%0 Journal Article %1 Spinillo2006 %A Spinillo, A. %A Gardella, B. %A Preti, E. %A Zanchi, S. %A Stronati, M. %A Fazzi, E. %D 2006 %J BJOG %K Cerebral Palsy; Cohort Studies; Developmental Disabilities; Female; Fetal Growth Retardation; Gestational Age; Humans; Infant Mortality; Infant, Newborn; Very Low Birth Weight; Italy; Nervous System Dise; Pregnancy; Pregnancy Outcome; Regression Analysis; Risk Factors; ases %N 7 %P 775--780 %R 10.1111/j.1471-0528.2006.00974.x %T Rates of neonatal death and cerebral palsy associated with fetal growth restriction among very low birthweight infants. A temporal analysis. %U http://dx.doi.org/10.1111/j.1471-0528.2006.00974.x %V 113 %X OBJECTIVE: To assess whether changes over time in neonatal survival and infants' neurodevelopmental outcome among very low birthweight (VLBW) infants was correlated with the obstetric aetiology of VLBW. DESIGN: A cohort study of 773 VLBW infants. SETTING: A University hospital in Northern Italy. POPULATION: All the VLBW infants born over a 20-year period (1983-2002) at a single institution. METHODS: Evaluation of neonatal mortality and neurodevelopmental outcome of the surviving infants at 2 years of corrected age. Logistic regression analysis was used to compare the improvements of neonatal outcome associated with obstetric risk factors over time. MAIN OUTCOME MEASURES: The risk reduction of neonatal death or cerebral palsy associated with each obstetric category responsible for VLBW over time. RESULTS: The overall rates of neonatal mortality and cerebral palsy were 38.7\% (43/111) and 17\% (9/53) in the period 1983-87 and 13.7\% (34/24) and 6.3\% (13/205) in the period 1998-2002, respectively. The adjusted decrement per 5-year period was 33.1\% (95\% CI = 7.9-51.4) for neonatal death and 29.1\% (95\% CI = 25.3-32.7) for cerebral palsy, respectively. The adjusted rise in the rate of intact survival at 2 years of corrected age was 7.6\% (95\% CI = 3.1-12.3) per quinquennium. In logistic models with neonatal death or cerebral palsy as a combined outcome variable, and gestational age, corticosteroid use, surfactant use, and time of birth as explanatory variables, fetal growth restriction (P < 0.001) and pre-eclampsia (P= 0.011) interacted significantly with period of birth. The adjusted decrement in the rate of neonatal death or cerebral palsy as a combined variable was 27.5\% per 5 years (95\% CI = 13-39.6) in the overall population, 54.5\% per 5 years (95\% CI = 46.8-61.2) (P < 0.001 compared with overall population) among growth-restricted infants and 50.3\% per 5 years (95\% CI = 42.5-57.1) (P= 0.003 compared with overall population) in infants born to mothers with pre-eclampsia. CONCLUSIONS: Over a period of 20 years, the decrement in the rate of neonatal death or cerebral palsy was higher in growth-restricted fetuses than in other VLBW infants. This reduction was not obtained at the expense of an increased rate of neurodevelopmental impairments in surviving infants.

@article{Spinillo2006, abstract = {OBJECTIVE: To assess whether changes over time in neonatal survival and infants' neurodevelopmental outcome among very low birthweight (VLBW) infants was correlated with the obstetric aetiology of VLBW. DESIGN: A cohort study of 773 VLBW infants. SETTING: A University hospital in Northern Italy. POPULATION: All the VLBW infants born over a 20-year period (1983-2002) at a single institution. METHODS: Evaluation of neonatal mortality and neurodevelopmental outcome of the surviving infants at 2 years of corrected age. Logistic regression analysis was used to compare the improvements of neonatal outcome associated with obstetric risk factors over time. MAIN OUTCOME MEASURES: The risk reduction of neonatal death or cerebral palsy associated with each obstetric category responsible for VLBW over time. RESULTS: The overall rates of neonatal mortality and cerebral palsy were 38.7\% (43/111) and 17\% (9/53) in the period 1983-87 and 13.7\% (34/24) and 6.3\% (13/205) in the period 1998-2002, respectively. The adjusted decrement per 5-year period was 33.1\% (95\% CI = 7.9-51.4) for neonatal death and 29.1\% (95\% CI = 25.3-32.7) for cerebral palsy, respectively. The adjusted rise in the rate of intact survival at 2 years of corrected age was 7.6\% (95\% CI = 3.1-12.3) per quinquennium. In logistic models with neonatal death or cerebral palsy as a combined outcome variable, and gestational age, corticosteroid use, surfactant use, and time of birth as explanatory variables, fetal growth restriction (P < 0.001) and pre-eclampsia (P= 0.011) interacted significantly with period of birth. The adjusted decrement in the rate of neonatal death or cerebral palsy as a combined variable was 27.5\% per 5 years (95\% CI = 13-39.6) in the overall population, 54.5\% per 5 years (95\% CI = 46.8-61.2) (P < 0.001 compared with overall population) among growth-restricted infants and 50.3\% per 5 years (95\% CI = 42.5-57.1) (P= 0.003 compared with overall population) in infants born to mothers with pre-eclampsia. CONCLUSIONS: Over a period of 20 years, the decrement in the rate of neonatal death or cerebral palsy was higher in growth-restricted fetuses than in other VLBW infants. This reduction was not obtained at the expense of an increased rate of neurodevelopmental impairments in surviving infants.}, added-at = {2014-07-19T21:22:56.000+0200}, author = {Spinillo, A. and Gardella, B. and Preti, E. and Zanchi, S. and Stronati, M. and Fazzi, E.}, biburl = {https://www.bibsonomy.org/bibtex/21a45ff0acfddafca4b49e809f8c4da5f/ar0berts}, doi = {10.1111/j.1471-0528.2006.00974.x}, groups = {public}, interhash = {7a809c1dec094cff7412b2cefb1e6709}, intrahash = {1a45ff0acfddafca4b49e809f8c4da5f}, journal = {BJOG}, keywords = {Cerebral Palsy; Cohort Studies; Developmental Disabilities; Female; Fetal Growth Retardation; Gestational Age; Humans; Infant Mortality; Infant, Newborn; Very Low Birth Weight; Italy; Nervous System Dise; Pregnancy; Pregnancy Outcome; Regression Analysis; Risk Factors; ases}, month = Jul, number = 7, pages = {775--780}, pii = {BJO974}, pmid = {16753043}, timestamp = {2014-07-19T21:22:56.000+0200}, title = {Rates of neonatal death and cerebral palsy associated with fetal growth restriction among very low birthweight infants. A temporal analysis.}, url = {http://dx.doi.org/10.1111/j.1471-0528.2006.00974.x}, username = {ar0berts}, volume = 113, year = 2006 }