Risk Factors For Cerebral Palsy Research Articles

Etiology, outcomes and co-morbidities among cerebral palsy children attending tertiary care hospital, India: a prospective study

Background: Cerebral palsy is the most common aetiology for motor dysfunction among children worldwide. It is associated with range of co-morbid conditions that affects the quality of life. Cerebral palsy has been studied extensively in western countries and there are only few articles available on epidemiological information in developing countries and low resource settings. This study focuses on the aetiology, risk factors, types and co-morbidities in cerebral palsy.Methods: Cerebral palsy children attending tertiary care hospital were prospectively recruited into the study. The study was conducted during January 2017 to July 2018. The cross-sectional study included complete prenatal, natal and postnatal history of the participants, BERA and Ophthalmological examinations were done.Results: One hundred and fifty children with cerebral palsy were enrolled. The mean age of participants were 36±30 months. Male to female ratio was 2.19:1. The most common maternal risk factor among study participants was consanguinity in marriage (23.33%). 16% had prolonged labour and 10% had toxaemia during pregnancy. 47% of the children were born by institutional normal vaginal delivery. The most common neonatal risk factor was Birth Asphyxia (23%), low birth weight (20%) and neonatal sepsis (21%). 122 had spastic type of cerebral palsy. The most common morbidity associated with cerebral palsy was Gastro intestinal disturbances in 61% of the participants.Conclusions: History of prolonged labour and birth asphyxia were risk factors for cerebral palsy. Spastic CP is the most common type. Malnutrition, Gross Motor delay, Seizures, Mental retardation were the most common morbidities associated with CP.

Cerebral palsy among children of immigrants in Denmark and the role of socioeconomic status.

Children of immigrants in Denmark have excess risk for some of the most well-established risk factors for cerebral palsy (CP). To study differences in risk of CP between children of immigrants and children of Danish-born mothers, and explore whether socioeconomic status drives any potential association. A register-based cohort study including 1,274,616 children born in Denmark between 1981 and 2007. Of these, 2807 had a validated CP diagnosis in the Danish CP Register. We estimated the risk of CP as odds ratios (OR) using logistic regression and assessed mediation through socioeconomic status using natural effect models. In children of Danish-born mothers, 2.2/1000 had CP overall and the prevalence was similar for children of immigrants. However, children of immigrants had lower risk of unilateral spastic CP than children of Danish native-born mothers; OR=0.59 (95% CI:0.38-0.91) for Western and OR=0.79 (95% CI:0.61-1.03) for Non-Western immigrants. By contrast, the risk of bilateral spastic CP was higher in children of Non-Western immigrants (OR=1.27 (95% CI:1.05-1.53)), especially from Turkey and Pakistan compared with children of Danish native-born mothers. The mediation analysis revealed an indirect effect (through maternal educational level and household income) with an OR of 1.06 (95% CI:0.99-1.14) for children of Non-Western immigrants. While children of immigrants had lower risk of unilateral spastic CP than children of Danish-born mothers, the risk of bilateral spastic CP was increased in children of Non-Western immigrants. Socioeconomic status did not appear to be a significant contributor to the increased risk of bilateral spastic CP.

Causal role of group B Streptococcus-induced acute chorioamnionitis in intrauterine growth retardation and cerebral palsy-like impairments.

Chorioamnionitis and intrauterine growth retardation (IUGR) are risk factors for cerebral palsy (CP). Common bacteria isolated in chorioamnionitis include group B Streptococcus (GBS) serotypes Ia and III. Little is known about the impact of placental inflammation induced by different bacteria, including different GBS strains. We aimed to test the impact of chorioamnionitis induced by two common GBS serotypes (GBSIa and GBSIII) on growth and neuromotor outcomes in the progeny. Dams were exposed at the end of gestation to either saline, inactivated GBSIa or GBSIII. Inactivated GBS bacteria invaded placentas and triggered a chorioamnionitis featured by massive polymorphonuclear cell infiltrations. Offspring exposed to GBSIII - but not to GBSIa - developed IUGR, persisting beyond adolescent age. Male rats in utero exposed to GBSIII traveled a lower distance in the Open Field test, which was correlating with their level of IUGR. GBSIII-exposed rats presented decreased startle responses to acoustic stimuli beyond adolescent age. GBS-exposed rats displayed a dysmyelinated white matter in the corpus callosum adjacent to thinner primary motor cortices. A decreased density of microglial cells was detected in the mature corpus callosum of GBSIII-exposed males - but not females - which was correlating positively with the primary motor cortex thickness. Altogether, our results demonstrate a causal link between pathogen-induced acute chorioamnionitis and (1) IUGR, (2) serotype- and sex-specific neuromotor impairments and (3) abnormal development of primary motor cortices, dysmyelinated white matter and decreased density of microglial cells.

