Long-term Neurological Morbidity Research Articles

Long-Term Neurological Morbidity Among Children Delivered by Vacuum Extraction—A National Cohort Study

(Abstracted from Acta Obstet Gynecol Scand 2023;102:843–853) Many factors during pregnancy and childbirth influence long term neurological outcomes, but some controllable factors have not been studied extensively; one of these factors is vacuum extraction (VE) as a method of assisted childbirth. This study was designed as the first nationwide cohort study examining VE and its impact on long-term neurological morbidity, and its aim was to assess the risks of neonatal mortality, cerebral palsy (CP), and epilepsy in children delivered by VE.

959 The association between cervical cerclage and offspring long-term neurological morbidity among twin pregnancies

959 The association between cervical cerclage and offspring long-term neurological morbidity among twin pregnancies

Outcome of patients with attempted suicidal hanging with pre-hospital cardiac arrest: A pilot observational ICU study

Background: Hanging with pre-hospital cardiac arrest is associated with increased hospital mortality and significant long-term neurological morbidity.
 Setting: Single centre, observational study at tertiary care ICU.
 Methods: All patients with suicidal hanging admitted to Westmead ICU from 1-Jan-2014 to 31-Dec-2019 were included in the study. Patient data obtained from ICU database and electronic health record was analysed for predictors of ICU outcome.
 Results: Seventy-six patients with suicidal hanging presented to Westmead Emergency Department over a period of 6 years; of these, 47 (33 males, 14 females) were admitted to ICU. Mean age of patient cohort was 39.0 years (+13.6) and median APACHE-III score was 69.0. Twenty-seven patients (57.4%) were admitted following pre-hospital cardiac arrest due to a non-shockable rhythm (16 PEA, 11 asystole) as the first documented rhythm. Most (74.0%) of these patients had GCS of 3 at scene and this remained unchanged on arrival in the ED. This notwithstanding, 33.3% patients had a good neurological outcome. Among hanging patients without pre-hospital cardiac arrest, 95% had a good neurological outcome. This difference in outcome was significant. While several factors were associated with patient outcome on univariate analysis, only high APACHE-III score demonstrated a significant inverse relationship with good outcome on regression analysis. Presence of myoclonus at admission and pre-hospital cardiac arrest also had an inverse association with good outcome, but this was not statistically significant.
 Conclusions: Outcome of hanging patients with pre-hospital cardiac arrest admitted to ICU was poor despite successful initial resuscitation as per international guidelines. High APACHE-III score was associated with poor outcome.

Syncope in pregnancy, immediate pregnancy outcomes, and offspring long-term neurologic health

There are limited data regarding the perinatal consequences of maternal syncope during pregnancy, and even less is known about the potential long-term effect on offspring health. This study aimed to examine perinatal outcomes as well as long-term offspring neurologic morbidity associated with prenatal maternal syncope, and the possible differential effect by trimester of first syncope episode. A retrospective cohort study was conducted, including all singleton deliveries occurring between 1991 and 2021 at a large tertiary medical center. Multivariable analyses were applied to study the associations between prenatal maternal syncope and various perinatal outcomes as well as offspring neurologic morbidity up to the age of 18 years, while adjusting for clinically relevant factors. Analyses were further conducted by trimester of first syncope episode. The study population included 232,475 pregnancies, 774 (0.3%) were affected by maternal syncope, which most frequently first occurred during the second trimester (44.5%), followed by the first trimester (31.8%) and finally the third trimester (27.7%). Maternal syncope was independently associated with increased risk for intrauterine growth restriction (adjusted odds ratio, 1.52; 95% confidence interval, 1.01-2.29), which appeared to be mainly driven by first trimester syncope occurrence; as well as with increased risk for cesarean delivery (adjusted odds ratio, 1.33; 95% confidence interval, 1.10-1.61), and for long-term offspring neurologic morbidity (adjusted hazard ratio, 1.79; 95% confidence interval, 1.65-2.08), regardless of the trimester of syncope occurrence. Prenatal maternal syncope is an independent risk factor for intrauterine growth restriction, cesarean delivery, and for long-term offspring neurologic morbidity.

