title: Perinatal risk factors for adverse neurodevelopmental outcome after spontaneous preterm birth.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynaecology, Diaconessenhuis Meppel, Meppel, The Netherlands. vermeulengm@diacmeppel.nl
authors.forename: G M
authors.initials: GM
authors.lastname: Vermeulen
authors.forename: H W
authors.initials: HW
authors.lastname: Bruinse
authors.forename: L S
authors.initials: LS
authors.lastname: de Vries
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents