Cerebral palsy more likely in late preterm babies

Section: Life, Pg. 07d

Babies born at 34 to 36 weeks' gestation are three times more likely to be diagnosed with
cerebral palsy than those born full term at 37 weeks or later, researchers report today.

In addition, these "late preterm" babies, born just a few weeks early, are "modestly" but
significantly more likely to be diagnosed with developmental delays or mental
retardation, according to the study of 141,321 children born at 30 weeks' gestation or
later.

"We're surprised to see the late preterm babies had a higher risk of cerebral palsy," says
lead author Joan Petrini, director of the March of Dimes Perinatal Data Center in White
Plains, N.Y. They also had a 25% higher risk of developmental delay or mental
retardation than full-term babies.

Most of the children in the study had not yet entered school, when learning disabilities
are more likely to be seen, the authors note, so their results may underestimate the
proportion of late preterm children with brain development problems.

Because babies born at 34 to 36 weeks are sometimes bigger than full-term infants, they
appear to be healthy, says co-author Gabriel Escobar, a senior research scientist at the
Kaiser Permanente Medical Care Program in Oakland. And that's part of the problem, he
says.

"There's a temptation to treat them as if they're term babies," Escobar says. "Being a
bigger baby doesn't necessarily protect you at all. It's really how mature you are."

Compared with the 70- or 80-fold increase seen in babies born at 26 weeks, a threefold
increase in cerebral palsy might not sound like much, he says. But "there's a ton of these
babies."

In fact, about one in 11 live births in the USA occurs between 34 and 36 weeks' gestation,
or more than 370,000 births a year, Petrini says.

And while the proportion of babies born earlier than 34 weeks has remained fairly stable,
Escobar says, the percentage of late preterm births has been growing. Increasing rates of
labor induction and cesarean sections -- not all of which are medically necessary -- and
wider use of assisted fertility therapies are partly to blame, he and Petrini say.

Whether the factors behind a preterm birth or the preterm birth itself raise the risk of
neurological problems isn't known, Petrini says. The study's authors lacked information
about whether the mothers had complications, such as pregnancy-induced high blood
pressure or gestational diabetes, or risk factors, such as smoking during pregnancy, that
led them to deliver prematurely.
In an accompanying editorial in The Journal of Pediatrics, Michael Kramer of McGill
University and the Montreal Children's Hospital writes that the new study "fills an
important gap in our knowledge" about the longer-term risks of late preterm births.
Doctors need to tell pregnant women about these risks, Kramer says, so they can take
them into account when considering fertility treatments and labor induction.

(c) USA TODAY, 2008