title: Hypoxic/ischemic and infectious events have cumulative effects on the risk of cerebral palsy in very-low-birth-weight preterm infants.
abstract: BACKGROUND
  Hypoxia/ischemia and inflammation are two major mechanisms for cerebral palsy (CP) in preterm infants.
  
  
  OBJECTIVE
  To investigate whether hypoxia/ischemia- and infection-related events in the perinatal and neonatal periods had cumulative effects on CP risk in very-low-birth-weight (VLBW) premature infants.
  
  
  METHODS
  From 1995 to 2005, 5,807 VLBW preterm infants admitted to Taiwan hospitals were enrolled. The cumulative effects of hypoxic/ischemic and infectious events during the perinatal and neonatal periods on CP risk at corrected age 24 months were analyzed.
  
  
  RESULTS
  Of the 4,355 infants with 24-month follow-up, 457 (10.5%) had CP. The CP group had significantly higher incidences of hypoxia/ischemia-related events in the perinatal and neonatal periods, and sepsis in the neonatal period than the normal group. Three hypoxic/ischemic events, including birth cardiopulmonary resuscitation (OR 2.25; 95% CI 1.81-2.82), patent ductus arteriosus (PDA) ligation (2.94; 1.35-5.75) and chronic lung disease (3.14; 2.61-3.85) had the most significant contribution to CP. Relative to CP risk for infants with neither the three hypoxic/ischemic events nor sepsis, the CP odds increased 1.98-, 2.26- and 2.15-fold for infants with birth cardiopulmonary resuscitation, PDA ligation and chronic lung disease, respectively; while the combination with sepsis further increased the odds to 3.18-, 3.83- and 3.25-fold, respectively. Using the three hypoxic/ischemic events plus sepsis, CP rates were 10.0, 16.7, 26.7, 40.0 and 54.7% for infants with none, one, two, three and four events, respectively.
  
  
  CONCLUSIONS
  Hypoxic/ischemic and infectious events across the perinatal and neonatal periods exerted cumulative effects on CP risk in VLBW premature infants.
authors.affiliation: Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan, ROC.
authors.forename: Lan-Wan
authors.initials: LW
authors.lastname: Wang
authors.forename: Yung-Chieh
authors.initials: YC
authors.lastname: Lin
authors.forename: Shan-Tair
authors.initials: ST
authors.lastname: Wang
authors.forename: Tsu-Fu
authors.initials: TF
authors.lastname: Yeh
authors.forename: Chao-Ching
authors.initials: CC
authors.lastname: Huang
mesh_terms: D002547:Cerebral Palsy / Q000151:congenital / Q000453:epidemiology / Q000209:etiology*; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D000860:Hypoxia / Q000150:complications* / Q000151:congenital / Q000453:epidemiology; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000209:etiology; D019102:Infant, Very Low Birth Weight; D007239:Infections / Q000150:complications* / Q000151:congenital / Q000453:epidemiology; D007511:Ischemia / Q000150:complications* / Q000151:congenital / Q000453:epidemiology; D055370:Lung Injury / Q000150:complications / Q000453:epidemiology; D008297:Male; D012307:Risk Factors