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Does bronchopulmonary dysplasia contribute to the occurrence of cerebral palsy among infants born before 28 weeks of gestation?
  1. Linda J Van Marter1,2,3,
  2. Karl C K Kuban4,5,
  3. Elizabeth Allred1,3,6,
  4. Carl Bose7,
  5. Olaf Dammann1,8,9,10,
  6. Michael O'Shea11,
  7. Matthew Laughon7,
  8. Richard A Ehrenkranz12,
  9. Michael D Schreiber13,
  10. Padmani Karna14,
  11. Alan Leviton1,3,
  12. for the ELGAN Study Investigators
  1. 1Children's Hospital Boston, Boston, Massachusetts, USA
  2. 2Brigham and Women's Hospital, Boston, Massachusetts, USA
  3. 3Harvard Medical School, Boston, Massachusetts, USA
  4. 4Boston Medical Center, Boston, Massachusetts, USA
  5. 5Boston University, Boston, Massachusetts, USA
  6. 6Harvard School of Public Health, Boston, Massachusetts, USA
  7. 7The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  8. 8Hannover Medical School, Hannover, Germany
  9. 9Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts, USA
  10. 10Tufts University School of Medicine, Boston, Massachusetts, USA
  11. 11Wake Forest University, Winston-Salem, North Carolina, USA
  12. 12Yale University School of Medicine, New Haven, Connecticut, USA
  13. 13University of Chicago, Chicago, Illinois, USA
  14. 14Michigan State University, East Lansing, Michigan, USA
  1. Correspondence to Dr Linda J Van Marter, Newborn Medicine, Children's Hospital, Hunnewell 430, 300 Longwood Avenue, Boston, MA 02115, USA; linda.vanmarter{at}childrens.harvard.edu

Abstract

Objective To evaluate the relationships among cerebral palsy (CP) phenotypes and bronchopulmonary dysplasia (BPD) severity and, in the process, to generate hypotheses regarding causal pathways linking BPD to CP.

Study design We studied 1047 infants born before the 28th week of gestation. Receipt of supplemental oxygen at 36 weeks postmenstrual age (PMA), with or without the need for mechanical ventilation (MV) at 36 weeks PMA, defined two levels of BPD. At 24 months, the children underwent neurologic examinations and CP diagnoses were made using an algorithm based on topographic localisation.

Results The 536 infants with BPD were at increased risk of all three CP phenotypes. In time-oriented multivariable analyses that adjusted for potential confounders, receipt of supplemental oxygen without MV at 36 weeks PMA (BPD) was not associated with increased risk of any CP phenotype. In contrast, BPD accompanied by MV at 36 weeks PMA (BPD/MV) was associated with a nearly sixfold increased risk of quadriparesis and a fourfold increased risk of diparesis.

Conclusions Combined treatment with both MV and supplemental oxygen at 36 weeks PMA strongly predicts the more common bilateral CP phenotypes. BPD without MV at 36 weeks PMA was not significantly associated with any form of CP.

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Footnotes

  • Funding This study was supported by a cooperative agreement with the National Institute of Neurological Diseases and Stroke (5U01NS040069-05) and a Mental Retardation and Developmental Disabilities Research Center grant from the National Institute of Child Health and Human Development (NIH-P30-HD-18655). CB was partially supported by the Thrasher Research Fund. LJVM was partially supported by the National Institutes of Heart, Lung, and Blood (1 P01 HL 67669-01).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of all 14 sites.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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