General Obstetrics and Gynecology: ObstetricsAre maternal hypertension and small-for-gestational age risk factors for severe intraventricular hemorrhage and cystic periventricular leukomalacia? Results of the EPIPAGE cohort study
Section snippets
Material and methods
All births (including stillbirths) occurring from 22 to 32 completed weeks of gestation in all the maternity units in 9 French regions in 1997 were included. These regions covered one third of all births in France in this year.9 The EPIPAGE cohort included 3675 very preterm births (22 to 32 completed weeks of gestation); 629 were fetal deaths, 143 died during labor, and 127 died immediately after birth in the delivery room; 2776 infants were transferred to a neonatal intensive care unit (NICU).
Statistical analysis
We used the chi-square test to compare the risks of grade III IVH, IPH, and of c-PVL associated with different pregnancy complications. We used logistic regression to evaluate the relationship between pregnancy complications and grade III IVH, IPH, and c-PVL after adjustment for factors that are common causes of the exposure and the disease under study.13, 14 Thus, we first examined the relationships between cerebral injuries and pregnancy complications after adjusting for sex of the infant, a
Results
Grade III IVH and IPH respectively occurred in 3.7% and 2.9% of the 1821 infants who had at least 1 ultrasound scan (Table I). The frequency of grade III IVH and IPH was inversely related to gestational age. C-PVL was found in 5.4% of cases, and bilateral c-PVL in 3.6%.
PPROM (31%) was the most common pregnancy complication that resulted in very preterm delivery (Table II). Other common factors that precipitated delivery were idiopathic preterm labor (22%), maternal hypertension (22%), SGA (9%),
Comment
One of the strong points of our study is that we used a large, population-based, prospective cohort (EPIPAGE) of very preterm infants. All infants, including stillbirths, were born in a geographically defined area. Inclusion was based on gestational age, which excludes bias related to the recruitment of low birth weight infants when studying the relationship between hypertensive diseases and neurologic outcome.8, 20 The EPIPAGE cohort also made it possible to investigate the etiologies of
References (34)
- et al.
Amniotic fluid infection, cytokines, and adverse outcome among infants at 34 weeks gestation or less
Obstet Gynecol
(2001) - et al.
Neonatal outcome after preterm delivery for preeclampsia
Am J Obstet Gynecol
(1995) Brain injury in the premature infant: overview of clinical aspects, neuropathology, and pathogenesis
Semin Pediatr Neurol
(1998)Classifying brain damage in preterm infants
J Pediatr
(1999)- et al.
Fetal sex and indicated very preterm birth: results of the EPIPAGE study
Am J Obstet Gynecol
(2004) - et al.
White matter disorders of prematurity: association with intraventricular hemorrhage and ventriculomegaly
J Pediatr
(1999) - et al.
Antenatal corticosteroids and cranial ultrasound abnormalities
Am J Obstet Gynecol
(1999) - et al.
Is foetal neurologic and physical development accelerated in preeclampsia?
Am J Obstet Gynecol
(1996) - et al.
Predictors of neonatal outcome in women with severe preeclampsia or eclampsia between 24 and 33 weeks' gestation
Am J Obstet Gynecol
(2000) - et al.
Neuropathology associated with stillbirth
Semin Perinatol
(2002)
How common are the cerebral palsies?
Cerebral palsies: Epidemiology and causal pathways
Characteristics of cranial ultrasound white-matter echolucencies that predict disability: a review
Dev Med Child Neurol
Chorioamnionitis as a risk factor for cerebral palsy. A meta-analysis
JAMA
Periventricular leukomalacia: risk factors revisited
Dev Med Child Neurol
Birth weight in relation to morbidity and mortality among newborn infants
N Engl J Med
Very low birth weight: a problematic cohort for epidemiologic studies of very small or immature neonates
Am J Epidemiol
Survival of very preterm infants: Epipage, a population based study
Arch Dis Child
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2022, American Journal of Obstetrics and Gynecology MFMRisk Factors for Periventricular Leukomalacia in Preterm Infants: A Systematic Review, Meta-analysis, and GRADE-Based Assessment of Certainty of Evidence
2021, Pediatric NeurologyCitation Excerpt :A total of 7241 studies were identified through the search strategy, of which 4403 titles and abstracts were screened after removing duplicates (Fig 1). Of the 685 full texts retrieved, 186 studies15-4041-8081-120121-150151-180181-200 were included for qualitative review and data from 183 studies15-27,29-45,47-64,66-8081-120121-150151-180181-200 were synthesized in a meta-analysis. Some of the excluded studies are given in eTable 2 in the supplement.
Neurodevelopmental impairment at 2 years of age in children born before 29 weeks’ gestation with bronchopulmonary dysplasia
2021, Archives de PediatrieCitation Excerpt :The Réseau Naitre et Devenir (RND) was created in 2006 to monitor preterm children born before 34 weeks’ gestation in the greater Grenoble area. It has created a database of preterm infants whose characteristics have changed in recent years: more antenatal steroids [4], more inborn births [5], more individualized developmental care and parent involvement [6], and less cystic periventricular leukomalacia (10.5% for children < 26 weeks’ gestation in 1997 [7] compared with 2.4% in 2011 in France [4]). In the same way, prescription of postnatal steroids (PNS), which are used to decrease the rate of BPD, has been reduced because of the controversial neurodevelopment sequelae [4,8–10].
Epidemiology, risk factors and child prognosis: CNGOF Preterm Premature Rupture of Membranes Guidelines
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2018, Journal de Pediatrie et de PuericultureIntraventricular Hemorrhage and White Matter Injury in the Preterm Infant
2018, Neurology: Neonatology Questions and Controversies
This study was funded by INSERM (French National Institute of Health and Medical Research), Merck-Sharp, Dohme-Chibret, la Fondation de la Recherche Médicale (The Medical Research Foundation), and la Direction Génerale de la Santé du Ministère des Affaires Sociales (The Directorate General for Health of the French Ministry for Social Affairs).