title: Cerebral palsy among very preterm children in relation to gestational age and neonatal ultrasound abnormalities: the EPIPAGE cohort study.
abstract: 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.
authors.affiliation: INSERM U149 Research Unit on Perinatal Health and Women's Health, Villejuif, France. ancel@vjf.inserm.fr
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Ancel
authors.forename: Florence
authors.initials: F
authors.lastname: Livinec
authors.forename: Béatrice
authors.initials: B
authors.lastname: Larroque
authors.forename: Stéphane
authors.initials: S
authors.lastname: Marret
authors.forename: Catherine
authors.initials: C
authors.lastname: Arnaud
authors.forename: Véronique
authors.initials: V
authors.lastname: Pierrat
authors.forename: Michel
authors.initials: M
authors.lastname: Dehan
authors.forename: Sylvie
authors.initials: S
authors.lastname: N'Guyen
authors.forename: Benoît
authors.initials: B
authors.lastname: Escande
authors.forename: Antoine
authors.initials: A
authors.lastname: Burguet
authors.forename: Gérard
authors.initials: G
authors.lastname: Thiriez
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Picaud
authors.forename: Monique
authors.initials: M
authors.lastname: André
authors.forename: Gérard
authors.initials: G
authors.lastname: Bréart
authors.forename: Monique
authors.initials: M
authors.lastname: Kaminski
mesh_terms: 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