Risk factors for cerebral palsy

Abstract

Background / Aim. Cerebral palsy (CP) etiology is multifactorial and heterogeneous, manifesting as damage to the developing brain. The associated risk factors can arise in the prenatal, perinatal, or postnatal period. This work is a part of a larger classical clinicalepidemiological qualitative study and some of its components were already described in our previous publications. The objective of this investigation was to determine the risk factors for CP and to examine the associations between CP type, gestational age, and perinatal risk factors. Methods. The study sample comprised of 206 children with CP. Pertinent data were collected from medical records, and included participants? gestational age at birth, medical history, and CP clinical characteristics. Risk factors were divided according to the timing of brain injury into prenatal, perinatal, and neonatal. Results. Hormonally maintained pregnancy (55.3%), twin pregnancy (28.9%), vaginal bleeding after the 20th week of gestation (21.1%), threatened abortion in the first half of pregnancy (13.2%), and maternal infection (10.5%) were identified as the main prenatal risk factors for CP. Prematurity (54.5%) was the leading perinatal risk factor, followed by low birthweight (50.8%), low Apgar score (41.7%), assisted delivery (41.4%), and breech presentation (13.5%). Respiratory distress syndrome (16%), need for treatment in the NICU (22.3%), assisted ventilation (18.4%), hypoxic ischemic encephalopathy ? HIE (11.2%), and neonatal convulsions (5.8%) were identified as the leading neonatal risk factors for CP. The total number of perinatal factors present differed significantly in relation to gestational age (p < 0.001) and CP type (p = 0.006). Perinatal risk factors were most prevalent in preterm infants and children affected by the CP of spastic bilateral type. Statistically significant difference was noted in the distribution of CP types depending on the gestational age (p < 0.001). In particular, spastic bilateral CP type was most prevalent in the group of preterm-born children. Conclusion. CP is characterized by heterogeneous risk factors and is a result of interaction among multiple risk factors.