Paediatric cerebral palsy prevalence and high-risk factors in Henan province, Central China.

To evaluate the prevalence of, and risk factors for, cerebral palsy in Henan province, China. The prevalence of cerebral palsy in children aged 0-6 years between September 2011 and September 2012 was investigated using a stratified-clustered-random sampling method. An age-, sex- , and residence-matched control group of typically developing children was recruited. Univariate analysis and multinomial logistic regression analysis were used to identify risk factors associated with cerebral palsy. The prevalence of cerebral palsy in Henan province was 2.37 per 1,000 live births. Risk factors included: moving into a newly painted room; complicating maternal diseases (infection, heart disease, hypertension, anaemia, diabetes, kidney disease) during pregnancy; high gravidity (> 3); foetal asphyxia; low birth-weight (< 2,500g); and hypoxic-ischaemic encephalopathy. The prevalence of cerebral palsy in Henan province was 2.37 per 1,000 live births. Parents and clinicians should be aware of the risk factors for cerebral palsy.

Risk of cerebral palsy by gestational age among pregnancies at-risk for preterm birth

Objective: Our objective was to describe cerebral palsy (CP) incidence stratified by gestational age (GA) groups within a group at risk for spontaneous preterm birth (sPTB).Study design: This is a secondary analysis of a large study of magnesium for neuroprotection. Nonanomalous, singleton gestations complicated by preterm premature rupture of membranes (PPROM) or preterm labor (PTL) were included. Infants that developed CP were compared to controls that did not. The incidence of CP was stratified by GA groups. A logistic regression model was fit to adjust for confounders.Results: Of 1747 included pregnancies, 75 (4.3%) were affected by CP. Increasing GA at delivery was associated with lower rates of CP (RR 0.96, 95% CI 0.95–0.97; p<.0001). The most significant risk factor for CP was neonatal sepsis while the most significant protective factors were magnesium and antibiotic exposure. In the adjusted analysis, magnesium exposure (aRR 0.52, 95% CI 0.33–0.84; p = .007) and antibiotic exposure (aRR 0.52, 95% CI 0.28–0.95; p = .034) remained protective.Conclusion: The risk of CP among populations at high risk for sPTB decreases with advancing GA. While the majority of cases of CP occurred in children born <34 weeks, residual risk persisted thereafter. The effect of magnesium exposure is most pronounced before 28 weeks.

Risk management and provider liabilities in infantile cerebral palsy based on malpractice litigation cases

AimInfantile cerebral palsy (CP) severely affects the survival and quality of life of infants. CP is typically caused by multiple factors, leading to causal uncertainty of the role of medical errors in CP and resulting in frequent medical disputes. No relevant research exists on risk management and malpractice liabilities in CP, including in China. MethodA retrospective analysis of 400 CP malpractice litigation cases from 18th June 1999 to 23rd November 2017, collected from China Judgments Online, included basic case information, CP risk factors, medical errors, medical malpractice liability determination, and compensation. ResultsUp to 63.5% of infants with CP were affected by asphyxia, followed by hypoxic-ischemic encephalopathy (63.3%), neonatal infection (52.3%) and intracranial hemorrhage (36.0%). Most (89.1%) of civil judgments resulted in liability for medical errors, with the highest proportion of ultimate liability. The three most frequent medical errors were failure of completing delivery in time (30.2%), incomplete assessment of birth process detection (28.8%), and nonstandard medical records (25.3%). Each case involved 2.5 medical errors on average. No difference in the distribution of medical errors between premature and full-term CP infants (P > 0.05) was found. Compensation for damage was awarded in 91.4% of claims, and the mean value of compensation was $73,506. The mean value of the total actual loss of the family was $128,198. InterpretationContradictions between the doctors and patients were prominent in malpractice CP litigation cases, with a total loss of $3.97 billion attributable to new CP cases in China in 2017. Asphyxia was the most frequent risk factor for CP since it may easily draw the attention of the sufferer's family. Medical service providers did not pay attention to risk management in preterm infants. The importance of fetal monitoring and standardized medical record writing should be emphasized.

