Why is there a modifying effect of gestational age on risk factors for cerebral palsy?
| Autor: | Lawrence Impey, S Sellers, Pat Doyle, P L Yudkin, Catherine Greenwood |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
medicine.medical_specialty
genetic structures Gestational Age Context (language use) Fetal Hypoxia Infant Newborn Diseases Cerebral palsy Pre-Eclampsia Pregnancy Risk Factors Sepsis medicine Humans Pregnancy Complications Infectious Neonatal sepsis Obstetrics business.industry Cerebral Palsy Infant Newborn Case-control study Obstetrics and Gynecology Gestational age General Medicine Odds ratio Delivery Obstetric medicine.disease Obstetric Labor Complications Case-Control Studies Infant Small for Gestational Age Pediatrics Perinatology and Child Health Gestation Female Original Article business Biomarkers |
| Zdroj: | Archives of Disease in Childhood - Fetal and Neonatal Edition. 90:F141-F146 |
| ISSN: | 1468-2052 1359-2998 |
| DOI: | 10.1136/adc.2004.052860 |
| Popis: | Objective: To investigate risk factors for cerebral palsy in relation to gestational age. Design: Three case-control studies within a geographically defined cohort. Setting: The former Oxfordshire Health Authority. Participants: A total of 235 singleton children with cerebral palsy not of postnatal origin, born between 1984 and 1993, identified from the Oxford Register of Early Childhood Impairment; 646 controls matched for gestation in three bands: ⩽32 weeks; 33–36 weeks; ⩾37 weeks. Results: Markers of intrapartum hypoxia and infection were associated with an increased risk of cerebral palsy in term and preterm infants. The odds ratio (OR) for hypoxia was 12.2 (95% confidence interval 1.2 to 119) at ⩽32 weeks and 146 (7.4 to 3651) at ⩾37 weeks. Corresponding ORs for neonatal sepsis were 3.1 (1.8 to 5.4) and 10.6 (2.1 to 51.9). In contrast, pre-eclampsia carried an increased risk of cerebral palsy at ⩾37 weeks (OR 5.1 (2.2 to 12.0)) but a decreased risk at ⩽32 weeks (OR 0.4 (0.2 to 1.0)). However, all infants ⩽32 weeks with maternal pre-eclampsia were delivered electively, and their risk of cerebral palsy was no lower than that of other electively delivered ⩽32 week infants (OR 0.9 (0.3 to 2.7)). Nearly 60% of ⩽32 week controls were delivered after spontaneous preterm labour, itself an abnormal event. Conclusion: Inflammatory processes, including pre-eclampsia, are important in the aetiology of cerebral palsy. The apparent reduced risk of cerebral palsy associated with pre-eclampsia in very preterm infants is driven by the characteristics of the gestation matched control group. Use of the term “protective” in this context should be abandoned. |
| Databáze: | OpenAIRE |
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