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Charlene M. T. Robertson, MD; Man-Joe Watt, MD; Yutaka Yasui, PhD

JAMA. 2007;297:2733-2740.

Context  Although cerebral palsy (CP) among extremely premature infants has been reported as a major morbidity outcome, there are difficulties comparing published CP rates from many sites over various birth years.

Objective  To assess the changes in population-based, gestational age–specific prevalence rates of CP among extremely premature infants over 30 years.

Design  Prospective population-based longitudinal outcome study.

Setting and Participants  In Northern Alberta, 2318 infants 20 to 27 weeks' gestational age with birth weights of 500 to 1249 g were liveborn from 1974 through 2003. By 2 years of age, 1437 (62%) had died, 23 (1%) were lost to follow-up, and 858 (37%) had received multidisciplinary neurodevelopmental assessment.

Main Outcome Measure  Population-based prevalence rates of CP were determined. Logistic regression with linear spline was used to assess changes in CP prevalence over time.

Results  At age 2 years, 122 (14.2%) of 858 survivors had CP. This diagnosis was confirmed for each child by age 3 years or older. Among those whose gestational age was 20 to 25 weeks, population-based survival increased from 4% to 31% (P<.001), while CP prevalence per 1000 live births increased monotonically from 0 to 110 until the years 1992-1994 (P<.001) and decreased thereafter to 22 in the years 2001-2003 (P<.001). Among those whose gestational age was 26 to 27 weeks, population-based survival increased from 23% to between 75% and 80% (P<.001), while CP prevalence per 1000 live births increased monotonically from 15 to 155 until the years 1992-1994 (P<.001) and then decreased to 16 in the years 2001-2003 (P<.001). For all survivors born in the years 2001-2003, CP prevalence was 19 per 1000 live births.

Conclusion  Population-based CP prevalence rates for children whose gestational age was 20 to 27 weeks and whose birth weight ranged from 500 to 1249 g show steady reductions in the last decade with stable or reducing mortality, reversing trends prior to 1992-1994.

Author Affiliations: Section of Neurosciences, Department of Pediatrics, Faculty of Medicine and Dentistry (Drs Robertson and Watt) and School of Public Health (Dr Yasui), University of Alberta, and Departments of Pediatrics (Drs Robertson and Watt) and Rehabilitative Medicine (Dr Watt), Glenrose Rehabilitation Hospital, Edmonton.

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