INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Hôpital Tenon, and UMPC University Paris, Paris, France.
Dev Med Child Neurol. 2010 Jun;52(6):e119-25. doi: 10.1111/j.1469-8749.2010.03612.x. Epub 2010 Feb 12.
The aim of this study was to assess the independent role of cerebral lesions on ultrasound scan, and several other neonatal and obstetric factors, as potential predictors of cerebral palsy (CP) in a large population-based cohort of very preterm infants.
As part of EPIPAGE, a population-based prospective cohort study, perinatal data and outcome at 5 years of age were recorded for 1812 infants born before 33 weeks of gestation in nine regions of France in 1997.
The study group comprised 942 males (52%) and 870 females with a mean gestational age of 30 weeks (SD 2 wks; range 24-32 wks) and a mean birthweight of 1367 g (SD 393 g; range 450-2645 g). CP was diagnosed at 5 years of age in 159 infants (prevalence 9%; 95% confidence interval [CI] 7-10%), 97 males and 62 females, with a mean gestational age of 29 weeks (SD 2 wks; range 24-32 wks) and a mean birthweight of 1305 g (SD 386 g; range 500-2480 g). Among this group, 67% walked without aid, 14% walked with aid, and 19% were unable to walk. Spastic, ataxic, and dyskinetic CP accounted for 89%, 7%, and 4% of cases respectively. The prevalence of CP was 61% among infants with cystic periventricular leukomalacia, 50% in infants with intraparenchymal haemorrhage, 8% in infants with grade I intraventricular haemorrhage, and 4% in infants without a detectable cerebral lesion. After controlling for cerebral lesions and obstetric and neonatal factors, only male sex (odds ratio [OR] 1.52; 95% CI 1.03-2.25) and preterm premature rupture of membranes or preterm labour (OR 1.72; 95% CI 0.95-3.14) were predictors of the development of CP in very preterm infants.
Cerebral lesions were the most important predictor of CP in very preterm infants. In addition, infant sex and preterm premature rupture of membranes or preterm labour were also independent predictors of CP.
本研究旨在评估脑超声扫描以及其他一些新生儿和产科因素的独立作用，作为预测大规模早产儿脑性瘫痪（脑瘫）的潜在因素。
作为 EPIPAGE 的一部分，这是一项基于人群的前瞻性队列研究，1997 年在法国九个地区对 1812 名胎龄小于 33 周的婴儿进行了围产期数据和 5 岁时的结局记录。
研究组包括 942 名男性（52%）和 870 名女性，平均胎龄为 30 周（标准差 2 周；范围 24-32 周），平均出生体重为 1367 克（标准差 393 克；范围 450-2645 克）。159 名婴儿（患病率 9%；95%置信区间[CI]为 7-10%）在 5 岁时被诊断为脑瘫，97 名男性和 62 名女性，平均胎龄为 29 周（标准差 2 周；范围 24-32 周），平均出生体重为 1305 克（标准差 386 克；范围 500-2480 克）。在这一组中，67%的人无需辅助就能行走，14%的人需要辅助行走，19%的人无法行走。痉挛型、共济失调型和运动障碍型脑瘫分别占 89%、7%和 4%。囊性脑室周围白质软化的婴儿脑瘫患病率为 61%，脑实质内出血的婴儿为 50%，脑室内出血 I 级的婴儿为 8%，无明显脑损伤的婴儿为 4%。在控制脑损伤和产科及新生儿因素后，只有男性（优势比[OR]1.52；95%CI 1.03-2.25）和胎膜早破或早产（OR 1.72；95%CI 0.95-3.14）是早产儿脑瘫发展的独立预测因素。
脑损伤是早产儿脑瘫最重要的预测因素。此外，婴儿性别和胎膜早破或早产也是脑瘫的独立预测因素。
