Some risk factors for cerebral palsy in very premature infants: Importanceof premature rupture of membranes and monochorionic twin placentation

Objective: To delineate the perinatal risk factors of neurodevelopmental di sabilities in very preterm birth applying logistic regression analysis. Des ign:This prospective, geographically defined collaborative study was carrie d out in the Franche-Comte region of France. Subjects: From October 1, 1990 to September 30, 1992, perinatal and follow-up data were collected on 203 consecutive liveborn singleton or twin non-malformed infants with strictly ascertained gestational ages of less than 33 weeks. Main Outcome Measure: T he rate of cerebral palsy and/or severe mental retardation as diagnosed by ;a family physician or pediatrician with a screening-skill test performed a t 2 years of age. Results: 167/171 (98%) survivors were evaluated. Twenty-t wo of the 167 examined infants (13%) showed signs of cerebral palsy, and 10 of these had severe cerebral palsy or mental retardation. Risk factors for disabilities were selected by a multivariate approach: premature rupture o f membranes greater than or equal to 48 h (OR 4.3, 95% CI 1.6-11.8); monoch orionic twin placentation (OR 6.0, 95% CI 1.7-21.3), and respiratory distre ss syndrome (OR 2.8, 95% CI 1.1-7.1). Conclusion: This geographically defin ed prospective study gives epidemiological data and highly suggests that th ere is EI link between prenatal events (premature rupture of membranes, mon ochorionic twin placentation), postnatal events (respiratory distress syndr ome), and neurological disabilities in former preterm infants.