P-764 Mode of conception and future neurologic morbidity of the offspring: a sibling analysis

Abstract Study question To investigate the risk of long-term neurological morbidity among children born following fertility treatments while employing sibling matched analysis to maximize confounder control. Summary answer Fertility treatments appear to be an independent risk factor for long-term neurological morbidity of the offspring up to 18 years of age. What is known already Controversy exists regarding the association between fertility treatments and long-term morbidity of the offspring. Study design, size, duration A retrospective population-based cohort analysis was performed, including all sibling deliveries occurring between 1991 and 2021 at a tertiary medical center. Offspring were followed-up until the age of 18 years. Participants/materials, setting, methods The study population included 10,810 siblings of women who had at least one spontaneous pregnancy and at least one pregnancy following fertility treatments - in vitro fertilization (IVF) and ovulation induction (OI). A Kaplan–Meier survival curve was used to compare the cumulative neurologic morbidity incidence and a multivariable Cox survival hazards regression model was used to control for confounders. Main results and the role of chance There were 5,935 siblings (54.9%) conceived following fertility treatment and 4875 spontaneously conceived siblings (45.1%). Gestational diabetes mellitus and hypertensive disorders were more common in the fertility treatment group (9.9% vs. 5%, and 7.7% vs. 4.7%, respectively, p < 0.001). Likewise, the rates of Cesarean delivery (33.6% vs. 2.3%, p < 0.001), preterm delivery (11.9% vs 7.6%, p < 0.001) and low birth weight (12.1% vs.7.2%, p < 0.001) were higher in the fertility treatments group, as compared with the spontaneous pregnancy group. Neurological morbidity was significantly higher among siblings born following fertility treatments as compared with those conceived spontaneously (10.2% vs. 8.2%; p < 0.001). In particular, psychiatric emotional disorders were more common in the fertility treatment group (4.4% vs. 3.3% p = 0.002). Using a Kaplan-Meier survival curve, siblings conceived following fertility treatments had higher cumulative incidence rates of neurological morbidity (Log-Rank, p = 0.012). After controlling for confounders, such as maternal age, diabetes mellitus, preterm delivery and hypertensive disorders, using a Cox regression model, being born following fertility treatments was associated with long term neurological morbidity (adjusted HR = 1.2, 95% CI 1.02-1.32, p = 0.027). Limitations, reasons for caution This retrospective cohort study can only provide evidence of association but not causation. Also, our study results are hospital-based diagnoses which most likely represent acute and severe disease. Wider implications of the findings In this large retrospective cohort study of siblings, a significant and independent association was found between fertility treatments and long-term neurological morbidities. Trial registration number N/A

Multiple meningiomas: Epidemiology, management, and outcomes.

Meningiomas are the most common nonmalignant brain tumor in adults, with an increasing incidence of asymptomatic meningiomas diagnosed on more ubiquitous neuroimaging. A subset of meningioma patients bear 2 or more spatially separated synchronous or metachronous tumors termed "multiple meningiomas" (MM), reported to occur in only 1%-10% of patients, though recent data indicate higher incidence. MM constitute a distinct clinical entity, with unique etiologies including sporadic, familial and radiation-induced, and pose special management challenges. While the pathophysiology of MM is not established, theories include independent origin in disparate locations through unique genetic events, and the "monoclonal hypothesis" of a transformed neoplastic clone with subarachnoid seeding precipitating numerous distinct meningiomas. Patients with solitary meningiomas carry the risk of long-term neurological morbidity and mortality, as well as impaired health-related quality of life, despite being a generally benign and surgically curable tumor. For patients with MM, the situation is even less favorable. MM should be regarded as a chronic disease, and in many cases, the management goal is disease control, as cure is seldom possible. Multiple interventions and lifelong surveillance are sometimes necessary. We aim to review the MM literature and create a comprehensive overview, including an evidence-based management paradigm.

Cerebral Hemorrhage with Edema in A Five-Week-Old: A Case of Late-Onset Vitamin K Deficiency Bleeding, Rare Diagnosis in Resource-Limited Settings

