Cerebral Palsy in Low‐birthweight Infants. I. Spastic Hemiplegia: Associations With Intrapartum Stress

Abstract

Children with and without spastic hemiplegia were identified among a representative sample of 1048 low-birthweight survivors by clinical assessment after three years of age. The hypothesis that hemiplegia was predetermined at birth was tested by estimating the probability of hemiplegia for each infant by logistic regression analysis, using data from hospital records on conditions known at the time of birth. 16 of 42 children with cerebral palsy had spastic hemiplegia. Allowing for the lower birthweights of hemiplegic children, increased prevalence was associated with previous reproductive loss, breech vaginal delivery, later birth-order, prolonged second stage of delivery, emergency caesarean section, and low Apgar scores. These variables identified correctly most children as having a higher or lower estimated probability of hemiplegia. Hemiplegia was also associated with prolonged respiratory disease and intraventricular haemorrhage. In this population it is likely that intrapartum events were closely related to the pathogenesis of hemiplegia; their effects may have been mediated by postnatal events.

Cerebral palsy: Evaluation of a model of risk

“…Low 5-min APGAR scores, an indicator of fetal distress, were also found to be a risk factor for CP. This finding is consistent with existing literature that supports a predictive relationship between low APGAR scores and CP development (Jonas et al, 1989;Nelson & Ellenberg, 1985;Powell et al, 1988a). Intrapartum hypoxia, reflected in low APGAR scores, has been posited to contribute to the development of CP (Blair & Stanley, 1990).…”

“…The link between parental occupation (occupational exposures) and CP has not been extensively explored. Laborers were found to have higher rates of spastic diplegic offspring (Atkinson & Stanley, 1983) and parents in nonmanual occupations more likely to have hemiplegic offspring (Powell et al, 1988a(Powell et al, , 1988b. In the only study reported to date in which the role of environmental exposures in development of CP was addressed, Hosking et al (1985) found no differ-ences in exposures between case and control mothers; however, they did not report the nature of the environmental contaminants assessed and exposure histories were taken as long as 12 years after the birth of the child.…”

Birthweight specific trends in cerebral palsy.

“…It was concluded that factors that influence the rate of fetal development may be implicated in the aetiology of diplegia.26 In contrast, variables known at the time of birth were able to identify most cases of hemiplegia and it was concluded that intrapartum events were closely related to the pathogenesis of hemiplegia though these effects may have been mediated by postnatal events. 27 If the increase in prevalence of diplegia in very low birthweight infants in the 1970s is the result of better survival of prenatally impaired infants, the decline in prevalence in the 1980s needs explaining. In a survey in Scotland a difference in prevalence between preschool and school aged children was attributed to more cases coming to light as a result of the greater demands placed on the child in the early school years.28 One possible explanation, therefore, is that there has been an incomplete registration of the youngest children, which will be made more complete should the survey continue.…”

Are there critical periods for brain growth in children born preterm?

“…Details of these assessments have been published. [15][16][17][18][19][20] For the purposes of this study, by measuring the head circumference in these children at birth, near term at discharge, and at 4 and 15 years of age, four periods of growth could be examined: antenatal, immediate postnatal, infancy, and early childhood. The occipitofrontal circumference (OFC) was extracted from the clinical record for each time point and converted into a standard deviation score (z score) taking in to account the sex and age at the time of measurement.…”