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PREDICITION OF CEREBRAL PALSY OR DEATH AMONG PRETERM INFANTS WHO SURVIVE THE NEONATAL PERIOD.

OBJECTIVE
To assess whether neonatal morbidities evident by the time of hospital discharge are associated with subsequent CP or death.


STUDY DESIGN
This is a secondary analysis of data from a multi-center placebo-controlled trial of magnesium sulfate for the prevention of CP. The association between pre-specified intermediate neonatal outcomes (n=11) and demographic and clinical factors (n=10) evident by the time of discharge among surviving infants (n=1889) and the primary outcome of death or moderate/severe CP at age 2 (n=73) was estimated, and a prediction model was created.


RESULTS
Gestational age in weeks at delivery (OR 0.74, 95% CI 0.67-0.83), grade III or IV intraventricular hemorrhage (IVH) (OR 5.3, CI 2.1-13.1), periventricular leukomalacia (PVL) (OR 46.4, CI 20.6-104.6), and male gender (OR 2.5, CI 1.4-4.5) were associated with death or moderate/severe CP by age 2. Outcomes not significantly associated with the primary outcome included respiratory distress syndrome, bronchopulmonary dysplasia, seizure, necrotizing enterocolitis, neonatal hypotension, 5 minute Apgar score, sepsis, and retinopathy of prematurity. Using all patients, the ROC curve for the final prediction model had an area under the curve of 0.84. Using these data, the risk of death or developing CP by age 2 can be calculated for individual surviving infants.


CONCLUSION
IVH and PVL were the only neonatal complications evident at discharge that contributed to an individual infant's risk of the long-term outcomes of death or CP by age 2. A model that includes these morbidities, gestational age at delivery, and gender is predictive of subsequent neurologic sequelae.