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

Objective: To delineate the perinatal risk factors of neurodevelopmental disabilities in very preterm birth applying logistic regression analysis. Design:This prospective, geographically defined collaborative study was carried 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: The rate of cerebral palsy and/or severe mental retardation as diagnosed by ;a family physician or pediatrician with a screening-skill test performed at 2 years of age. Results: 167/171 (98%) survivors were evaluated. Twenty-two 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 of membranes greater than or equal to 48 h (OR 4.3, 95% CI 1.6-11.8); monochorionic twin placentation (OR 6.0, 95% CI 1.7-21.3), and respiratory distress syndrome (OR 2.8, 95% CI 1.1-7.1). Conclusion: This geographically defined prospective study gives epidemiological data and highly suggests that there is EI link between prenatal events (premature rupture of membranes, monochorionic twin placentation), postnatal events (respiratory distress syndrome), and neurological disabilities in former preterm infants.