Cerebral palsy among very preterm children in relation to gestational age and neonatal ultrasound abnormalities: the EPIPAGE cohort study.
OBJECTIVE
To estimate the prevalence of cerebral palsy at 2 years of age among children born very preterm, according to gestational age, infant gender, plurality, and neonatal cranial ultrasound abnormalities.


METHODS
All infants born between 22 and 32 weeks of gestation in 9 regions of France in 1997 were included in this prospective, population-based, cohort study. The main outcome measure was cerebral palsy prevalence at 2 years. Of the 2364 survivors eligible for follow-up evaluation, 1954 (83%) were assessed at 2 years of age.


RESULTS
Among the 1954 children assessed at 2 years, 8.2% had cerebral palsy. Bilateral spastic cerebral palsy, hemiplegia, and monoplegia accounted for 72%, 9%, and 10% of cases, respectively. Fifty percent of the children with cerebral palsy walked independently at the age of 2, 31% were unable to walk but could sit independently, and 19% could not sit (unable to maintain head and trunk control). The prevalence of cerebral palsy was 20% at 24 to 26 weeks of gestation, compared with 4% at 32 weeks. On the basis of ultrasound findings in the neonatal period, we found that 17% of children with isolated grade III intraventricular hemorrhage and 25% of children with white matter damage (ie, ventricular dilation, persistent echodensities, or cystic periventricular leukomalacia) had cerebral palsy, compared with 4% of children with normal ultrasound scans.


CONCLUSIONS
Despite recent improvements in survival rates, cerebral palsy remains highly prevalent among very preterm children. Severe cranial ultrasound abnormalities predict motor disability strongly, but one third of infants with cerebral palsy had no ultrasound abnormalities.
Ancel
Pierre-Yves
PY
INSERM U149 Research Unit on Perinatal Health and Women's Health, Villejuif, France. ancel@vjf.inserm.fr
Livinec
Florence
F
Larroque
Béatrice
B
Marret
Stéphane
S
Arnaud
Catherine
C
Pierrat
Véronique
V
Dehan
Michel
M
N'Guyen
Sylvie
S
Escande
Benoît
B
Burguet
Antoine
A
Thiriez
Gérard
G
Picaud
Jean-Charles
JC
André
Monique
M
Bréart
Gérard
G
Kaminski
Monique
M
D001921:Brain / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging; D002547:Cerebral Palsy / Q000150:complications / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D004453:Echoencephalography; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007969:Leukomalacia, Periventricular / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D012307:Risk Factors