Abstract
AimTo study whether early intervention services (EI) and a follow-up program (FU) influence outcomes of children with cerebral palsy (CP) in Moldova.MethodsRecords from 351 children with CP in Moldova born during 2009 and 2010 were retrieved from hospital and orphanage archives between 1 July 2016 and 30 September 2017. We investigated the proportion enrolled in EI and FU at the Early Intervention Centre Voinicel and at the Institute of Mother and Child in 2009–2012. Logistic regression analyses were applied to calculate crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) for outcomes in children enrolled and not enrolled.ResultsAmong all children with CP, 166 (47%) were enrolled in EI and FU. Of the 51 children born extremely preterm (gestational age ≤ 31 weeks), 46 (90%) were enrolled, compared to 97 (39%) of the 250 children born at term. Among 110 non-walking children with CP, 82 (74%) were enrolled into EI and FU, compared to 84 (35%) of 241 able to walk.There was no difference in outcomes of cognition, communication, vision and hearing impairments between those enrolled or not enrolled in EI and FU. However, the subgroup analyses showed that the risk of contractures was 11 times higher among non-walking children who were not enrolled in EI and FU programs (OR = 10.931, 95% CI 2.328–51.328, p = 0.002).ConclusionIn Moldova, EI and FU seem to be offered mostly to extremely preterm and non-walking children with CP. The results indicate a decreased risk for contractures in these children.
Highlights
Cerebral palsy (CP) is an umbrella term covering disorders of movement and posture, leading to activity limitations, caused by non-progressive lesions or malformations in the immature brain [1]
Eligible for inclusion in this comparative crosssectional study were children with CP enrolled in follow-up program (FU) from 2009 to 2012 at the National Hospital Institute of Mother and Child, children enrolled in early intervention (EI) at Centre of Early Intervention (CEI) Voinicel, and children with CP not enrolled in rehabilitation programs, born between 1 January 2009 and 31 December 2010 (Fig. 1)
Among the 166 children enrolled in EI and/or FU programs, 84 (35%) children were classified at Gross Motor Function Classification System (GMFCS) levels I–III, compared to 157 (65%) of the children who had no intervention
Summary
Cerebral palsy (CP) is an umbrella term covering disorders of movement and posture, leading to activity limitations, caused by non-progressive lesions or malformations in the immature brain [1]. Among clinicians in paediatric rehabilitation, a general consensus is that children with lesions of the central nervous system should receive rehabilitation interventions as soon as possible, due to the rapid brain development during early life [4]. Clinicians and researchers share a common goal to enhance development of function and prevent known secondary complications in as many developmental. Bufteac et al BMC Pediatrics (2020) 20:29 areas as possible in children at risk of CP, or already diagnosed with CP These services are called early intervention (EI). The Early Intervention Handbook [5] defines it as “multidisciplinary services provided to children from birth to five years of age to promote child health and well-being, enhance emerging competencies, minimise developmental delays, remediate existing or emerging disabilities, prevent functional deterioration and promote adaptive parenting and overall family function”
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