Perinatal risk factors for adverse neurodevelopmental outcome after spontaneous preterm birth.
OBJECTIVE
The aim of this study was to investigate to what extend perinatal factors contribute to the neurodevelopmental outcome in a group neonates born after spontaneous preterm labour with or without prolonged rupture of the membranes (PROM).


METHODS
In a cohort of neonates born after the spontaneous onset of labour with or without PROM before 34 weeks of gestation a stepwise forward logistic regression was performed to analyse the influence of antenatal and postnatal variables on adverse outcome. Adverse neurodevelopmental outcome was defined as a Griffith's developmental score <85, cerebral palsy, a major disability or perinatal death associated with severe cerebral damage.


RESULTS
The study group consisted of 185 neonates. Seven neonates died with severe cerebral damage. After a forward logistic regression analysis three factors appeared to have an independent influence: gestational age protected against an adverse outcome (odds ratio (OR) per day increase 0.95, 95% confidence interval (CI) 0.90-0.97) while abnormal cranial ultrasound (intraventricular haemorrhage and periventricular leucomalacia) (OR 6.33, 95% CI 2.16-18.52) and the need for a second course of antibiotics (OR 1.85, 95% CI 1.02-3.33) increased the risk for adverse outcome. Comparing the group with a normal neurodevelopmental outcome with those with cerebral palsy, cranial ultrasound abnormalities were independently associated with cerebral palsy (OR 48.75, 95% CI 11.78-201.76).


CONCLUSIONS
The most important way of preventing neurological damage in infants is to increase gestational age at birth and to avoid the development of intraventricular haemorrhage and periventricular leucomalacia.
Vermeulen
G M
GM
Department of Obstetrics and Gynaecology, Diaconessenhuis Meppel, Meppel, The Netherlands. vermeulengm@diacmeppel.nl
Bruinse
H W
HW
de Vries
L S
LS
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology; D002547:Cerebral Palsy / Q000453:epidemiology; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007239:Infections / Q000188:drug therapy / Q000453:epidemiology; D007969:Leukomalacia, Periventricular / Q000000981:diagnostic imaging / Q000453:epidemiology; D016015:Logistic Models; D009420:Nervous System / Q000254:growth & development*; D007752:Obstetric Labor, Premature; D016017:Odds Ratio; D011247:Pregnancy; D012307:Risk Factors; D014463:Ultrasonography
D000900:Anti-Bacterial Agents