Decreasing Incidence and Severity of Cerebral Palsy in Prematurely Born Children

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).