Trends in Prevalence and Severity of Pre/Perinatal Cerebral Palsy Among Children Born Preterm From 2004 to 2010: A SCPE Collaboration Study

Abstract

Aim: To report on prevalence of cerebral palsy (CP), severity rates, and types of brain lesions in children born preterm 2004 to 2010 by gestational age groups.Methods: Data from 12 population-based registries of the Surveillance of Cerebral Palsy in Europe network were used. Children with CP were eligible if they were born preterm (<37 weeks of gestational age) between 2004 and 2010, and were at least 4 years at time of registration. Severity was assessed using the impairment index. The findings of postnatal brain imaging were classified according to the predominant pathogenic pattern. Prevalences were estimated per 1,000 live births with exact 95% confidence intervals within each stratum of gestational age: ≤27, 28–31, 32–36 weeks. Time trends of both overall prevalence and prevalence of severe CP were investigated using multilevel negative binomial regression models.Results: The sample comprised 2,273 children. 25.8% were born from multiple pregnancies. About 2-thirds had a bilateral spastic CP. 43.5% of children born ≤27 weeks had a high impairment index compared to 37.0 and 38.5% in the two other groups. Overall prevalence significantly decreased (incidence rate ratio per year: 0.96 [0.92–1.00[) in children born 32–36 weeks. We showed a decrease until 2009 for children born 28–31 weeks but an increase in 2010 again, and a steady prevalence (incidence rate ratio per year = 0.97 [0.92–1.02] for those born ≤27 weeks. The prevalence of the most severely affected children with CP revealed a similar but not significant trend to the overall prevalence in the corresponding GA groups. Predominant white matter injuries were more frequent in children born <32 weeks: 81.5% (≤27 weeks) and 86.4% (28–31 weeks), compared to 63.6% for children born 32–36 weeks.Conclusion: Prevalence of CP in preterm born children continues to decrease in Europe excepting the extremely immature children, with the most severely affected children showing a similar trend.

Risk factors for cerebral palsy

“…According to our data, perinatal risk factors are more prevalent in preterm infants than in those carried to term. This observation is in line with the available evidence suggesting that the number of children with at least one of the perinatal risk factors decreases significantly with gestational age, which may be associated with a gradual decline in the CP prevalence after 32 weeks of gestation (19,26).…”

“…Bilateral spastic form of CP (6,19,30) is most common in premature infants, and prematurity is recognized as the main risk factor in the perinatal period (31,32). Arnaud et al noted bilateral spastic form of CP in two-thirds of preterm infants (19). According to our results, three quarters of children with diplegic form and half of children with quadriplegic form of CP were delivered prematurely.…”

“…The association between CP and twin pregnancy can be explained by a greater prevalence of premature birth in twins (5,18). In a population-based study conducted by Arnaud et al involving 2,273 premature babies, a quarter of the children were from multiple pregnancies (19). These authors noted that presence of nonspecific infection indicators, such as maternal fever, antibiotic use, and chorioamnionitis in the period immediately preceding labor is associated with an increased risk of CP.…”

“…Our analyses further revealed that perinatal risk factors are most prevalent in spastic bilateral type, followed by dyskinetic type of CP. Bilateral spastic form of CP (6,19,30) is most common in premature infants, and prematurity is recognized as the main risk factor in the perinatal period (31,32). Arnaud et al noted bilateral spastic form of CP in two-thirds of preterm infants (19).…”

Declining trends in birth prevalence and severity of singletons with cerebral palsy of prenatal or perinatal origin in Australia: A population‐based observational study

“…In recent research from Europe that investigated trends amongst children with CP (singletons and multiples born preterm, birth years 2004–2010), the authors identified significant declines in birth prevalence of CP 2004 to 2009, for those born at 32 to 36 weeks’ gestation and 28 to 31 weeks’ gestation but not for children born at <28 weeks’ gestation 19 . The declining trend in CP prevalence for children born at <28 weeks’ gestation reported in Australia pertained to singletons born in the period 1995 to 2014.…”