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Biomedical subjects

J K Grether

Publications and source records attributed to J K Grether.

29 records · Page 2Linked to original sources
PubMed1996

Prenatal and perinatal factors and cerebral palsy in very low birth weight infants.

OBJECTIVE: To identify prenatal and perinatal characteristics associated with cerebral palsy (CP) in infants born weighing < 1500 gm (very low birth weight, VLBW). DESIGN: All 42 VLBW singleton infants with CP born in the period from 1983 to 1985 in a defined population were compared with 75 randomly selected VLBW control infants. RESULTS: Birth in a level I facility was associated with increased risk of CP (odds ratio (OR) 6.3, 95% confidence interval (CI) 1.8, 19), as was birth within 3 hours of the mother's first admission for delivery (OR 3.2, CI 1.4, 7.4). Delivery occurred within 3 hours of admission to a level I facilty in 24% of VLBW children with CP and no control children (OR (0.5 added to each cell of 2 x 2 table) 49, CI 3.1, 204). Chorionitis was associated with increased risk in children born more than 5 hours after admission (OR 4.3, CI 1.1, 13). Chorionitis followed by neonatal seizures occurred in 14% of VLBW children with CP (in 25% with spastic diplegia) and in no control child (OR (0.5 added to each cell of 2 x 2 table) 26, CI 1.6, 116). Preeclampsia was associated with decreased risk (OR 0.08, CI 0.02, 0.67), as was use of magnesium sulfate (OR 0.14, CI 0.05, 0.51) administered for preeclampsia or preterm labor. Other risk factors for CP included gravidity greater than one (OR 3.9, CI 1.2, 11), short interbirth interval (OR 4.1, CI 1.3, 12), and vaginal bleeding on the day of admission (OR 2.9, CI 1.2, 7.4). CONCLUSIONS: In this population-based study, almost one fourth of the CP in VLBW children occurred in infants delivered in level I facilities soon after their mothers' admissions. Another 14% was in children who had neonatal seizures after birth to women with chorionitis. No control subject experienced either of these sequences.

Adult↗
PubMed1995

Can magnesium sulfate reduce the risk of cerebral palsy in very low birthweight infants?

OBJECTIVES: To investigate whether in utero exposure to magnesium sulfate (MgSO4) was associated with a lower prevalence of cerebral palsy (CP) in infants born weighing < 1500 g. DESIGN: Singleton infants weighing < 1500 g at birth (very low birthweight, VLBW) and surviving to 3 years with moderate or severe congenital CP were identified among 155,636 children born 1983 through 1985 in four California counties. VLBW children with CP were compared with randomly selected VLBW control survivors with respect to whether their mothers received MgSO4 to prevent convulsions in preeclampsia or as a tocolytic agent, and other information abstracted from labor and delivery records. RESULTS: During the admission for delivery, 7.1% of the 42 VLBW infants with later CP and 36% of the 75 VLBW controls were exposed to MgSO4 (odds ratio (OR) .14, 95% confidence interval (CI) .05, .51). The overall association of MgSO4 with reduced risk of CP was also observed in the subgroup of infants born to women who were not preeclamptic (OR .25, CI .08, .97). Infants with CP were less often exposed antenatally to MgSO4 whether or not there was cotreatment with non-MgSO4 tocolytics (other tocolytics administered, OR for MgSO4 exposure .23, CI .06, 1.2; other tocolytics not administered, OR for MgSO4 .08, CI .02, .68), or antenatal corticosteroids (steroids given, OR for MgSO4 exposure .24, CI .06, 1.3; steroids not given, OR for MgSO4, .08, CI .02, .72). Apparent benefit of magnesium was observed in the presence or absence of a variety of characteristics of pregnancies, births, and infants. CONCLUSION: In this observational study, in utero exposure to MgSO4 was more frequent in controls than in children with CP, suggesting a protective effect of MgSO4 against CP in these VLBW infants.

Cerebral Palsy↗
PubMed1993

Cerebral palsy in four northern California counties, births 1983 through 1985.

