Alan M Peaceman1, Lisa Mele2, Dwight J Rouse3, Kenneth J Leveno4, Brian M Mercer5,6, Michael W Varner7, Uma M Reddy8, Ronald J Wapner9,10, Yoram Sorokin11, John M Thorp12, Susan M Ramin13, Fergal D Malone14, Mary J O'Sullivan15, Donald J Dudley16, Steve N Caritis17. 1. Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois. 2. Department of Biostatistics and Bioinformatics, The George Washington University, Washington, District of Columbia. 3. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama. 4. Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas. 5. Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio. 6. Department of Obstetrics and Gynecology, University of Tennessee, Memphis, Tennessee. 7. Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah. 8. Pregnancy and Perinatology Branch, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland. 9. Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania. 10. Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania. 11. Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan. 12. Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 13. Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas. 14. Department of Obstetrics and Gynecology, Columbia University, New York, New York. 15. Department of Obstetrics and Gynecology, University of Miami, Miami, Florida. 16. Department of Obstetrics and Gynecology, University of Texas at San Antonio, San Antonio, Texas. 17. Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Abstract
OBJECTIVE: To assess whether neonatal morbidities evident by the time of hospital discharge are associated with subsequent cerebral palsy (CP) or death. STUDY DESIGN: This is a secondary analysis of data from a multicenter placebo-controlled trial of magnesium sulfate for the prevention of CP. The association between prespecified 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 (odds ratio [OR]: 0.74, 95% confidence interval [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 receiver operating characteristic curve for the final prediction model had an area under the curve of 0.84 (CI: 0.78-0.89). 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. KEY POINTS: · Factors known at hospital discharge are identified which are independently associated with death or CP by age 2.. · A model was created and validated using these findings to counsel parents.. · The risk of death or CP can be calculated at the time of hospital discharge.. Thieme. All rights reserved.
OBJECTIVE: To assess whether neonatal morbidities evident by the time of hospital discharge are associated with subsequent cerebral palsy (CP) or death. STUDY DESIGN: This is a secondary analysis of data from a multicenter placebo-controlled trial of magnesium sulfate for the prevention of CP. The association between prespecified 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 (odds ratio [OR]: 0.74, 95% confidence interval [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 receiver operating characteristic curve for the final prediction model had an area under the curve of 0.84 (CI: 0.78-0.89). 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. KEY POINTS: · Factors known at hospital discharge are identified which are independently associated with death or CP by age 2.. · A model was created and validated using these findings to counsel parents.. · The risk of death or CP can be calculated at the time of hospital discharge.. Thieme. All rights reserved.
Authors: Lindsay A Patrick; Laura M Gaudet; Anne E Farley; John P Rossiter; Lewis L Tomalty; Graeme N Smith Journal: Am J Obstet Gynecol Date: 2004-10 Impact factor: 8.661
Authors: Dwight J Rouse; Deborah G Hirtz; Elizabeth Thom; Michael W Varner; Catherine Y Spong; Brian M Mercer; Jay D Iams; Ronald J Wapner; Yoram Sorokin; James M Alexander; Margaret Harper; John M Thorp; Susan M Ramin; Fergal D Malone; Marshall Carpenter; Menachem Miodovnik; Atef Moawad; Mary J O'Sullivan; Alan M Peaceman; Gary D V Hankins; Oded Langer; Steve N Caritis; James M Roberts Journal: N Engl J Med Date: 2008-08-28 Impact factor: 91.245
Authors: N S Wood; K Costeloe; A T Gibson; E M Hennessy; N Marlow; A R Wilkinson Journal: Arch Dis Child Fetal Neonatal Ed Date: 2005-03 Impact factor: 5.747