was diagnosed in 4 (3.7%) of babies. Factors associated with poor outcome included cystic periventricular leukomalacia (PVL), resuscitation at birth, maternal parity, prolonged hospitalisation and duration of supplemental oxygen. PVL was associated with poor outcome on all three subscales. Birth weight and gestational age were not predictive of neurodevelopmental outcome.ConclusionAlthough the neurodevelopmental outcome of this group of VLBW infants was within the normal range, with a low incidence of cerebral palsy, these results may reflect the low survival of babies with a birth weight below 900 grams. In addition, mean subscale scores were low and one third of the babies were identified as "at risk", indicating that this group of babies warrants long-term follow up into school going age.

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Section: Discussionsupporting

confidence: 92%

Developmental outcome of very low birth weight infants in a developing country

et al. 2012

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“…8,15 Socio economic status has a recognized strong influence on intelligence, behavioral problems, and academic achievement. 16 Individual predictors such as gestational age, birthweight, Apgar score, and cranial ultrasound abnormalities have been used to predict long-term outcomes in preterm infants.…”

Section: Discussionmentioning

confidence: 99%

Clinical Risk Index for Babies score for the prediction of neurodevelopmental outcomes at 3 years of age in infants of very low birthweight

Lodha

Sauvé

Chen

et al. 2009

Develop Med Child Neuro

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Aim In this study, we evaluated the Clinical Risk Index for Babies ‐ revised (CRIB‐II) score as a predictor of long‐term neurodevelopmental outcomes in preterm infants at 36 months’ corrected age. Method CRIB‐II scores, which include birthweight, gestational age, sex, admission temperature, and base excess, were recorded prospectively on all infants weighing 1250g or less admitted to the neonatal intensive care unit (NICU). The sensitivity and specificity of CRIB‐II scores to predict poor outcomes were examined using receiver operating characteristic curves, and predictive accuracy was assessed using the area under the curve (AUC), based on the observed values entered on a continuous scale. Poor outcomes were defined as death or major neurodevelopmental disability (cerebral palsy, neurosensory hearing loss requiring amplification, legal blindness, severe seizure disorder, or cognitive score >2SD below the mean for adjusted age determined by clinical neurological examination and on the Wechsler Preschool and Primary Scale of Intelligence, Bayley Scales of Infant Development, or revised Leiter International Performance Scale). Results Of the 180 infants admitted to the NICU, 155 survived. Complete follow‐up data were available for 107 children. The male:female ratio was 50:57 (47–53%), median birthweight was 930g (range 511–1250g), and median gestational age was 27 weeks (range 23–32wks). Major neurodevelopmental impairment was observed in 11.2% of participants. In a regression model, the CRIB‐II score was significantly correlated with long‐term neurodevelopmental outcomes. It predicted major neurodevelopmental impairment (odds ratio [OR] 1.57, bootstrap 95% confidence interval [CI] 1.26–3.01; AUC 0.84) and poor outcome (OR 1.46; bootstrap 95% CI 1.31–1.71, AUC 0.82) at 36 months’ corrected age. Interpretation CRIB‐II scores of 13 or more in the first hour of life can reliably predict major neurodevelopmental impairment at 36 months’ corrected age (sensitivity 83%; specificity 84%).

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“…Twins born <32 weeks' are 2 times more likely to develop intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) compared to singletons born of the same preterm gestational age [91] . Wadhaman et al [82,83,92] reported a large cohort of infants born <1,000 g with a higher rate of CP in twins (8.4%) over singletons (6.3%) at 18-22 months of age. For infants born <36 weeks', the relative risk of at least 1 twin developing PVL is 2.181 ( p < 0.001) compared to singletons.…”

Section: Neurologicalmentioning

confidence: 99%

Re-Thinking Elective Single Embryo Transfer: Increased Risk of Monochorionic Twinning - A Systematic Review

Dziadosz

Evans²

2017

Fetal Diagn Ther

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Background/Objectives: Multiple pregnancies have tripled in the United States over the past 3 decades. Attributed to increasing maternal age at delivery but more so assisted reproductive technological advances, an effort has been made to decrease twinning through elective single embryo transfer. We sought to review and evaluate risks of monochorionic twinning as a predictable consequence of increasing utilization of elective single embryo transfer on perinatal outcomes. Primary outcomes included twinning rates, fetal anomalies, growth, preterm birth, and mortality. Secondary outcomes included neurological and pulmonary disability, intrauterine growth restriction, and congenital cardiac anomalies and twin-twin transfusion syndrome. Data sources: PubMed and Embase. Results: A total of 106 studies identified by systematic search met the inclusion criteria. The trend for lower numbers of embryos transferred has inadvertently led to an increase in monochorionic twinning. This is associated with worse outcomes compared to dichorionic twinning and singleton gestations for all outcomes studied. Discussion: Of great concern for monochorionic twins is the risk profile of significant morbidity and mortality. Transfer of 2 embryos should be considered to avoid higher risks inherent to the shared placental phenomena related to monochorionic twins.

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Some Risk Factors for Cerebral Palsy in Very Premature Infants: Importance of Premature Rupture of Membranes and Monochorionic Twin Placentation

Cited by 47 publications

References 28 publications

Developmental outcome of very low birth weight infants in a developing country

Developmental outcome of very low birth weight infants in a developing country

Clinical Risk Index for Babies score for the prediction of neurodevelopmental outcomes at 3 years of age in infants of very low birthweight

Re-Thinking Elective Single Embryo Transfer: Increased Risk of Monochorionic Twinning - A Systematic Review

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