To examine the impact of demographic shifts and changes in perinatal medicine on the distribution of cerebral palsy (CP), we investigated characteristics of affected children in a large, recent population-based American cohort study. Children with moderate or severe congenital CP born in four northern California counties in 1983 through 1985 and surviving to age 3 years were identified through records of state service agencies and clinical examination or record review by a single physician. We compared information from birth certificates for 192 children with CP and 155,636 survivors without CP born in those counties in the same period. Children with birth weights < 2500 gm contributed 47.4% of the CP in this population; those < 1000 gm, who were 0.20% of survivors, contributed 7.8%. Children with birth weights of 4000 to 4500 gm were at lowest risk. Among singletons, prevalence of CP was lowest (0.92/1000) in infants born to women aged 25 to 34 years, and was significantly higher in children whose mothers were 40 years or older (3.3/1000), especially if they were high in parity (6.9/1000). Children of teenaged mothers or fathers were at somewhat increased risk of CP. Early gestational age at birth was also an important independent risk factor. Prevalence of CP was slightly higher in black children, apparently related to a greater tendency to be low in birth weight. The time during pregnancy when prenatal care began was similar for children with CP and for the general population. For the 95% of children born weighing > or = 2500 gm, birth in a hospital lacking a special care nursery was not associated with increased risk of CP. Almost 8% of CP occurred in children born weighing < 1000 gm, a group that produced few survivors in the past; 28.1% occurred in children born weighing < 1500 gm. Neither early initiation of prenatal care nor, for that large majority of neonates weighing > 1500 gm, delivery at a hospital with specialized facilities was associated with a lower risk of CP.

Adult↗
PubMed1993

Twinning and cerebral palsy: experience in four northern California counties, births 1983 through 1985.

BACKGROUND: Twinning is associated with heightened risk of cerebral palsy (CP) and is increasing in the United States and elsewhere. METHODS: Twins with moderate or severe congenital CP were identified in a cohort of 155,572 children born 1983 through 1985 in four northern California counties and surviving to 3 years. The prevalence of CP in twins and factors associated with increase in risk were examined. RESULTS: Among 2985 twins, 20 children in 18 pairs had CP. The prevalence of CP was 6.7 per thousand 3-year-old twin children (95% confidence interval [CI], 4.2 to 11), 12 per thousand twin pregnancies (95% CI, 7.2 to 19), and 1.1 per thousand singletons (95% CI, 0.97 to 1.3). Ten percent of all CP was in twins; 22% of CP in infants of less than 1500 g birth weight occurred in twins. Twins were over-represented among very low birth weight infants but their risk of CP was comparable with that of very low birth weight singletons. Twins born weighing 2500 g and more had a CP risk 3.6 times that of singletons of similar weight. In children who survived fetal death of a co-twin, CP was 108 times more prevalent (95% CI, 42 to 273) than in singletons and 13 times more prevalent (95% CI, 4.5 to 37) than in twins whose co-twin was born alive. The CP rate in unlike-sex pairs was 13 per thousand (95% CI, 4.8 to 32), not significantly different from 11 per thousand (95% CI, 5.7 to 19) for like-sex pairs. CONCLUSION: Twin pregnancies produced a child with CP 12 times more often than singleton pregnancies. The heightened risk was largely related to the tendency of twins to be low in birth weight and to a greater risk of CP in twins of normal birth weight compared with singletons of similar weight. Twins of unlike-sex pairs, necessarily dizygotic, were not at lower risk than like-sex pairs. The current increase in multiple births is likely to contribute more children with CP.

California↗
PubMed1992

The California Cerebral Palsy Project.

