Published online March 1, 2006
PEDIATRICS Vol. 117 No. 3 March 2006, pp. 828-835 (doi:10.1542/10.1542/peds.2005-0091)

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Cerebral Palsy Among Very Preterm Children in Relation to Gestational Age and Neonatal Ultrasound Abnormalities: The EPIPAGE Cohort Study

Pierre-Yves Ancel, MD, PhD^a, Florence Livinec, MD^a, Béatrice Larroque, MD, PhD^a, Stéphane Marret, MD, PhD^b, Catherine Arnaud, MD, PhD^c, Véronique Pierrat, MD, PhD^d, Michel Dehan, MD^e, Sylvie N'Guyen, MD^f, Benoît Escande, MD^g, Antoine Burguet, MD, PhD^a, Gérard Thiriez, MD^h, Jean-Charles Picaud, MDⁱ, Monique André, MD^j, Gérard Bréart, MD, PhD^a, Monique Kaminski, MsC^a and the EPIPAGE Study Group

^a INSERM U149 Research Unit on Perinatal Health and Women's Health, Villejuif, France
^b Hôpital Charles Nicolle, Rouen, France
^c Research Unit on Epidemiology and Public Health, INSERM U558, Toulouse, France
^d Hôpital Jeanne de Flandre, Lille, France
^e Hôpital Antoine Béclère, Paris, France
^f Hôpital Mère-Enfant, Nantes, France
^g Hôpital Hautepierre, Strasbourg, France
^h Hôpital Saint-Jacques, Besançon, France
ⁱ CHU Montpellier, Montpellier, France
^j Hôpital Universitaire, Nancy, France

OBJECTIVE. To estimate the prevalence of cerebral palsy at 2 years of age among children born very preterm, according to gestational age, infant gender, plurality, and neonatal cranial ultrasound abnormalities.

METHODS. All infants born between 22 and 32 weeks of gestation in 9 regions of France in 1997 were included in this prospective, population-based, cohort study. The main outcome measure was cerebral palsy prevalence at 2 years. Of the 2364 survivors eligible for follow-up evaluation, 1954 (83%) were assessed at 2 years of age.

RESULTS. Among the 1954 children assessed at 2 years, 8.2% had cerebral palsy. Bilateral spastic cerebral palsy, hemiplegia, and monoplegia accounted for 72%, 9%, and 10% of cases, respectively. Fifty percent of the children with cerebral palsy walked independently at the age of 2, 31% were unable to walk but could sit independently, and 19% could not sit (unable to maintain head and trunk control). The prevalence of cerebral palsy was 20% at 24 to 26 weeks of gestation, compared with 4% at 32 weeks. On the basis of ultrasound findings in the neonatal period, we found that 17% of children with isolated grade III intraventricular hemorrhage and 25% of children with white matter damage (ie, ventricular dilation, persistent echodensities, or cystic periventricular leukomalacia) had cerebral palsy, compared with 4% of children with normal ultrasound scans.

CONCLUSIONS. Despite recent improvements in survival rates, cerebral palsy remains highly prevalent among very preterm children. Severe cranial ultrasound abnormalities predict motor disability strongly, but one third of infants with cerebral palsy had no ultrasound abnormalities.

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Key Words: population-based study • very preterm infants • white matter damage • intraventricular hemorrhage • prevalence of cerebral palsy

Abbreviations: PVL—periventricular leukomalacia • IVH—intraventricular hemorrhage • IPH—intraparenchymal hemorrhage

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Accepted Jul 19, 2005.

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