Cerebral palsy in preterm infants

Čila Demeši Drljan; Aleksandra Mikov; Karmela FilipoviĆ; SneŽana TomaŠeviĆ TodoroviĆ; Aleksandar KneŽeviĆ; Rastislava Krasnik

doi:10.2298/5756

Čila Demeši Drljan Institute for Children and Youth Health Care of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Aleksandra Mikov Institute for Children and Youth Health Care of Vojvodina, Novi Sad, Serbia
Karmela FilipoviĆ Special Hospital for Rheumathic Diseases,Novi Sad, Serbia
SneŽana TomaŠeviĆ TodoroviĆ Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Aleksandar KneŽeviĆ Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Rastislava Krasnik Institute for Children and Youth Health Care of Vojvodina, Novi Sad, Serbia

DOI: https://doi.org/10.2298/5756

Keywords: Cerebral palsy, risk factors, infant, premature,

Abstract

Background/Aim. Cerebral palsy (CP) is one of the leading causes of neurological impairment in childhood. Preterm birth is a significant risk factor in the occurrence of CP. Clinical outcomes may include impairment of gross motor function and intellectual abilities, visual impairment and epilepsy. The aim of this study was to examine the relationships among gestational age, type of CP, functional ability and associated conditions. Methods. The sample size was 206 children with CP. The data were obtained from medical records and included gestational age at birth, clinical characteristics of CP and associated conditions. Clinical CP type was determined according to Surveillance of Cerebral Palsy in Europe (SCPE) and topographically. Gross motor function abilities were evaluated according to the Gross Motor Function Classification System (GMFCS). Results. More than half of the children with CP were born prematurely (54.4%). Statistically significant difference was noted with respect to the distribution of various clinical types of CP in relation to gestational age (p < 0.001). In the group with spastic bilateral CP type, there is a greater proportion of children born preterm. Statistically significant difference was noted in the functional classification based on GMFCS in terms of gestational age (p = 0.049), children born at earlier gestational age are classified at a higher GMFCS level of functional limitation. The greatest percentage of children (70.0%) affected by two or more associated conditions was found in the group that had extremely preterm birth, and that number declined with increasing maturity at birth. Epilepsy was more prevalent in children born at greater gestational age, and this difference in distribution was statistically significant (p = 0.032). Conclusion. The application of antenatal and postnatal protection of preterm children should be a significant component of the CP prevention strategy.

Author Biographies

Čila Demeši Drljan, Institute for Children and Youth Health Care of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia

Docent

Aleksandra Mikov, Institute for Children and Youth Health Care of Vojvodina, Novi Sad, Serbia

Profesor

Karmela FilipoviĆ, Special Hospital for Rheumathic Diseases,Novi Sad, Serbia

Asistent

SneŽana TomaŠeviĆ TodoroviĆ, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia

Docent

Aleksandar KneŽeviĆ, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia

Asistent

Rastislava Krasnik, Institute for Children and Youth Health Care of Vojvodina, Novi Sad, Serbia

Asistent

References

Stelmach T, Pisarev H, Talvik T. Ante- and perinatal factors for cerebral palsy: case-control study in Estonia. J Child Neurol 2005; 20(8): 654−60.

Himmelmann K, Hagberg G, Wiklund LM, Eek MN, Uvebrant P. Dyskinetic cerebral palsy: a population-based study of children born between 1991 and 1998. Dev Med Child Neurol 2007; 49(4): 246−51.

Winter S, Autry A, Boyle C, Yeargin-Allsopp M. Trends in the prevalence of cerebral palsy in a population-based study. Pediatrics 2002; 110(6): 1220−5.

Pakula AT, Van Braun NK, Yeargin-Allsopp M. Cerebral palsy: classification and epidemiology. Phys Med Rehabil Clin N Am 2009; 20(3): 425−52.

Serdaroğlu A, Cansu A, Ozkan S, Tezcan S. Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Dev Med Child Neurol 2006; 48(6): 413−6.

Dolk H, Parkes J, Hill N. Trends in the prevalence of cerebral palsy in Northern Ireland, 1981-1997. Dev Med Child Neurol 2006; 48(6): 406−12.

O'Callaghan ME, MacLennan AH, Gibson CS, McMichael GL, Haan EA, Broadbent JL, et al. Epidemiologic associations with cerebral palsy. Obstet Gynecol 2011; 118(3): 576−82.

Colvin M, McGuire W, Fowlie PW. Neurodevelopmental out-comes after preterm birth. BMJ 2004; 329(7479): 1390−3.

Venkateswaran S, Shevell MI. Comorbidities and clinical deter-minants of outcome in children with spastic quadriplegic cere-bral palsy. Dev Med Child Neurol 2008; 50(3): 216−22.

Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 2005; 47(8): 571−6.

Palisano RJ, Cameron D, Rosenbaum PL, Walter SD, Russell D. Stability of the Gross Motor Function Classification System. Dev Med Child Neurol 2006; 48(6): 424−8.

Bonellie SR, Currie D, Chalmers J. Comparison of risk factors for cerebral palsy in twins and singletons. Dev Med Child Neurol 2005; 47(9): 587−91.

Thorngren-Jerneck K, Herbst A. Perinatal factors associated with cerebral palsy in children born in Sweden. Obstet Gynecol 2006; 108(6): 1499−505.

Himpens E, van den Broeck C, Oostra A, Calders P, Vanhaesebrouck P. Prevalence, type, distribution, and severity of cerebral palsy in relation to gestational age: a meta-analytic review. Dev Med Child Neurol 2008; 50(5): 334−40.

Hoon AH, Stashinko EE, Nagae LM, Lin DD, Keller J, Bastian A, et al. Sensory and motor deficits in children with cerebral palsy born preterm correlate with diffusion tensor imaging abnor-malities in thalamocortical pathways. Dev Med Child Neurol 2009; 51(9): 697−704.

Marret S, Zupan V, Gressens P, Lagercrantz H, Evrard P. Periven-tricular leukomalacia. I. Histological and pathophysiological aspects. Arch Pediatr 1998; 5(5): 525−37.

Sigurdardóttir S, Thórkelsson T, Halldórsdóttir M, Thorarensen O, Vik T. Trends in prevalence and characteristics of cerebral palsy among Icelandic children born 1990 to 2003. Dev Med Child Neurol 2009; 51(5): 356−63.

Andersen GL, Irgens LM, Haagaas I, Skranes JS, Meberg AE, Vik T. Cerebral palsy in Norway: prevalence, subtypes and severity. Eur J Paediatr Neurol 2008; 12(1): 4−13.

Himmelman K. Cerebral Palsy in Western Sweden-Epidemiology and Function. Sweden: The Sahlgrenska Academy at Goteborg University; 2006.

Beckung E, Carlsson G, Carlsdotter S, Uvebrant P. The natural his-tory of gross motor development in children with cerebral palsy aged 1 to 15 years. Dev Med Child Neurol 2007; 49(10): 751−6.

Voorman JM, Dallmeijer AJ, Knol DL, Lankhorst GJ, Becher JG. Prospective longitudinal study of gross motor function in children with cerebral palsy. Arch Phys Med Rehabil 2007; 88(7): 871−6.

Caram LH, Funayama CA, Spina CI, Giuliani Ld, de Pina NJM. Investigation of neurodevelopment delay etiology: re-sources and challenges. Arq Neuropsiquiatr 2006; 64(2B): 466−72.

Pfeifer LI, Silva DB, Funayama CA, Santos JL. Classification of cerebral palsy: association between gender, age, motor type, topography and Gross Motor Function. Arq Neuropsiquiatr 2009; 67(4): 1057−61.

Himmelmann K, Beckung E, Hagberg G, Uvebrant P. Gross and fine motor function and accompanying impairments in cere-bral palsy. Dev Med Child Neurol 2006; 48(6): 417−23.

Howard J, Soo B, Graham KH, Boyd RN, Reid S, Lanigan A, et al. Cerebral palsy in Victoria: Motor types, topography and gross motor function. J Paediatr Child Health 2005; 41(9−10): 479−83.

Laptook AR, O'Shea MT, Shankaran S, Bhaskar B. Adverse neu-rodevelopmental outcomes among extremely low birth weight infants with a normal head ultrasound: prevalence and antece-dents. Pediatrics 2005; 115(3): 673−80.

Marlow N, Wolke D, Bracewell MA, Samara M. Neurologic and developmental disability at six years of age after extremely pre-term birth. N Engl J Med 2005; 352(1): 9−19.

Mongan D, Dunne K, O'Nuallain S, Gaffney G. Prevalence of ce-rebral palsy in the West of Ireland 1990-1999. Dev Med Child Neurol 2006; 48(11): 892−5.

Beckung E, Hagberg G, Uldall P, Cans C. Surveillance of Cerebral Palsy in Europe. Probability of walking in children with cere-bral palsy in Europe. Pediatrics 2008; 121(1): e187−92.

Sigurdardottir S, Eiriksdottir A, Gunnarsdottir E, Meintema M, Ar-nadottir U, Vik T. Cognitive profile in young Icelandic children with cerebral palsy. Dev Med Child Neurol 2008; 50(5): 357−62.

Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil 2006; 28(4): 183−91.

Pennefather PM, Tin W. Ocular abnormalities associated with ce-rebral palsy after preterm birth. Eye (Lond) 2000; 14(Pt 1): 78−81.