The California Cerebral Palsy Project (CACP) is a population-based study of 192 children with moderate or severe congenital cerebral palsy who were born between 1983 and 1985 in four San Francisco Bay area counties and who were alive and residing in California at age 3 years. Initial ascertainment of cases was based on records of two agencies known to enrol virtually all CACP-eligible children. Final case status was established by standardised clinical examination in 67% of cases and extensive record review in 33%. The 192 cases gave a prevalence at age 3 of 1.23/1000 survivors. Twins were 10% of the cases with a prevalence of 6.7/1000. Overall, 53% of the cases had birthweight greater than or equal to 2500 g and 28% had birthweight less than 1500 g. There was no association between birthweight and severity of functional impairment and no consistent association between birthweight and the presence of associated disabilities. The CACP prevalence is lower than that reported in other studies and is believed to be due to the more stringent case inclusion criteria employed for this research data base.

Birth Weight↗
PubMed1992

Prevalence of developmental enamel defects in children with cerebral palsy.

Enamel defects observed in primary anterior teeth of 123 children with congenital cerebral palsy (CP) born 1983 through 1985 in four northern California counties were categorized using an adaptation of the Developmental Defects of Enamel Index. Nineteen children (15%) had crowns or loss of tooth substance (LTS) due to attrition. Missing enamel (ME) including horizontal groove, was observed in 39 children (32%). Twenty-four children without ME (20%) had enamel pits, vertical grooves, or colored enamel opacities. Forty-one (33%) had clinically normal enamel. ME children did not differ significantly from those with normal enamel with respect to race, sex, singleton vs twin, severity or type of CP, or presence of dysmorphic features. ME children more often had shorter gestational ages than children with normal enamel. More ME children, even those who were not low in birth weight, were reported by parents to have required neonatal intensive care.

California↗
PubMed1990

Sudden infant death syndrome among Asians in California.

We analyzed California linked birth and infant death records for 1978 to 1985 to determine the ethnic-specific incidence of sudden infant death syndrome in five Asian-American subgroups, and to assess the association of sudden infant death syndrome with cultural assimilation. The overall incidence of sudden infant death syndrome for these groups was 1.1/1000 live births (194 cases). The ethnic-specific incidence was statistically associated with the immigration status of each ethnic group, as measured by the proportion of all live births for which the mother was born in the United States, with a higher incidence for groups that have been in the United States for the longest period. A logistic model was used to examine simultaneously the association of sudden infant death syndrome with maternal ethnicity, ethnic homogeneity or heterogeneity of the parents, and maternal birthplace (United States, or elsewhere). The logistic analysis did not yield statistically significant evidence to support cultural assimilation as a factor in the incidence of sudden infant death syndrome for these groups. This finding may be due to small sample size and inadequate indicators of assimilation. It may also be that other factors relating to immigration and selective migration affect the incidence of sudden infant death syndrome among Asian-Americans.

Adult↗
PubMed1989

Sudden infant death syndrome and birth weight.

We studied 2962 cases of sudden infant death syndrome (SIDS), derived from linked birth and death records, to specify further the descriptive epidemiologic data on recognized SIDS risk factors and to examine interrelationships among multiple risk factors and SIDS while controlling for the influence of birth weight (using logistic regression). The results generally confirmed those of other studies, with the exception of a higher incidence of SIDS among Chinese and Japanese babies and a lower incidence among Hispanic babies, all in comparison with white, non-Spanish (Anglo) infants. Median age at death was found to vary by birth weight, with very low birth weight babies being about 6 weeks older (postnatal age) than normal birth weight babies at time of death. The association of the risk factors with SIDS remained when birth weight data were statistically controlled; the association of these risk factors with SIDS cannot be explained by their relationship to birth weight. An interaction was found between race and maternal age and between multiparity and type of hospital of birth. There was no interaction between birth weight and the other risk factors.

Birth Weight↗
PubMed1987

Exposure to aerial malathion application and the occurrence of congenital anomalies and low birthweight.

The association between exposure to low dose malathion, after its aerial application to 13,000 square miles in the San Francisco Bay area, and the occurrence of birth defects and low birthweight was examined using newborn hospital discharge data and vital records. No biologically plausible pattern of association was found. Limitations in the data and analysis are discussed.

Abnormalities, Drug-Induced↗