Epidemiology of cerebral palsy in Bangladesh: a population-based surveillance study.

To examine the prevalence, clinical characteristics, and risk factors of cerebral palsy (CP) in children in Bangladesh. The Bangladesh CP Register is an ongoing population-based surveillance database of children with CP from a geographically defined area in Bangladesh. Cases were defined based on Surveillance of CP in Europe and Australian CP Register criteria after clinical assessments and identification by the key informant's method. In total, 726 children with CP were identified between January 2015 and December 2016. Mean age was 7 years 7 months (standard deviation [SD] 4y 6mo; range: 4.8mo-18y; median 7y 1.2mo; 61.8% male, 38.2% female). Mean age at CP diagnosis was 5 years 2 months (SD 3.8). Observed prevalence was 3.4 per 1000 children (95% confidence interval [CI]: 3.2-3.7), resulting in an estimated 233 514 children (95% CI: 219 778-254 118) with CP in Bangladesh. The majority (79.6%) had spastic CP. Altogether, 79.6% of the children with CP had at least one associated impairment (speech 67.6%, intellectual 39.0%, epilepsy 23.7%, visual 10.2%, and hearing 10.2%). In total, 78.2% never received rehabilitation. In Bangladesh, the burden of CP is high, and diagnosis is substantially delayed, limiting opportunities for early intervention. There is a lack of available services and the majority of the children had preventable risk factors. Prevalence of cerebral palsy (CP) is 3.4 per 1000 children in rural Bangladesh. There are an estimated 233 514 children with CP in Bangladesh. The majority have potentially preventable risk factors. Diagnosis of CP is delayed, limiting opportunities for early intervention. There is a lack of available services for children with CP in rural Bangladesh.

Variants of the OLIG2 Gene are Associated with Cerebral Palsy in Chinese Han Infants with Hypoxic-Ischemic Encephalopathy.

Cerebral palsy (CP) is a leading cause of neurological disability among young children. Congenial and adverse perinatal clinical conditions, such as genetic factors, perinatal infection, and asphyxia, are risk factors for CP. Oligodendrocyte transcription factor (OLIG2) is a protein that is expressed in brain oligodendrocyte cells and is involved in neuron repair after brain injury. In this study, we employed a Chinese Han cohort of 763 CP infants and 738 healthy controls to study the association of OLIG2 gene polymorphisms with CP. We found marginal association of the SNP rs6517135 with CP (p = 0.044) at the genotype level, and the association was greatly strengthened when we focused on the subgroup of CP infants who suffered from hypoxic-ischemic encephalopathy (HIE) after birth, with p = 0.003 (OR = 0.558) at the allele level and p = 0.007 at the genotype level, indicating a risk-associated role of the T allele of the SNP rs6517135 under HIE conditions. The haplotype CTTG for rs6517135-rs1005573-rs6517137-rs9653711 in OLIG2 was also significantly associated with the occurrence of CP in infants with HIE (p = 0.01, OR = 0.521). Our results indicate that in the Han Chinese population, the polymorphisms of OLIG2 were associated with CP, especially in patients who had suffered HIE injury. This finding could be used to develop personalized care for infants with high susceptibility to CP.

Association between bronchopulmonary dysplasia and cerebral palsy in children: a meta-analysis

ObjectiveTo investigate the association between bronchopulmonary dysplasia (BPD) and the risk of cerebral palsy (CP) in children.Data sourcesWe used EMBASE, PubMed and Web of Science to conduct a meta-analysis of...

