CRANIAL ULTRASOUND PREDICTION OF DISABLING AND NONDISABLING CEREBRAL-PALSY AT AGE-2 IN A LOW-BIRTH-WEIGHT POPULATION

Objective. To employ multivariate analytic techniques to assess the as sociation between neonatal cranial ultrasound (US) abnormalities and s ubsequent cerebral palsy (CP), defined as disabling CP (DCP) or nondis abling CP (NDCP) depending on the level of motor dysfunction. Design. Prospective cohort study. Subjects and Methods. The Neonatal Brain Hem orrhage Study enrolled a geographically representative sample of 1105 newborns 501 to 2000 g and obtained follow-up data on 777 (86%) of the 901 survivors at age two. One hundred thirteen children (14.6%) had m otor findings severe enough to classify them as having CP. The 61 (7.9 %) of these children who were disabled by their motor impairment we cl assified as having DCP. The remaining 52 (6.7%) who had definite neuro logic findings (usually mild spastic diplegia) but without evidence of interference with daily living, we classified as having NDCP. Results . In a multivariate logistic regression model of perinatal and postnat al variables, the following factors were found to be significant risk factors for DCP: parenchymal echodensities/lucencies or ventricular en largement (PEL/VE) on cranial US (OR = 15.4; 7.6, 31.1), germinal matr ix/intraventricular hemorrhage (GM/IVH) (OR = 3.5; 1.7, 6.9) and mecha nical ventilation (OR = 2.9; 1.2, 7.1). Fully 93.4% of infants were co rrectly classified as to presence or absence of DCP on the basis of th is model. Birth weight, gestational age, length of hospital stay, gend er, race, plurality, presence of labor and Apgar score were not signif icant independent predictors of DCP. For NDCP, the only risk factor si gnificant in the multivariate model was PEL/VE (OR = 5.3; 2.2, 12.6). Conclusions. Among perinatal and postnatal factors, cranial US abnorma lities are by far the most powerful predictors of disabling CP in low birth weight infants. Although PEL/VE was the strongest predictor, GM/ IVH also appeared to independently contribute to the risk of DCP. NDCP in low birth weight infants appears to have a different risk profile than DCP. In particular, it is less closely related to US evidence of perinatal brain injury.