Abstract
Background: The increasing survival of very low birthweight babies and the improvement of their management are not associated with a decreased incidence of cerebral palsy (CP). Among many risk factors, postnatal systemic steroids have been pointed out by clinical and experimental studies. The aim of this work is to explore the relationship between these treatments and CP at the age of two years in a population based cohort.
Methods: We conducted a population based study on the Epipage cohort, including 2358 premature infants of less than 32 weeks of gestation, and surviving at discharge, born in 1997 in 9 french areas. From this population 408 were lost to follow-up ( 17 %). The analyses have been performed on 1950 neonates followed up to the age of two years. We choosed the definition of cerebral palsy used by the SCPE. There was no data about the type of steroid used. All infants were evaluated from a medical form filled by a physician. We made an univariate analysis to identify risk factors of CP in this cohort, then a multivariate analysis by logistic regression. We also studied two subgroups of preterm neonates: below 28 weeks, and those free of cerebral lesions.
Results: mean gestational age was 30 weeks (± 0.1) and the average weight 1380 g (± 9.1). The incidence of cerebral palsy was 7.6 % and 14 % of infants treated by postnatal steroids ( OR = 1.8 [1.1 – 2.8] ). The other risk factors after multivariat analysis were cerebral hypoxia ( OR = 5.5 [1.8 – 8.9] ), and severe intraventricular haemorrhages (stage 3 or 4) ( OR = 6.1 [1.6 – 6.3] ). The decreasing gestational age was nearly significative (OR = 1.2 [1.0 – 1.3]). Protective factors were maternal hypertension ( OR = 0.6 [0.3 – 1.0] ), and fetal growth restriction ( OR = 0.5 [0.2 – 0.9] ). Although not significantly, the same trend was observed in the studied subgroups (neonates below 28 weeks ( OR = 2.1 [0.9 – 4.8] ) and neonates free of neonatal cerebral lesions ( OR = 1.3 [0.6 – 2.4])).
Conclusion: These results are consistent with the data from randomized trials, and are supported by many physiopathological arguments. Analysis concerned a broader population than ventilated newborns included in these trials. Prescription of postnatal systemic steroids should be restricted, and only used in rescue for babies with severe respiratory distress.
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Mourdie, J., Truffert, P. 193 Postnatal Steroid Treatment and Occurrence of Cerebral Palsy at The Age of Two Years Among Neonates Below 32 Weeks. The Epipage Cohort. Pediatr Res 56, 497 (2004). https://doi.org/10.1203/00006450-200409000-00216
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DOI: https://doi.org/10.1203/00006450-200409000-00216