Introduction: Vitamin K deficiency bleeding (VKDB) is a term that describes the condition of hemorrhagic disorders in newborns. Late-onset VKDB occurs between the second week and sixth month of life. Intracranial hemorrhage often occurs in cases of late-onset VKDB and can cause 14-20% mortality and 40% long-term neurological morbidity, so it is important to treat patients until they are stable, especially with limited health facilities. Case Report: A baby boy aged 1 month 8 days was brought by his parents to RSUD Deli Serdang Lubuk Pakam with the chief complaint of an enlarged stomach, accompanied by paleness, weakness, convulsions, and altered consciousness. A midwife assisted the delivery with unknown history of immediate vitamin K injection after birth. We diagnosed the patient with VKDB according to the clinical symptoms. The head CT scan showed subdural and subarachnoid hemorrhage with cerebral edema. We transfused the patient with Packed Red Cells and Fresh Frozen Plasma 20 cc/12 hours 5 times, administered Vitamin K injection 3 mg/IM for 3 days, and other supportive therapy. The patient's condition improved within the third day of hospitalization with recovered consciousness and was transferred to the referral hospital. Discussion: The key feature of late-onset VKDB is the incidence of ICH in 30-88% of patients, leading to a high incidence of mortality. This study highlights the importance of prompt, and early treatment of VKDB with proper history taking, clinical examination, and relevant investigations to reduce morbidity and mortality. Conclusion: In conclusion, secondary late-onset PDVC is more common than the primary subtype, and late-onset PDVC is still an important cause of morbidity and mortality in developing countries including Indonesia, where vitamin K prophylaxis is not routinely performed

Long-term neurological morbidity among children delivered by vacuum extraction - a national cohort study.

This is the first nationwide cohort study of vacuum extraction (VE) and long-term neurological morbidity. We hypothesized that VE per se, and not only complicated labor, can cause intracranial bleedings, which could further cause neurological long-term morbidity. The aim of this study was to investigate the risk of neonatal mortality, cerebral palsy (CP), and epilepsy among children delivered by VE in a long-term perspective. The study population included 1 509 589 term singleton children planned for vaginal birth in Sweden (January 1, 1999 to December 31, 2017). We investigated the risk of neonatal death (ND), CP, and epilepsy among children delivered by VE (successful or failed) and compared their risks with those born by spontaneous vaginal birth and emergency cesarean section (ECS). We used logistic regression to study the adjusted associations with each outcome. The follow-up time was from birth until December 31, 2019. The percentage and total number of children with the outcomes were ND (0.04%, n = 616), CP (0.12%, n = 1822), and epilepsy (0.74%, n = 11 190). Compared with children delivered by ECS, those born by VE had no increased risk of ND, but there was an increased risk for those born after failed VE (adj OR 2.23 [1.33-3.72]). The risk of CP was similar among children born by VE and those born spontaneously vaginally. Further, the risk of CP was similar among children born after failed VE compared with ECS. The risk of epilepsy was not increased among children born by VE (successful/failed), compared with those who had spontaneous vaginal birth or ECS. The outcomes ND, CP, and epilepsy are rare. In this nationwide cohort study, children born after successful VE had no increased risk of ND, CP or epilepsy compared with those delivered by ECS, but there was an increased risk of ND among those born by failed VE. Concerning the studied outcomes, VE appears to be a safe obstetric intervention; however, it requires a thorough risk assessment and awareness of when to convert to ECS.

“Unspecified organic personality and behavioral disorder due to brain damage from HHV-6 encephalitis in child. case report and literature review”

IntroductionWe present a case of a 15 year-old boy diagnosed with Unspecified Personality and Beheavioral Disorder Due to Brain Damage from a Human Herpes Virus-6 Encephalitis.ObjectivesTo describe a case of an Unspecified Organic Personality and Behavioral Disorder secondary to brain damage from Human Herpes Virus-6 (HHV-6) Encephalitis in an 11 year-old childand to review recent literature, in order to improve clinical practice.MethodsClinical case report and brief review of literature. A bibliographic research was made in the database PubMed, using the terms “Viral Encephalitis” AND “Neuropsychiatric symptoms”; “Viral Encephalitis” AND “Behavioral Disorder”; “Long-Term Neurological Morbidity” AND “Viral Encephalitis”.Results15 year-old boy diagnosed with Unspecified Personality and Beheavioral Disorder Due to Brain Damage from a Human Herpes Virus-6 Encephalitis, secondary to immunosupression in the context of haematopoietic progenitor transplantation (HPT) at 11 years old. MRI showed supratentorial ventriculomegaly, atrophic changes in encephalon and right hippocampus with subcortical retraction secondary to previous encephalitis. Clinically, main changes appeared in behavior, presenting a serious frontal syndrome with high disinhibition, what implied severe social and academic difficulties. During the outpatient follow-up, the behavioural disorder is being pharmacologically treated with Risperidone 1,5mg per day with a partially favorable evolution. The patient presented intolerance to olanzapine, with an episode of low level of conciuosness after taking it.Bibliographic research results indicate that the gold standard treatment for behavioral disturbances are antipsychotics. Risperdidone is proven save for treatment in children. Results point out also the importance of an early multidisciplinar intervention, involving family training, rehabilitation resources and curricular adaptations.Image:Image 2:ConclusionsViral encephalitis may have serious neuropsychiatric consequences, especially during childhood while the brain development is not finished. When the neurological damage affects the frontal lobes of the brain, behavioural and personality disturbances are expected and an early multidisciplinar intervention should be considered. Antypsichotics are the gold standard pharmacological treatment for behavioural disturbances. During the scholar period, special curricular adaptations should be done in order to reduce study-related stress.Disclosure of InterestNone Declared

