Does perinatal asphyxia contribute to neurological dysfunction in preterm infants?
BACKGROUND
Children born preterm are known to be at risk for neurodevelopmental disorders. The role of perinatal asphyxia in this increased risk is still a matter of debate.


OBJECTIVE
To analyze the contribution of perinatal asphyxia in a population of preterm infants admitted to a secondary paediatric setting to neurological dysfunction in the first months after birth and to the development of cerebral palsy.


METHODS
17 preterm infants with perinatal asphyxia born before 35 weeks postmenstrual age (PMA) and 34 carefully matched preterm controls without asphyxia were studied. Neuromotor outcome was examined by means of three assessments of the quality of general movements (GM) at "preterm" (around 34 weeks PMA), "writhing" (around term age) and "fidgety" GM age (around 3 months post term). Follow-up until at least 18 months corrected age focused on the presence of cerebral palsy (CP).


RESULTS
GM-quality of infants with asphyxia and of those without did not differ. Multivariate analysis revealed that abnormal GMs at "preterm" age were associated with respiratory problems, those at "writhing" age with none of the assessed risk factors, and those at "fidgety" age with the severity of periventricular leukomalacia (PVL) on neonatal ultrasound scan. Perinatal asphyxia was not associated with the development of CP. CP was associated with PVL and the presence of abnormal GMs at "fidgety" age.


CONCLUSIONS
Perinatal asphyxia in preterm infants is not associated with an increased risk for neurodevelopmental problems including CP. Respiratory problems during the neonatal period are associated with PVL and adverse neurological outcome.
van Iersel
Patricia A M
PA
Gelre Hospital, Department of Physical Therapy, Apeldoorn, The Netherlands. pat.iersel@planet.nl
Bakker
Saskia C M
SC
Jonker
Arnold J H
AJ
Hadders-Algra
Mijna
M
D001238:Asphyxia Neonatorum / Q000150:complications*; D002547:Cerebral Palsy / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000209:etiology*; D007969:Leukomalacia, Periventricular / Q000453:epidemiology / Q000209:etiology; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors