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Abstract
Objectives Infant respiratory distress syndrome (IRDS) is a known risk factor for intracerebral haemorrhage/intraventricular haemorrhage (ICH/IVH) and periventricular leucomalacia. These lesions are known to increase the risk of cerebral palsy (CP). Thus, we wanted to examine the long-term risk of CP following IRDS in moderately late and late preterm infants.
Design Population-based cohort study.
Setting All hospitals in Denmark.
Participants We used nationwide medical registries to identify a cohort of all moderately and late preterm infants (defined as birth during 32–36 full gestational weeks) born in Denmark in 1997–2007 with and without hospital diagnosed IRDS.
Main outcomes measures We followed study participants from birth until first diagnosis of CP, emigration, death or end of follow-up in 2014. We computed the cumulative incidence of CP before age 8 years and used Cox's regression analysis to compute HRs of IRDS, comparing children with IRDS to those without IRDS. HRs were adjusted for multiple covariates.
Results We identified 39 420 moderately late and late preterm infants, of whom 2255 (5.7%) had IRDS. The cumulative incidence of CP was 1.9% in infants with IRDS and 0.5% in the comparison cohort. The adjusted HR of CP was 2.0 (95% CI 1.4 to 2.9). The adjusted HR of CP was 12 (95% CI 4.5 to 34) in children with IRDS accompanied by a diagnosis of ICH/IVH. After restriction to children without diagnoses of perinatal breathing disorders other than IRDS, congenital heart disease and viral or bacterial infections occurring within 4 days of birth, the overall adjusted HR was 2.1 (95% CI 1.4 to 3.1).
Conclusions The risk of CP was increased in moderately late and late preterm infants with IRDS compared with infants without IRDS born during the same gestational weeks.
- EPIDEMIOLOGY
- respiratory distress syndrome
- cerebral palsy
- neurodevelopmental disorder
- cohort study
- PERINATOLOGY
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Footnotes
Contributors SKT conceptualised and designed the study, acquired the data, carried out the analyses, drafted the initial manuscript, reviewed and revised the manuscript and approved the final manuscript as submitted. MO, JRO and HTS conceptualised and designed the study, supervised the data interpretation, critically reviewed and revised the manuscript for important intellectual content and approved the final manuscript as submitted. MO helped to acquire the data and extract the raw data, critically supervised/reviewed the data analyses and reviewed the data interpretation, revised the manuscript and approved the final manuscript as submitted.
Funding This study was supported by grants from the Clinical Epidemiological Research Foundation (‘Klinisk Epidemiologisk Forskningsfond’), Denmark (HTS) and the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck and the Novo Nordisk Foundations (HTS). The funding agencies had no role in the design of the study; the collection, analysis and interpretation of the data; the writing of the article; or the decision to submit the article for publication.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Author statement All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Transparency declaration SKT affirms that the study hypothesis arose before inspection of the data and that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.
Data sharing statement No additional data are available.