Time of Delivery Among Low-Risk Women at 37–42 Weeks of Gestation and Risks of Stillbirth and Infant Mortality, and Long-term Neurological Morbidity

(Abstracted from Paediatr Perinat Epidemiol 2022;36:577–587) Time of delivery in low-risk pregnancies is an important consideration for clinicians. They must balance the risks associated with early delivery, including respiratory and other neonatal complications, versus those associated with later delivery, including stillbirth, meconium aspiration syndrome and maternal complications.

Prenatal maternal hyperemesis gravidarum and long-term neurological morbidity of the offspring: a population-based cohort study

Hyperemesis gravidarum (HG) is one of the leading causes for hospitalization and morbidity during pregnancy. Intrauterine environment has an important role in shaping fetal development, still not much is known about the effect of maternal HG on long-term offspring morbidity, and specifically neurological morbidity. The study objective was to clarify whether offspring exposed to maternal HG are at an increased risk for neurological -related hospitalization .

Gestational diabetes mellitus and long-term neurological morbidity.

This commentary is on the original article by Chen et al. on pages 933–941 of this issue.

Peri- and neonatal factors influencing mortality and morbidity 2years after esophageal atresia primary repair: a single center retrospective study.

Post-operative ventilation and feeding management strategies may represent an opportunity for quality-of-care improvement to positively impact long-term outcomes after primary esophageal atresia repair. • Children operated on for esophageal atresia experience long-term digestive, respiratory, and neurologic morbidity, especially after multiple-stage esophageal repair. • Exclusive oral feeding at discharge is associated with a decreased risk of medical complications in the first years of life, in studies including all types of esophageal atresia repair.Outcomes of children after primary repair (non-long gap populations) have been less documented. • In our retrospective cohort of children with one-stage esophageal atresia repair, ventilatory support for more than 8 days and inability to achieve full oral feeding before hospital discharge in the neonatal period were independently associated with adverse digestive, respiratory, and neurologic outcomes at 2 years in survivors. • Both these factors are potentially modifiable, representing an opportunity for quality-of-care improvement to positively impact long-term outcomes.These results might also help identify children at risk of unfavorable evolution, to customize a multi-disciplinary follow-up program.

Assessment of fetal circulation and mechanisms of heart adaptation during umbilical cord compression: An experimental model in fetal sheep

Perinatal asphyxia is a serious health issue with long-term neurologic morbidities. Cerebral lesions are induced by low cardiac output which occurs often during labour without reliable predictive factors. To assess hemodynamic changes during umbilical cord (UC) compression in fetal sheep. Experimental study on chronically instrumented sheep fetuses (surgery at 131 days of gestation, term = 141 days). Under general anesthesia, a hysterotomy is performed. An aortic catheter is inserted via the axillary artery for blood sampling, and a 6 Fr. Sheath is introduced to the left ventricle (LV) through the right carotid artery under pressures and echocardiographic control. Then a 5 Fr. Transonic PV loop catheter (EMKA Technologies, France) is inserted through the sheath into the LV, and the sheath is withdrawn towards the aorta to allow permanent measurement of the aortic pressure. A 16 mm inflatable occlusion device is placed around the UC (OC16, California, USA). Series of complete occlusion of the UC are done with progressive increasing duration to simulate labour. LV pressures and volumes are registered continuously. Pressure-volume loops and blood samples are analyzed before during and after the occlusions. During the first experimentations, short occlusions did not induce significant modifications. Longer occlusions induced progressive systolic and diastolic disorders which appeared before the metabolic acidosis ( Fig. 1 ). Knowledge of foetal heart adaptation could be interesting to prevent neurologic lesions. This hemodynamic model could also be applied in other situations such as congenital diaphragmatic hernia, pulmonary hypertension or aortic coartation.

