Increasing rates of cerebral palsy across the severity spectrum in north-east England 1964-1993

Abstract

Objectives-To report epidemiological trends in cerebral palsy including analyses by severity. Design-Descriptive longitudinal study in north-east England. Every child with suspected cerebral palsy was examined by a developmental paediatrician to confirm the diagnosis. Severity of impact of disability was derived from a parent completed questionnaire already developed and validated for this purpose. Subjects-All children with cerebral palsy, not associated with any known postneonatal insult, born 1964-1993 to mothers resident at the time of birth in the study area. Main outcome measures-Cerebral palsy rates by year, birth weight, and severity. Severity of 30% and above defines the more reliably ascertained cases; children who died before assessment at around 6 years of age are included in the most severe group (70% and above). Results-584 cases of cerebral palsy were ascertained, yielding a rate that rose from 1.68 per 1000 neonatal survivors during 1964-1968 to 2.45 during 1989-1993 (rise = 0.77; 95% confidence interval 0.2-1.3). For the more reliably ascertained cases there was a twofold increase in rate from 0.98 to 1.96 (rise = 0.98; 95% confidence interval 0.5-1.4). By birth weight, increases in rates were from 29.8 to 74.2 per 1000 neonatal survivors < 1500 g and from 3.9 to 11.5 for those 1500-2499 g. Newborns < 2500 g now contribute one half of all cases of cerebral palsy and just over half of the most severe cases, whereas in the first decade of this study they contributed one third of all cases and only one sixth of the most severe ( 2 and 2 for trend p < 0.001). Conclusions-The rate of cerebral palsy has risen in spite of falling perinatal and neonatal mortality rates, a rise that is even more pronounced when the mildest and least reliably ascertained are excluded. The eVect of modern care seems to be that many babies < 2500 g who would have died in the perinatal period now survive with severe cerebral palsy. A global measure of severity should be included in registers of cerebral palsy to determine a minimum threshold for international comparisons of rates, and to monitor changes in the distribution of severity. (Arch Dis Child Fetal Neonatal Ed 2000;83:F7-F12)

Trends in prevalence of cerebral palsy in children born with a birthweight of 2,500 g or over in Europe from 1980 to 1998

“…Few papers have analyzed trends over time by CP subtypes and birthweight and usually it is proportions of subtypes that are compared, not prevalence. 9, [33] In our study, we found a non-significant increase in prevalence of dyskinetic forms. A recent study, also based on the SCPE common database, reported a significant increase in the prevalence of dyskinetic CP among NBW children for the period 1976-1984, followed by a plateau.…”

“…This explanation is supported by the stability of prevalence over the period 1964-1993 in the initial catchment area. [33] We observed a significant decrease in the bilateral spastic group, the most common subtype, of more than 40%. At the same time, there was an increase in unilateral spastic subtype.…”

Regional Variation in Survival of People With Cerebral Palsy in the United Kingdom

“…The 5 participating registers were the Merseyside and Cheshire Cerebral Palsy Register 2,9,11 ; the North of England Collaborative Cerebral Palsy Survey 7,12 ; the Northern Ireland Cerebral Palsy Register 13 ; 4Child-the Four Counties Database of Cerebral Palsy, Vision Loss and Hearing Loss in Children 14,15 (formerly the Oxford Register of Early Childhood Impairments); and the Scottish Register of Children with a Motor Deficit of Central Origin. 14,16 Henceforth, the registers will be referred to as Mersey, North of England, Oxford, Northern Ireland, and Scotland, respectively.…”

Cerebral Palsy Among Asian Ethnic Subgroups

“…[2][3][4] The underlying causes of CP are poorly understood. Factors associated with an elevated risk of CP include older maternal age, low educational attainment, male gender, preterm birth, and low birth weight.…”