Neonatal risk factors in cerebral palsy

Cerebral palsy (CP) is a movement disorder caused by damage to the developing brain. It affects patient self-help, creates family problems, and increases care costs. CP has many risk factors, although the trigger is often unclear, resulting in treatment delays and permanent complications. To improve monitoring and early diagnosis, a study to establish total risk factors for predicting cerebral palsy in the neonate is a useful study especially for patients in small hospitals who do not have specialized doctors. A case-control study of CP risk factors in neonate, born at Thammasat University Hospital, Thailand from 2005 to 2014. Using multivariable logistic regression, neonatal and maternal characteristics, as well as prenatal, perinatal and postnatal risks, were compared in normal children (control) and patients diagnosed with CP (case). These risks and evidence of difference ( P -value) are in Table 1 and Table 2 ; CP independent risk is in Table 3 . Cerebral and non-cerebral malformation, small for gestational age, preterm, multifetal gestation, neonatal jaundice, and non-congenital infections of neonatal infants were risks, with odds ratio (OR) = 313.03, 16.45, 5.67, 8.45,11.39, 10.99 and 147.87, respectively. Cerebral and non-cerebral malformation, small for gestational age, preterm, multifetal gestation, neonatal jaundice, and non-congenital infections of the neonatal infants were predictive risks. However, low Apgar score, uterine and cord anomalies, neonatal seizure, neonatal encephalopathy, congenital infections, and ventilator use remain questionable with low incidence. Multicenter research to enhance data scope would be useful.

Analysis of Genetic Factors in Children with Cerebral Palsy

Cerebral palsy is a group of permanent limb posture and movement abnormalities caused by certain injuries to fetal or neonatal brain before its growth and development is completed. It is reported abroad that the incidence of cerebral palsy in live births (including full-term and preterm infants) is about 1/500, which is the most common disability disease in children. Despite many epidemiological studies, the cause of the epidemic has not yet been identified, because cerebral palsy is a complex group of symptoms, rather than a simple disease which is usually diagnosed clinically around the age of one. Some severe complications during pregnancy, such as placental abruption, umbilical cord prolapse, and uterine rupture, significantly increase the risk of cerebral palsy, but in general these factors account for only a small proportion of cerebral palsy. At present, the major risk factors for cerebral palsy widely known at home and abroad are preterm infants, intrauterine infections or maternal fever at birth, ischemic stroke, congenital malformations, fetal intrauterine abnormal growth, and multiple pregnancies. In addition, a great deal of evidence suggests that although genetic factors are not the primary cause of cerebral palsy, they may increase genetic susceptibility to cerebral palsy. Any kind of pathogenic factor reaching a certain degree of severity may cause cerebral palsy. But more often than not, multiple risk factors jointly destroy the body's defense mechanism and eventually lead to cerebral palsy.

Neonatal interventions for preventing cerebral palsy: an overview of Cochrane Systematic Reviews.

This is a protocol for a Cochrane Review (Overview). The objectives are as follows: The primary objective of this overview is to summarise the evidence from Cochrane systematic reviews regarding the effects of neonatal interventions for preventing cerebral palsy (reducing cerebral palsy risk). A secondary objective of this overview is to summarise any evidence identified from Cochrane systematic reviews regarding the effects of neonatal interventions that increase cerebral palsy.

Causes of Cerebral Palsy in Sulaimani

Background and objectives:Cerebral palsy is a common neurodevelopmental condition encountered by pediatricians The condition may present itself in many different clinical spectra. The etiological and risk factors are many and an awareness of the interplay of multiple factors in the causation of cerebral palsy is crucial. The aim of the study is to evaluate the risk factors of cerebral palsy in Sulaimani city. A better understanding of the etiology of cerebral palsy is necessary for preventive strategies and treatments to be developed. Methods:This is a retrospective case control study including 100 cerebral palsy patients; data were taken from the records of rehabilitation center in Sulaimani city from 1st Jan 2017 up to 1st- Sep 2017and 100 control group of the same age admitted in our hospital. Results: One hundred cases of CP (52% male) and (48% female) were collected ,their mean age was 1.64 years and standard deviation (.52262) ,the risk factors of the cerebral palsy were birth asphyxia , prematurity , unknown cause ,and jaun- dice were (31 % , 26 %, 17%, 11% ,) respectively. There was a significant difference between control and cerebral palsy groups regarding (birth asphyxia, prematurity, pregnancy induced hypertension and jaundice). Conclusions: Birth asphyxia was identified as a major cause of cerebral palsy in Sulaimani city according to our study followed by prematurity as a second risk factor of cerebral palsy.

