Antenatal Risk Factors Associated With Unfavorable Neurologic Status in Newborns and at 2 Years of Age

Abstract

The aim of this prospective cohort study was to evaluate the influence of different antenatal factors on neurologic signs in the first days of life and neurodevelopmental outcome at 2 years of age. The study group consisted of 390 children drawn from a cohort of 828 consecutive live births. The data about potential antenatal risk factors, birth complications, and neonatal course were abstracted from pregnancy and delivery records and the hospital register. Odds ratio estimates with 95% confidence intervals were used to measure the associations between antenatal factors and neurologic status in newborns and at 2 years of age. Significance level was set at P < .05. At the mean age of 2 years, 49 of 390 children exhibited adverse neurodevelopmental outcome (cerebral palsy and other developmental disorders). The development of 341 children was normal. Comparative analysis of risk factors was conducted. The strongest correlation with development of hypoxic-ischemic encephalopathy during the first days of life was found in trichomoniasis during pregnancy (odds ratio 4.34; 95% confidence interval 1.32—14.23) and acute respiratory disease (temperatures 38°C) in the second half of pregnancy (odds ratio 2.86; 95% confidence interval 1.08—7.58). Of various antenatal factors, bacterial vaginosis combined with impending abortion in the first half of pregnancy (odds ratio 4.96; 95% confidence interval 1.35—18.26) had a significant association with adverse outcome at 2 years of age. The presence of at least one complication at delivery placed the child at risk of adverse neurologic outcome (odds ratio 2.44; 95% confidence interval 1.32—4.54). The study provides supportive evidence that antenatal factors associated with maternal infections can influence the development of hypoxic-ischemic encephalopathy and later neurodevelopmental outcome. These children should be assigned to risk groups for early intervention. (J Child Neurol 2004;19:116—122).

Get full access to this article

View all access options for this article.

References

Nelson KB : The neurologically impaired child and alleged malpractice at birth . Neurol Clin 1999;17:283—293.

Levene MI , Sands C. , Grindulis H. , et al: Comparison of two methods of predicting outcome in perinatal asphyxia. Lancet 1986;1:67—69.

Ellenberg JH , Nelson KB : Cluster of perinatal events identifying infants at high risk for death or disability. J Pediatr 1988; 113:546—552.

Nelson KB , Dambrosia JM , Grether JK , et al: Neonatal cytokines and coagulation factors in children with cerebral palsy. Ann Neurol 1998;44:665—675.

Rothwell NJ , Loggick SA , Stroemer P. : Interleukins and cerebral ischemia. Int Rev Neurobiol 1997;40:281—288.

Yoon BH , Romero R. , Park JS , et al: Fetal exposure to an intra-amniotic inflammation and the development of cerebral palsy at the age of three years. Am J Obstet Gynecol 2000;182:675—681.

Grether JK , Nelson KB : Maternal infection and cerebral palsy in infants of normal birth weight . JAMA 1997;278:207—211.

Nelson KB , Grether JK : Causes of cerebral palsy. Curr Opin Pediatr 1999;11:487—491.

O'Shea TM , Klinepeter KL , Meis PJ , et al: Intrauterine infection and the risk of cerebral palsy in very low-birthweight infants. Paediatr Perinatal Epidemiol 1998; 12: 72—83.

10.

Matsuda Y. , Kouno S. , Hiroyama Y. , et al: Intrauterine infection, magnesium sulfate exposure and cerebral palsy in infants born between 26 and 30 weeks of gestation. Eur J Obstet Gynecol Reprod Biol 2000;91:159—164.

11.

Volpe JJ : Hypoxic-ischemic encephalopathy, in Volpe JJ (ed): Neurology of the Newborn. Philadelphia , WB Saunders, 1995 , 314—369.

12.

Ilves P. : Hypoxic-ischemic encephalopathy in asphyxiated term infants. A prospective clinical, biochemical, ultrasonographical study, dissertation. Tartu, Tartu University Press, 1999 .

13.

