Background

Preterm infants have an increased risk of neurodevelopmental disorders. We established a direct quantitative comparison of the association between the degree of prematurity and three different neurodevelopmental disorders.

Methods

In this cohort study, we combined data from 995,498 children in the Danish Medical Birth Register, from birth years 1997–2013, with information on cerebral palsy, epilepsy, and special educational needs. We estimated the gestational week-specific prevalence and risk for each of the disorders.

Results

The risk ratio of cerebral palsy at gestational weeks 21–24, compared to term birth, was more than ten times higher than for the two other disorders. The prevalence of epilepsy and special educational needs declined almost parallel, with 9.2% (4.6%–13.5%) and 12.5% (11.2%–13.7%), respectively, per week of gestation toward term birth. Cerebral palsy did not decline similarly: from gestational weeks 21–24 until week 29 the prevalence declined insignificantly by 0.6% (−11.1%–11.0%) per week; whereas from week 29 until term, the prevalence declined markedly by 36.7% (25.9%–45.9%) per week.

Conclusions

The prevalence and risk of cerebral palsy are affected differently by the degree of prematurity compared with epilepsy and special educational needs, possibly reflecting important differences in cerebral pathophysiology.

Impact

• For each week of gestation toward term birth, there was a clear log-linear decline in the prevalence of early childhood epilepsy and special educational needs.

• In contrast, the risk of cerebral palsy was high at the earliest gestational age, and the prevalence did not decline significantly until gestational week 29, from where it declined notably by nearly 40% for each week of gestation until term birth.

• Our results indicate important differences in the pathophysiological processes that associate preterm birth with these three neurodevelopmental disorders.

中文翻译：

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胎龄对早产儿主要神经发育障碍的影响

背景

早产儿患神经发育障碍的风险增加。我们建立了早产程度与三种不同神经发育障碍之间关联的直接定量比较。

方法

在这项队列研究中，我们将 1997 年至 2013 年出生年份丹麦医学出生登记册中 995,498 名儿童的数据与有关脑瘫、癫痫和特殊教育需求的信息相结合。我们估计了每种疾病的妊娠周特异性患病率和风险。

结果

与足月分娩相比，妊娠 21-24 周脑瘫的风险比是其他两种疾病的十倍以上。癫痫和特殊教育需求的患病率几乎平行下降，妊娠期每周分别下降 9.2% (4.6%–13.5%) 和 12.5% (11.2%–13.7%)。脑性麻痹并没有类似的下降：从妊娠第 21-24 周到第 29 周，患病率每周下降 0.6%（-11.1%-11.0%），但并不显着；而从第 29 周到足月，患病率每周显着下降 36.7% (25.9%–45.9%)。

结论

与癫痫和特殊教育需求相比，早产程度对脑瘫患病率和风险的影响不同，这可能反映了脑病理生理学的重要差异。

影响

• 从妊娠到足月出生的每一周，儿童早期癫痫和特殊教育需求的患病率呈对数线性下降。

• 相比之下，脑瘫的风险在最早胎龄时就很高，并且直到妊娠第 29 周患病率才显着下降，从妊娠的每个星期到足月分娩，患病率都显着下降了近 40%。

• 我们的研究结果表明，早产与这三种神经发育障碍相关的病理生理过程存在重要差异。