%0 Journal Article %1 Cooke1999 %A Cooke, R. W. %D 1999 %J Arch Dis Child Fetal Neonatal Ed %K Cerebral Hemorrhage; Palsy; Chi-Square Distribution; Databases, Factual; Echoencephalography; England; Glucocorticoids; Humans; Incidence; Infant, Newborn; Very Low Birth Weight; Intensive Care, Neonatal; Leukomalacia, Periventricular; Prevalence; Prospective Studies; Pulmonary Surfactants %N 2 %P F115--F117 %T Trends in incidence of cranial ultrasound lesions and cerebral palsy in very low birthweight infants 1982-93. %V 80 %X AIM: To evaluate the effects of changing perinatal practice on outcome in terms of cranial ultrasound appearances and subsequent cerebral palsy rates in survivors. METHODS: A tertiary neonatal centre based prospective cohort study was undertaken of very low birthweight infants, in three 4 year periods: 1982-5, 1986-9, 1990-3. Rates of survival, parenchymal cerebral haemorrhage (PH), and leucomalacia on cerebral ultrasound scans, and cerebral palsy (CP) at the age of 3 years were compared. Antenatal steroid prophylaxis and postnatal surfactant use were also compared. RESULTS: VLBW infants (1722) were admitted over the 12 years, of whom 1268 (73.6\%) were discharged home. Neonatal survival increased significantly over the three periods (69.2\%, 72.9\%, 79.7\%; p < 0.0001). PH declined from 14.9\% to 10.5\% (p = 0.032) after 1990 as did CP rate (10.9\% to 7.3\%; p = 0.046). The use of antenatal steroids and postnatal surfactant greatly increased during this period. Steroid use was significantly associated with increased survival (OR 3.34, 2.31-4.79), decreased PH (OR 0.44, 0.28-0.71), and decreased risk of CP in survivors (OR 0.47, 0.27-0.81) after standardising for gestation, birthweight, sex, place and mode of delivery. Similar effects for surfactant did not remain significant after steroid use had been accounted for. CONCLUSION: Improved survival in VLBW infants since 1990 has been accompanied by a fall in PH and subsequent CP rates in survivors. This change is most likely to be due to the greater use of antenatal steroid prophylaxis.

@article{Cooke1999, abstract = {AIM: To evaluate the effects of changing perinatal practice on outcome in terms of cranial ultrasound appearances and subsequent cerebral palsy rates in survivors. METHODS: A tertiary neonatal centre based prospective cohort study was undertaken of very low birthweight infants, in three 4 year periods: 1982-5, 1986-9, 1990-3. Rates of survival, parenchymal cerebral haemorrhage (PH), and leucomalacia on cerebral ultrasound scans, and cerebral palsy (CP) at the age of 3 years were compared. Antenatal steroid prophylaxis and postnatal surfactant use were also compared. RESULTS: VLBW infants (1722) were admitted over the 12 years, of whom 1268 (73.6\%) were discharged home. Neonatal survival increased significantly over the three periods (69.2\%, 72.9\%, 79.7\%; p < 0.0001). PH declined from 14.9\% to 10.5\% (p = 0.032) after 1990 as did CP rate (10.9\% to 7.3\%; p = 0.046). The use of antenatal steroids and postnatal surfactant greatly increased during this period. Steroid use was significantly associated with increased survival (OR 3.34, 2.31-4.79), decreased PH (OR 0.44, 0.28-0.71), and decreased risk of CP in survivors (OR 0.47, 0.27-0.81) after standardising for gestation, birthweight, sex, place and mode of delivery. Similar effects for surfactant did not remain significant after steroid use had been accounted for. CONCLUSION: Improved survival in VLBW infants since 1990 has been accompanied by a fall in PH and subsequent CP rates in survivors. This change is most likely to be due to the greater use of antenatal steroid prophylaxis.}, added-at = {2014-07-19T19:16:04.000+0200}, author = {Cooke, R. W.}, biburl = {https://www.bibsonomy.org/bibtex/27f5fa149c1e986d63e24cb3f5623155c/ar0berts}, groups = {public}, interhash = {0b93826658753770a3347e20603a4aca}, intrahash = {7f5fa149c1e986d63e24cb3f5623155c}, journal = {Arch Dis Child Fetal Neonatal Ed}, keywords = {Cerebral Hemorrhage; Palsy; Chi-Square Distribution; Databases, Factual; Echoencephalography; England; Glucocorticoids; Humans; Incidence; Infant, Newborn; Very Low Birth Weight; Intensive Care, Neonatal; Leukomalacia, Periventricular; Prevalence; Prospective Studies; Pulmonary Surfactants}, month = Mar, number = 2, pages = {F115--F117}, pmid = {10325787}, timestamp = {2014-07-19T19:16:04.000+0200}, title = {Trends in incidence of cranial ultrasound lesions and cerebral palsy in very low birthweight infants 1982-93.}, username = {ar0berts}, volume = 80, year = 1999 }