Document Detail


Trends in incidence of cranial ultrasound lesions and cerebral palsy in very low birthweight infants 1982-93.
MedLine Citation:
PMID:  10325787     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: To evaluate the effects of changing perinatal practice on outcome in terms of cranial ultrasound appearances and subsequent cerebral palsy rates in survivors. METHODS: A tertiary neonatal centre based prospective cohort study was undertaken of very low birthweight infants, in three 4 year periods: 1982-5, 1986-9, 1990-3. Rates of survival, parenchymal cerebral haemorrhage (PH), and leucomalacia on cerebral ultrasound scans, and cerebral palsy (CP) at the age of 3 years were compared. Antenatal steroid prophylaxis and postnatal surfactant use were also compared. RESULTS: VLBW infants (1722) were admitted over the 12 years, of whom 1268 (73.6%) were discharged home. Neonatal survival increased significantly over the three periods (69.2%, 72.9%, 79.7%; p < 0.0001). PH declined from 14.9% to 10.5% (p = 0.032) after 1990 as did CP rate (10.9% to 7.3%; p = 0.046). The use of antenatal steroids and postnatal surfactant greatly increased during this period. Steroid use was significantly associated with increased survival (OR 3.34, 2.31-4.79), decreased PH (OR 0.44, 0.28-0.71), and decreased risk of CP in survivors (OR 0.47, 0.27-0.81) after standardising for gestation, birthweight, sex, place and mode of delivery. Similar effects for surfactant did not remain significant after steroid use had been accounted for. CONCLUSION: Improved survival in VLBW infants since 1990 has been accompanied by a fall in PH and subsequent CP rates in survivors. This change is most likely to be due to the greater use of antenatal steroid prophylaxis.
Authors:
R W Cooke
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of disease in childhood. Fetal and neonatal edition     Volume:  80     ISSN:  1359-2998     ISO Abbreviation:  Arch. Dis. Child. Fetal Neonatal Ed.     Publication Date:  1999 Mar 
Date Detail:
Created Date:  1999-05-20     Completed Date:  1999-05-20     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9501297     Medline TA:  Arch Dis Child Fetal Neonatal Ed     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  F115-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Child Health, University of Liverpool Regional Neonatal Intensive Care Unit, Liverpool Women's Hospital.
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MeSH Terms
Descriptor/Qualifier:
Cerebral Hemorrhage / diagnosis*
Cerebral Palsy / epidemiology*
Chi-Square Distribution
Databases, Factual
Echoencephalography
England / epidemiology
Glucocorticoids / therapeutic use
Humans
Incidence
Infant, Newborn
Infant, Very Low Birth Weight*
Intensive Care, Neonatal / methods*
Leukomalacia, Periventricular / diagnosis*
Prevalence
Prospective Studies
Pulmonary Surfactants / therapeutic use
Chemical
Reg. No./Substance:
0/Glucocorticoids; 0/Pulmonary Surfactants
Comments/Corrections
Comment In:
Arch Dis Child Fetal Neonatal Ed. 2000 May;82(3):F259   [PMID:  10885939 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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