Animal Models of Chorioamnionitis: Considerations for Translational Medicine.

Preterm birth is defined as any birth occurring before 37 completed weeks of gestation by the World Health Organization. Preterm birth is responsible for perinatal mortality and long-term neurological morbidity. Acute chorioamnionitis is observed in 70% of premature labor and is associated with a heavy burden of multiorgan morbidities in the offspring. Unfortunately, chorioamnionitis is still missing effective biomarkers and early placento- as well as feto-protective and curative treatments. This review summarizes recent advances in the understanding of the underlying mechanisms of chorioamnionitis and subsequent impacts on the pregnancy outcome, both during and beyond gestation. This review also describes relevant and current animal models of chorioamnionitis used to decipher associated mechanisms and develop much needed therapies. Improved knowledge of the pathophysiological mechanisms underpinning chorioamnionitis based on preclinical models is a mandatory step to identify early in utero diagnostic biomarkers and design novel anti-inflammatory interventions to improve both maternal and fetal outcomes.

Time of delivery among low-risk women at 37-42weeks of gestation and risks of stillbirth and infant mortality, and long-term neurological morbidity.

BackgroundThe most important knowledge gap in connection with obstetric management for time of delivery in term low‐risk pregnancies relates to the absence of information on long‐term neurodevelopmental outcomes.ObjectivesWe examined risks of stillbirth, infant mortality, cerebral palsy (CP) and epilepsy among low‐risk pregnancies.MethodsIn this population‐based Swedish study, we identified, from 1998 to 2019, 1,773,269 singleton infants born between 37 and 42 completed weeks in women with low‐risk pregnancies. Poisson log‐linear regression models were used to examine the association between gestational age at delivery and stillbirth, infant mortality, CP and epilepsy. Adjusted rate ratios (RR) and 95% confidence intervals expressing the effect of birth at a particular gestational week compared with birth at a later gestational week were estimated.ResultsCompared with those born at a later gestation, RRs for stillbirth and infant mortality were higher among births at 37 weeks' and 38 weeks' gestation. The RRs for infant mortality were approximately 20% and 25% lower among births at 40 or 41 weeks compared with those born at later gestation, respectively. Infants born at 37 and 38 weeks also had higher RRs for CP (vs infants born at ≥38 and ≥39 weeks, respectively), while those born at 39 gestation had similar RRs (vs infants born at ≥40 weeks); infants born at 40 and 41 weeks had lower RRs of CP (vs those born at ≥41 and 42 weeks, respectively). The RRs for epilepsy were higher in those born at 37 and 38 weeks compared with those born at later gestation.ConclusionsAmong low‐risk pregnancies, birth at 37 or 38 completed weeks' gestation is associated with increased risks of stillbirth, infant mortality and neurological morbidity, while birth at 39–40 completed weeks is associated with reduced risks compared with births at later gestation.

Intrapartum fetal heart rate monitoring and offspring long-term neurological health

Although some evidence suggests that intrapartum fetal heart rate (FHR) monitoring is associated with a reduction in intrapartum death, a reduction in long-term neurological impairment or cerebral palsy (CP) has not been proven. However, continuous intrapartum FHR monitoring resulted in more cesarean deliveries (CDs) for abnormal FHR patterns. In this study, we sought to evaluate offspring long-term neurological morbidity of children born via CD for non-reassuring FHR (NRFHR) indication as compared with non-progressive labor (NPL)

Destructive hypoxic-ischemic brain injury in full-term infants with normothermia and hypothermia

