title: The ELGAN study of the brain and related disorders in extremely low gestational age newborns.
abstract: BACKGROUND
  Extremely low gestational age newborns (ELGANs) are at increased risk for structural and functional brain abnormalities.
  
  
  OBJECTIVE
  To identify factors that contribute to brain damage in ELGANs.
  
  
  METHODS
  Multi-center cohort study.
  
  
  METHODS
  We enrolled 1506 ELGANs born before 28 weeks gestation at 14 sites; 1201 (80%) survived to 2 years corrected age. Information about exposures and characteristics was collected by maternal interview, from chart review, microbiologic and histological examination of placentas, and measurement of proteins in umbilical cord and early postnatal blood spots.
  
  
  METHODS
  Indicators of white matter damage, i.e. ventriculomegaly and echolucent lesions, on protocol cranial ultrasound scans; head circumference and developmental outcomes at 24 months adjusted age, i.e., cerebral palsy, mental and motor scales of the Bayley Scales of Infant Development, and a screen for autism spectrum disorders.
  
  
  RESULTS
  ELGAN Study publications thus far provide evidence that the following are associated with ultrasongraphically detected white matter damage, cerebral palsy, or both: preterm delivery attributed to preterm labor, prelabor premature rupture of membranes, or cervical insufficiency; recovery of microorganisms in the placenta parenchyma, including species categorized as human skin microflora; histological evidence of placental inflammation; lower gestational age at delivery; greater neonatal illness severity; severe chronic lung disease; neonatal bacteremia; and necrotizing enterocolitis.
  
  
  CONCLUSIONS
  In addition to supporting a potential role for many previously identified antecedents of brain damage in ELGANs, our study is the first to provide strong evidence that brain damage in extremely preterm infants is associated with microorganisms in placenta parenchyma.
authors.affiliation: Department of Pediatrics (Neonatology), Wake Forest University Health Sciences, Medical Center Blvd, Winston-Salem, NC 27157, USA. moshea@wfubmc.edu
authors.forename: T M
authors.initials: TM
authors.lastname: O'Shea
authors.forename: E N
authors.initials: EN
authors.lastname: Allred
authors.forename: O
authors.initials: O
authors.lastname: Dammann
authors.forename: D
authors.initials: D
authors.lastname: Hirtz
authors.forename: K C K
authors.initials: KC
authors.lastname: Kuban
authors.forename: N
authors.initials: N
authors.lastname: Paneth
authors.forename: A
authors.initials: A
authors.lastname: Leviton
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000150:complications / Q000151:congenital / Q000175:diagnosis / Q000209:etiology*; D001997:Bronchopulmonary Dysplasia / Q000150:complications / Q000453:epidemiology; D002657:Child Development / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000254:growth & development / Q000502:physiology; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development / Q000502:physiology; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D018743:Perinatal Care; D010922:Placenta Diseases / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D012307:Risk Factors; D055815:Young Adult