Kim J N, Namgung R, Chang W, Oh C H, Shin J C, Park E S, Park C I, Park M S, Park K I, Lee C, Han D G
Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 1999 Aug;40(4):363-70. doi: 10.3349/ymj.1999.40.4.363.
Prematurity, intrauterine infection and perinatal brain injury have been reported to be significant risk factors of cerebral palsy (CP). We examined the perinatal predictors of cerebral palsy and delayed development (DD) in 184 high risk infants. Thirty-five infants were diagnosed as cerebral palsy and delayed development at 12 months corrected age. Antenatal, intrapartum, and neonatal factors were prospectively evaluated in 2 groups of high risk infants compared with controls; Group A (n = 79), infants weighing less than 2,000 g; Group B (n = 43), infants weighing 2,000 g or more. In univariate analysis, there were no significant antenatal and intrapartum factors associated with cerebral palsy and delayed development in either group. We found that significant postnatal risk factors of CP in group A included sepsis (p = 0.008), BPD (bronchopulmonary dysplasia) (p = 0.028), IVH (intraventricular hemorrhage) (p = 0.042), ventriculomegaly (VM) (p = 0.001) and a longer duration of mechanical ventilation (p = 0.001); while in group B, sepsis (p = 0.047) and neonatal seizure (p = 0.027) were significant risk factors. In multivariate analysis, sepsis in group B was a moderate risk factor of CP (OR (odds ratio) 1.47; 95% CI (confidence interval) 1.02-2.13). In conclusion, neonatal sepsis may contribute to the development of cerebral palsy and delayed development. We suggest that high risk infants who have sepsis should be carefully followed for cerebral palsy and delayed development. The prevention of cerebral palsy may be feasible by decreasing neonatal risk factors such as sepsis during the neonatal period.
早产、宫内感染和围产期脑损伤已被报道为脑瘫（CP）的重要危险因素。我们研究了184例高危婴儿中脑瘫和发育迟缓（DD）的围产期预测因素。35例婴儿在矫正年龄12个月时被诊断为脑瘫和发育迟缓。与对照组相比，对两组高危婴儿的产前、产时和新生儿因素进行了前瞻性评估；A组（n = 79），体重小于2000克的婴儿；B组（n = 43），体重2000克或以上的婴儿。在单因素分析中，两组中均无与脑瘫和发育迟缓相关的显著产前和产时因素。我们发现，A组中CP的显著产后危险因素包括败血症（p = 0.008）、支气管肺发育不良（BPD）（p = 0.028）、脑室内出血（IVH）（p = 0.042）、脑室扩大（VM）（p = 0.001）和机械通气时间延长（p = 0.001）；而在B组中，败血症（p = 0.047）和新生儿惊厥（p = 0.027）是显著危险因素。在多因素分析中，B组中的败血症是CP的中度危险因素（优势比（OR）1.47；95%置信区间（CI）1.02 - 2.13）。总之，新生儿败血症可能导致脑瘫和发育迟缓的发生。我们建议，对患有败血症的高危婴儿应密切随访脑瘫和发育迟缓情况。通过减少新生儿期的败血症等新生儿危险因素，预防脑瘫可能是可行的。