Background. Despite the achievements of neonatology, severe asphyxia at birth and hypoxic-ischemic encephalopathy in full-term infants are still associated with high lethality, long-term neurological morbidity and disability. In the algorithm for the ma­nagement of children with hypoxic-ischemic encephalopathy, it is important to use methods of additional examinations, including ultrasound examination of the brain (neurosonography), its potential for the early evaluation of the severity of the brain tissue injury using therapeutic hypothermia. Thus, the aim of the research was to determine the effect of therapeutic hypothermia on the severity of neurosonographic signs of destructive hypoxic-ischemic brain injury in full-term newborns. Materials and methods. Data were analyzed for 50 full-term neonates with severe asphyxiation and signs of destructive hypoxic-ischemic brain injury. The first group (hypothermia group 1) included 12 newborn infants who were treated with hypothermia in 2014–2016. The second group (hypothermia group 2) — 14 children with severe asphyxiation who were treated with hypothermia in 2011–2013. The third group (group of normothermia) consisted of 24 full-term babies born in 2009–2010, with no therapeutic hypothermia. Results. The share of the most severe destructive brain injuries (diffuse ischemic lesions) was 33.3 % in the first group, 35.7 % in the second group and 45.8 % in the third group. Significant differences between groups in terms of the frequency of diffuse ischemic brain injures were not found. In general, in the structure of destructive hypoxic-ischemic brain injuries in newborns after hypothermia, diffuse ischemic lesions were detected in 34.6 % of cases (non-significant differences with the group of normothermia, p = 0.385 according to Fisher’s criterion calculations). When studying the indicators of cerebral blood flow, reliable differences were found for the index of resistance of the anterior cerebral artery on the third day of life (0.53 ± 0.05 for normothermia group and 0.65 ± 0.04 for hypothermia group). Conclusions. Despite the reduction in the proportion of the most severe diffuse ischemic brain injuries among the total number of diagnosed destructive hypoxic-ischemic lesions during the introduction of hypothermia, the statistical analysis did not reveal any significant differences between the groups. After all, the development of diffuse ischemic brain injuries, first of all, is due to primary asphyxia lesions that lead to global deaths of neurons, or by these injuries, the phase of the therapeutic window in which ended up at the time of birth. But significant differences in the parameters of cerebral hemodynamics prove the fact that the potential of therapeutic hypothermia for the prevention of secondary reperfusion injury remains in these cases.

Maternal Systemic Lupus Erythematosus (SLE) High Risk for Preterm Delivery and Not for Long-Term Neurological Morbidity of the Offspring.

Objective: Pregnancies of women with systemic lupus erythematosus (SLE) are associated with preterm delivery. As preterm delivery is associated with long-term neurological morbidity, we opted to evaluate the long-term neurologic outcomes of offspring born to mothers with SLE regardless of gestational age. Methods: Perinatal outcomes and long-term neurological disease of children of women with and without SLE during pregnancy were evaluated. Children of women with and without SLE were followed until 18 years of age for neurological diseases. Generalized estimating equation (GEE) models were used to assess perinatal outcomes. To compare cumulative neurological morbidity incidence a Kaplan–Meier survival curve was used, and a Cox proportional hazards model was used to control for confounders. Result: A total of 243,682 deliveries were included, of which 100 (0.041%) were of women with SLE. Using a GEE model, maternal SLE was noted as an independent risk factor for preterm delivery. The cumulative incidence of long-term neurological disease was not found to be significantly higher when using the Kaplan Meier survival curves and maternal SLE was not found to be associated with long-term neurological disease of the offspring when a Cox model was used. Conclusion: Despite the association of SLE with preterm delivery, no difference in long-term neurological disease was found among children of women with or without SLE.

Identifying the Critical Threshold for Long-Term Pediatric Neurological Hospitalizations of the Offspring in Preterm Delivery.

We opted to investigate whether a critical threshold exists for long-term pediatric neurological morbidity, and cerebral palsy (CP), in preterm delivery, via a population-based cohort analysis. Four study groups were classified according to their gestational age at birth: 24–27.6, 28–31.6, 32–36.6 weeks and term deliveries, evaluating the incidence of long-term hospitalizations of the offspring due to neurological morbidity. Cox proportional hazard models were performed to control for confounders. A Kaplan–Meier survival curve was used to compare the cumulative neurological morbidity incidence for each group. A total of 220,563 deliveries were included: 0.1% (118) occurred at 24–27.6 weeks of gestation, 0.4% (776) occurred at 28–31.6 weeks of gestation, 6% (13,308) occurred at 32–36.6 weeks of gestation and 93% (206,361) at term. In a Cox model, while adjusting for confounders, delivery before 25 weeks had a 3.9-fold risk for long-term neurological morbidity (adjusted HR (hazard ratio) = 3.9, 95% CI (confidence interval) 2.3–6.6; p < 0.001). The Kaplan–Meier survival curve demonstrated a linear association between long-term neurological morbidity and decreasing gestational age. In a second Cox model, adjusted for confounders, infants born before 25 weeks of gestation had increased rates of CP (adjusted HR = 62.495% CI 25.6–152.4; p < 0.001). In our population, the critical cut-off for long-term neurological complications is delivery before 25 weeks gestation.