Does the risk of cerebral palsy increase or decrease with increasing gestational age?

BACKGROUND: It is generally accepted that the risk of cerebral palsy decreases with increasing gestational age of live born infants. However, recent studies have shown that cerebral palsy often has prenatal antecedents including congenital malformations, vascular insults and maternal infection. Cerebral palsy is therefore better viewed as occurring among fetuses, rather than among infants. We explored the epidemiologic implications of this change in perspective. METHODS: We used recently published data from Shiga Prefecture, Japan and from North-East England to examine the pattern of gestational age-specific rates of cerebral palsy under these alternative perspectives. We first calculated gestational age-specific rates of cerebral palsy as per convention, by dividing the number of cases of cerebral palsy identified among live births within any gestational age category by the number of live births in that gestational age category. Under the alternative formulation, we calculated gestational age-specific rates of cerebral palsy by dividing the number of cases of cerebral palsy identified among live births within any gestational age category by the number of fetuses who were at risk of being born at that gestation and being afflicted with cerebral palsy. RESULTS: Under the conventional formulation, cerebral palsy rates decreased with increasing gestational age from 63.9 per 1,000 live births at <28 weeks gestation to 0.9 per 1,000 live births at 37 or more weeks gestation. When fetuses were viewed as potential candidates for cerebral palsy, cerebral palsy rates increased with increasing gestational age from 0.08 per 1,000 fetuses at risk at <28 weeks gestation to 0.9 per 1,000 fetuses at risk at 37 or more weeks gestation. CONCLUSIONS: The fetuses-at-risk approach is the appropriate epidemiologic formulation for calculating the gestational age-specific rate of cerebral palsy from a causal perspective. It shows that the risk of cerebral palsy increases as gestational duration increases. This compelling view of cerebral palsy risk may help refocus research aimed at understanding and preventing cerebral palsy

Neonatal mortality rate trends and adjusted rates at a tertiary maternity hospital in Qatar: a six-year review

Introduction Neonatal mortality is a major public health concern, with approximately 2.4 million neonates dying each year in the first 28 days of life worldwide. The Women's Wellness & Research Center (WWRC) is a large tertiary maternity hospital in Qatar that aims to improve the intact survival of its NICU graduates. This quality review examines the trends in neonatal mortality rates in WWRC over the last six years (2015-2020) and compares them to historical data and other NICUs around the world. Methods This is a retrospective quality review study that examines all neonatal deaths in WWRC from 2015 to 2020. To provide a standardized review process, the study used a structured neonatal-specific mortality trigger tool and electronic medical records were used to validate the data. The Neonatal Mortality Rate (NMR), Early Neonatal Mortality Rate (ENMR), and Late Neonatal Mortality Rate (LNMR) are calculated, as well as an adjusted NMR (aNMR) for infants born at or below 23 weeks gestation. The study includes all infants who died in WWRC, regardless of where they died, and examines infants who died in the NICU after the neonatal period as a percentage of all NICU admissions during the chosen period. Results During the study period, there were 101,172 live births more than 20 weeks of gestational age. A total of 586 died in the first 28 days of life yielding a crude NMR of 5.8 deaths per 1000 live births for the study period. Out of these 586 neonatal deaths, 180 infants were born below the threshold of viability (less than 23 weeks) and further, 174 infants died due to conditions incompatible with life. This results in an adjusted neonatal mortality rate (aNMR) of 2.3/1000 live births over the six-year study period. Throughout the 6-year study period, there was a reduction of 23% & 50% in the crude NMR & aNMR, respectively (equivalent to approximately 32.4 fewer deaths in 2020). Similarly, during this time frame, the Infant mortality rate (IMR) dropped by 55%, and the adjusted IMR reduced by 62%. Conclusion This study shows that WWRC has significantly improved over the past six years in lowering the aNMR, with results that are comparable to other NICUs globally. In order to continue making progress in reducing neonatal mortality rates, this study emphasizes the significance of monitoring neonatal mortality rates as a primary quality indicator for NICUs. It also emphasizes the need for continual quality improvement efforts.</p

Gestational Age Specific Neonatal Survival in the State of Qatar (2003-2008) - A Comparative Study with International Benchmarks

Objective: To analyze and compare the current gestational age specific neonatal survival rates between Qatar and international benchmarks