Neurologic impairment (NI), including CP, is considered to be largely determined by antenatal events. To explore the impact of antenatal and neonatal events and therapies we compared 72 singleton inborn infants born'83-'91 with neurologic impairment (NI) at 20 months corrected age (xbar Bwt 1kg; xbar GA 28 wks, 58% black, 53% male), including 50 with CP (25 di-, 12 hemi-, 13 quadri-plegia); 11 hypotonia, 4 hypertonia and 7 hydrocephalus to the next born neurologically normal (NN) VLBW matched by BWt, GA, and race, and sex.

There were no differences in antepartum or intrapartum complications/therapies including preeclampsia, antenatal steroids and tocolytics. Nor did chorioamnionitis (NI 46% vs NN 43%) or magnesium (Mg) therapy differ (NI 22% vs NN 21%). See table for significant differences. Although few mothers were screened for cocaine, 10 of 16 (63%) of the NI group screened were positive at delivery vs 3 of 13 (23%) in the NN group (p<.03).

Table 1
Full size table

Multivariate analysis controlling for Bwt, GA, race, sex and birth period(<'90vs'90+) revealed direct and independent effects of severe US abn., O2 at 36 wks, and sepsis on NI, but not T4. Mg had no direct effect on NI, but had a moderating effect on the relationship between severe US abn. and NI. Consideration of the 50 cases with CP only, revealed similar results.

Thus, neonatal sequelae rather than prenatal factors determine the risk of NI, including CP, among VLBW. The role of maternal cocaine abuse needs to be examined prospectively.