NEONATAL RISK-FACTORS FOR CEREBRAL-PALSY IN VERY PRETERM BABIES - CASE-CONTROL STUDY

Objective: To identify neonatal risk factors for cerebral palsy among very preterm babies and in particular the associations independent of the coexistence of antenatal and intrapartum factors. Design: Case-con trol study. Setting: Oxford health region. Subjects: Singleton babies born between 1984 and 1990 at less than 39 weeks' gestation who surviv ed to discharge from hospital: 59 with cerebral palsy and 234 randomly selected controls without cerebral palsy. Main outcome measures: Adve rse neonatal factors expressed as odds ratios and 95% confidence inter vals. Results: Factors associated with an increased risk of cerebral p alsy after adjustment for gestational age and the presence of previous ly identified antenatal and intrapartum risk factors were patent ductu s arteriosus (odds ratio 2.3; 95% confidence interval 1.2 to 4.5), hyp otension (2.3; 1.3 to 4.7), blood transfusion (4.8; 2.5 to 9.3), prolo nged ventilation (4.8; 2.5 to 9.0), pneumothorax (3.5; 1.6 to 7.6), se psis (3.6; 1.8 to 7.4), hyponatraemia (7.9; 2.1 to 29.6) and total par enteral nutrition (5.5; 2.8 to 10.5). Seizures were associated with an increased risk of cerebral palsy (10.0; 4.1 to 24.7), as were parench ymal damage (32; 12.4 to 84.4) and appreciable ventricular dilatation (5.4; 3.0 to 9.8) detected by cerebral ultrasound. Conclusion: A reduc tion in the Tate of cerebral palsy in very preterm babies requires an integrated approach to management throughout the antenatal intrapartum , and neonatal periods.