Detection of Risk Factor Interactions in Cerebral Palsy Using Statistical Methods

Background The interaction of the risk factors is an important focus in medical study. The etiology of CP is multi-factorial and usually arises from a series of causal pathways.Objectives The aim of this study was to compare four statistical methods to detect the interactions of risk factors of cerebral palsy (CP).Methods In this cross-sectional study, 225 children aged 1 - 6 years were studied during 2008 and 2009 in Tehran, Iran. Penalized logistic regression (PLR), multifactor dimensionality reduction (MDR), logic regression (LR) and classification regression (CR) methods were used to detect interactions.Results There was an interaction between the consanguinity factor and gender, asphyxia, preterm delivery, vaginal delivery, previous pregnancies, history of pregnancy, history of illness, sepsis, and small for gestational age (SGA). The methods used in this study were detect two-way (6 terms), three-way (11 terms) and four-way (2 terms) interaction terms. Of these interactions, asphyxia × consanguinity interaction was detected by MDR, LR, and CR methods.Conclusions Our findings showed that the consanguinity factor had an interaction with most of the risk factors and especially consanguinity × asphyxia term was detected in all methods. So this interaction term is very important for considering by clinicians.

Risk factors and the occurrence of cerebral palsy in high risk infants

Background The incidence of cerebral palsy (CP) has increased due to better survival rates of high-risk babies. Early detection and time to the occurrence of CP in the first year of life is important in order to provide early intervention.Objectives To determine the proportion of CP in high-risk babies, the time to the occurrence of CP in the first year, and assess possible associations between risk factors of CP and time to the occurrence of CP.Methods A prospective cohort study was done on 150 high-risk babies up to the age of 12 months. We obtained history of motor ability and assessed primitive reflexes and postural reactions of subjects at the ages of 4 and 6 months. The diagnosis of CP was established at 6 and 12 months of age.Results The proportion of CP was 26% at 6 months and 24% at 12 months of age. Significant risk factors associated with CP at 6 and 12 months of age were cerebral ultrasound abnormalities, hypoxic-ischemic encephalopathy, and intracranial hemorrhage. In 88.7% of subjects with CP, CP was detected in the first 6 months. Mean age at the occurrence of CP was 9.99 months (95%CI 9.46 to 10.53). Risk factors that significantly affected the time to the occurrence of CP by survival analysis were ultrasound abnormalities and hypoxic-ischemic encephalopathy.Conclusions Cerebral palsy can be detected as early as the first 6 months of life. Cerebral ultrasound abnormalities and hypoxic ischemic encephalopathy are the risk factors associated with CP.

Clinical Profile, Associated Co-morbidities and Risk Factors of Cerebral Palsy in Children in Sohag, Egypt

Clinical Profile, Associated Co-morbidities and Risk Factors of Cerebral Palsy in Children in Sohag, Egypt

White Matter Damage in 4,725 Term-Born Infants Is Determined by Head Circumference at Birth: The Missing Link.

Background White matter damage (WMD) is a prime risk factor for cerebral palsy, in part occurring unexplained. Though primarily a problem of preterm infants, there is growing evidence that in large newborns cephalopelvic disproportion and prolonged labor are involved. Objective To explore both incidence of and morphometric risk factors for WMD in term-born infants. Study Design We related growth variables and risk factors of term-born infants to WMD (61/4,725) using odds ratios of z-score bands. Results The key result is the novel observation that head circumference is a prime and unique index for WMD in term-born neonates over the whole range of centiles (U-shaped; WMD (%) = 3.1168–0.12797∗HC (centile) + 0.0014741∗HC2; p < 0.0001). This suggests different mechanisms for WMD in the lowest and highest z-score band. In the latter, cephalic pressure gradients and prolonged labor with preserved neonatal vitality prevail, whereas in the previous one, acute and chronic oxygen deprivation with reduced vitality predominate. Conclusions The fact that seemingly healthy term-born neonates are not screened by head imaging, in spite of both large head circumference and prolonged labor, is considered to be the missing link between the insult that escapes diagnosis and the development of unexplained developmental delay and cerebral palsy in childhood.

