Risk factors for cerebral palsy

Abstract

Cerebral palsy is a major cause of crippling in children, but it's etiology is poorly understood. This case control study was done to assess some of the identified risk factors for cerebral palsy, 125 cerebral palsy cases selected from hospital clinic and 125 age and sex matched neighbourhood controls, all aged less than 5 years and residing in Delhi (India) were studied. Information regarding antenatal, natal and postnatal period was collected by mother's interview, and wherever available, from hospital records with the study subjects. Most common type of cerebral palsy was spastic (88%). Quadriplegia was the commonest topographical subtype (86.4%). Birth asphyxia was found to be present in only 25.6% of cases. The commonest risk factor amongst cases was low birth weight (28.8%). The multivariate odds ratios (confidence limits) for the risk factors found to be significantly associated with cerebral palsy were 36.1 (7.76-160) for birth asphyxia, 13.8 (4.95-38.3) for low birth weight, 37.4 (4.47-313) for neonatal convulsion, 23 (4.7-112) for neonatal jaundice, 14.4 (3.69-56.4) for neonatal infection, 24.9 (2.78-223) for instrument assisted delivery and 15.4 (1.57-152) for antepartum hemorrhage. Precipitate labour, caesarean section, twins, toxemia, breech delivery and head injury were not found to be significantly associated with cerebral palsy. Thus birth asphyxia, low birth weight, neonatal convulsions, neonatal jaundice, neonatal infection, instrument assisted delivery and antepartum hemorrhage are significant risk factors for cerebral palsy.

A clinico-epidemiological study of cerebral palsy in western Rajasthan

“…10,12,15 The next most common post-natal factor observed was meconium aspiration syndrome (MAS) in 6 (13.04%) patients and icterus neonatorum in 6 (13.04%) patients, maximum being observed in patients with spastic quadriplegia, on the contrary, higher proportion of icterus among patients of CP was reported by Kapoor et al, Dale and Stanley and Pharoah et al reported higher proportion of icterus among patients of CP. 6,7,12,19 Intracranial hemorrhage and neonatal septicemia were observed as risk factors in 5 (10.86%) patients each. Grether et al, and others observed both were significantly associated with increased risk of developing CP.…”

“…As Kapoor et al and others also found no association with the parental age. 6,7,10,12 As per their living area no specific pattern of CP with rural 27(58.69%) or urban 19 (41.31%) background was found in review of literature.…”

“…Similar male preponderance has been reported earlier in so many other studies also. 2,6,7,[9][10][11][12] Maximum numbers of patients at presentation were in the age group of 1-3 years in both sexes. Mean age of 2.04±1.53 years was observed in males and 3.67±3.14 years in females with an overall mean age of 2.39±2.04 years among all patients.…”

Motor Severity in Children With Cerebral Palsy Studied in a High-Resource and Low-Resource Country

“…15 Studies of clinic attendees in these settings have reported high rates of spasticity similar to that in high-resource countries, from 70% to 90%. 14,[16][17][18][19][20] Studies have tended to identify higher rates of quadriplegia than those reported in the west (60% to 86%), 16,17,20 although the only population-based study found a high rate of spastic diplegia (72.9%). 14 Differences in prevalence and motor patterns between high-and low-resource countries reported in the literature remain unclear; however, the etiology has been reported to differ markedly.…”

“…12 In low-resource countries there is poor survival of preterm infants, and home deliveries by unskilled birth attendants continue to dominate. 17 Birth asphyxia and low birth weight are reported as the prevailing causes of CP in low-resource countries, 16,17 along with kernicterus and postnatal causes such as meningitis and cerebral malaria. 3,14 The motor outcomes of children in highresource countries have been well described based on their level of gross motor function (Gross Motor Function Classification System [GMFCS]).…”