Prospective evaluation of perinatal risk factors for cerebral palsy and delayed development in high risk infants

Prematurity, intrauterine infection and perinatal brain injury have been reported to be significant risk factors of cerebral palsy (CP). We examined the perinatal predictors of cerebral palsy and delayed development (DD) in 184 high risk infants. Thirty-five infants were diagnosed as cerebral palsy and delayed development at 12 months corrected age. Antenatal, intrapartum, and neonatal factors were prospectively evaluated in 2 groups of high risk infants compared with controls; Group A (n = 79), infants weighing less than 2,000 g; Group B (n = 43), infants weighing 2,000 g or more. In univariate analysis, there were no significant antenatal and intrapartum factors associated with cerebral palsy and delayed development in either group. We found that significant postnatal risk factors of CP in group A included sepsis (p = 0.008), BPD (bronchopulmonary dysplasia) (p = 0.028), IVH (intraventricular hemorrhage) (p = 0.042), ventriculomegaly (VM) (p = 0.001) and a longer duration of mechanical ventilation (p = 0.001); while in group B, sepsis (p = 0.047) and neonatal seizure (p = 0.027) were significant risk factors. In multivariate analysis, sepsis in group B was a moderate risk factor of CP (OR (odds ratio) 1.47; 95% CI (confidence interval) 1.02-2.13). In conclusion, neonatal sepsis may contribute to the development of cerebral palsy and delayed development. We suggest that high risk infants who have sepsis should be carefully followed for cerebral palsy and delayed development. The prevention of cerebral palsy may be feasible by decreasing neonatal risk factors such as sepsis during the neonatal period.

Epidemiology of Pressure Sore in Spinal Cord Injured Patients

OBJECTIVE: To provide epidemiologic data of the pressure sores and to determine the most effective prevention and treatment methods. METHOD: Seventy patients with pressure sores who were admitted to the Rehabilitation Hospital, Yonsei University College of Medicine from 1991 to 1995 were included in this study. RESULTS: The average age of the patients was 36. Traffic accident was the most common(46 cases) cause of injury, followed by falling injury. Thirty-one patients developed pressure sores at home, while 39 patients in various hospitals. According to Frankel's classification, 51 cases were Frankel A, 13 cases were Frankel B, 5 cases were Frankel C and none was Frankel D. Sacrum was the most common site of the sore followed by buttock, ischial tuberosity, greater trochanter, and coccyx. Among many factors investigated, the anemia and hypotension had a significant correlation with the healing time. The treatment methods were variable among the patients depending on the size and severity of the sores. The severe and larger lesions required more surgical managements. CONCLUSION: The results support that an intensive prevention is necessary at homes as well as at the hospitals. More educational programs should be provided not only for the patients, but also for the hospital personnels.

Risk Factors of Cerebral Palsy and Delayed Development in Term Infants with Perinatal asphyxia / 대한주산의학회잡지

Although prenatal and neonatal intensive care in recent years improved survival of infants, the risk of cerebral palsy (CP) in infants with perinatal asphyxia persisted. Screening criteria for risk factors of cerebral palsy and delayed development (DD) in term infants with perinatal asphyxia are required so that early diagnosis and rehabilitation and physical therapy could decrease the neurologic complications and maximize quality of life. To identify the risk factors of CP and DD in infants with perinatal asphyxia, we undertook a case-control study of 25 infants with perinatal asphyxia (5 min Apgar score below 6). At one year follow-up, 12 infants developed CP and DD and 13 control infants showed normal development. Risk factors associated with an increased risk of CP and DD were the number of abortion (p=0. 031), history of neonatal seizure (p=0.021), hypoxic ischemic encephalopathy (p=0.046), and poor response to resuscitation immediately after birth (p=0.017). In term infants with perinatal asphyxia, the risk factors of CP and DD were increased number of abortion, history of neonatal seizure, and hypoxic ischemic encephalopathy and poor response to resuscutation. Thus infants with these risk factors should be carefully followed up after hospital discharge and further extensive and prospective study in term infants with perinatal asphyxia could elucidate possible mechanisms related to cerebral palsy and delayed development.