Prevalence of Vitamin D Deficiency and Associated Risk Factors in Cerebral Palsy A study in North-West of Iran.

This study aimed to compare the prevalence of 25-hydroxyvitamin D deficiency in cerebral palsied (CP) with healthy control children and evaluate possible correlations between 25-hydroxyvitamin D and severity of CP and motor function. In this case-control study, serum levels of 25-hydroxyvitamin D were evaluated in 65 children with CP and compared with 65 healthy children referred to Tabriz Pediatric Hospital, Tabriz, northwestern Iran in 2015. Blood samples were taken to measure levels of 25-hydroxyvitamin D, calcium, phosphorus and alkaline phosphatase. Regarding 25-hydroxyvitamin D levels, patients were classified as sufficient (≥30 ng/ml), insufficient (20-30 ng/ml) and deficient (<20 ng/ml). Mean 25-hydroxyvitamin D levels were 28.03±24.2 ng/ml in patients and 30±1.94 ng/ml in control group. 25-hydroxyvitamin D deficiency was seen in 44.6% of CP and 18.5% of healthy children. There was no significant difference in 25-hydroxyvitamin D levels between boys and girls, CP types and use of antiepileptics in case group. There was significant negative correlation between age and 25-hydroxyvitamin D levels (P=0.007). The correlation between 25-hydroxyvitamin D and Gross Motor Function Classification System was not significant. 25-hydroxyvitamin D deficiency is common in children with CP in comparison with healthy children. There was significant negative correlation between age and 25-hydroxyvitamin D levels. Routine measurement of 25-hydroxyvitamin D levels and its proper treatment is recommended to prevent its deficiency and subsequent consequences.

A study on maternal and perinatal risk factors of cerebral palsy among children attending a cerebral palsy clinic in Visakhapatnam

Background: Cerebral palsy (CP) is a disorder of movement and posture, defined as an “umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of its development”. Risk factors for CP include maternal infection, placental insufficiency, gestational diabetes, pregnancy induced hypertension, instrumental delivery, low birth weight, hypoxic ischemic injury, hyperbilirubinemia, metabolic abnormalities (hypoglycemia). The families are affected psychologically, financially and socially. It also imposes burden on national health system. The objective of the study was to study the distribution of maternal and perinatal risk factors of cerebral palsy among children attending a cerebral palsy clinic in Visakhapatnam.Methods: A retrospective cohort study was conducted by eliciting history from the mothers of 90 cerebral palsy children who were treated in cerebral palsy clinic, Visakhapatnam, Andhra Pradesh, India for a period of 6 months in 2016. After taking consent, data was collected using a pretested questionnaire. Detailed history was taken from the mothers of 90 cerebral palsy children regarding the period of gestation at which the child was born (preterm or full term), any previous history of pre-term delivery or abortions and neonatal complications was obtained from the care givers. Data was entered into MS-excel sheet and analysed by using SPSS Trial Version 20.Results: Total numbers of study subjects were 90, out of which 58 were boys and 32 were girls. Around 38% of study subjects were born out of consanguineous marriage. As per the records available, only 7% of mothers had gestational diabetes. It was found that 13% study subjects were preterm, 22% had low birth weight, 24% had perinatal hypoglycaemia, 33% had neonatal jaundice and 33% had birth asphyxia.Conclusions: Consanguinity, birth asphyxia, neonatal jaundice are found to be the important risk factors for Cerebral Palsy in our study which can be avoided by improving maternal and paediatric health services.

Protocol for hospital based-surveillance of cerebral palsy (CP) in Hanoi using the Paediatric Active Enhanced Disease Surveillance mechanism (PAEDS-Vietnam): a study towards developing hospital-based disease surveillance in Vietnam

IntroductionThe epidemiology, pathogenesis, management and outcomes of cerebral palsy (CP) in low-income and middle-income countries including Vietnam are unknown because of the lack of mechanisms for standardised collection of data....