Simon NP : Long-term neurodevelopmental outcome of asphyxiated newborns. Clin Perinatol 1999;26:767—778.

14.

Low JA : Intrapartum fetal asphyxia: definition, diagnosis, and classification . Am J Obstet Gynecol 1997;177:1558-1559.

15.

MacLennan A, for the International Cerebral Palsy Task Force: A template for defining a causal relationship between acute intrapartum events and cerebral palsy: International consensus statement. BMJ 1999;319:1054—1059.

16.

Badawi N. , Watson L. , Petterson B. , et al: What constitutes cerebral palsy? Dev Med Child Neurol 1998;40:520—527.

17.

Surveillance of cerebral palsy in Europe: A collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol 2000; 42:816—824.

18.

Gosselin J. , Amiel-Tison C. , Infante-Rivard C. , et al: Minor neurological signs and developmental performance in high risk children at preschool age . Dev Med Child Neurol 2002;44:323—328.

19.

Hagberg B. , Hagberg G. , Beckung E. , Uvebrant P. : Changing panorama of cerebral palsy in Sweden.VIII. Prevalence and origin in the birth year period 1991-94. Acta Paediatr 2001;90:271—277.

20.

Sarnat HB , Sarnat MS : Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976;33:696—705.

21.

Palisano R. , Rosenbaum P. , Walter S. , et al: Development and reliability of a system to classify gross motor function in children with CP. Dev Med Child Neurol 1997;39:214—223.

22.

Haataja L. , Mercuri E. , Guzzetta A. , et al: Neurologic examination in infants with hypoxic-ischemic encephalopathy at age 9 to 14 months: Use of optimality scores and correlation with MRI findings . J Pediatr 2001;138:332—337.

23.

Talvik T. : Hypoxic-ischemic brain damage in neonates (clinical, biochemical and brain computed tomographical investigation), dissertation [in Russian]. Tartu, Tartu University Press, 1992 .

24.

Mälksoo M. : Hypoxic-ischemic encephalopathy in newborn infants (prospective clinical and biochemical investigations), dissertation [in Russian]. Tartu, Tartu University Press, 1988 .

25.

Sööt A. : Prospective clinical, biochemical and computed tomographical investigation of central nervous system of preterm infants, dissertation [in Russian]. Tartu, Tartu University Press, 1989 .

26.

Murphy DJ , Sellers S. , MacKenzie IZ , et al: Case-control study of antenatal and intrapartum risk factors for cerebral palsy in very preterm singleton babies. Lancet 1995;346:1449—1454.

27.

Nelson KB , Willoughby RE : Infection, inflammation and the risk of cerebral palsy. Curr Opin Neurol 2000;13:133—139.

28.

French JI : Gestational bleeding, bacterial vaginosis, and common reproductive tract infections: Risk for preterm birth and benefit of treatment. Obstet Gynecol 1999;93:715—724.

29.

Gaffney G. , Sellers S. , Flavell V. , et al: Case-control study of intrapartum care, cerebral palsy and perinatal death. BMJ 1994; 308:743—750.

30.

Badawi N. , Kurinczuk J. , Keogh JM , et al: Antepartum risk factors for newborn encephalopathy: The Western Australian case-control study. BMJ 1998;317:1549—1553.

31.

Gray PH , Jones P. , O'Callaghan MJ : Maternal antecedents for cerebral palsy in extremely preterm babies: A case-control study. Dev Med Child Neurol 2001;43:580—585.

32.

The Eclampsia Trial Collaborative Group: Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial . Lancet 1995;345:1455—1463.

33.

Collins M. , Paneth N. : Preeclampsia and cerebral palsy: Are they related? Dev Med Child Neurol 1998;40:207—211.

34.

Dilenge ME , Majnemer A. , Shevell MI : Long-term developmental outcome of asphyxiated term neonates. J Child Neurol 2001;16:781.

35.

Mercer BM , Arheart KL : Antimicrobial therapy in expectant management of preterm premature rupture of the membranes. Lancet 1995;346:1271—1279.