Analysis by gestational age of cerebral palsy in singleton births in north‐east England 1970–94

Abstract

Summary We report from a well‐established cerebral palsy (CP) register the changes in CP rates by gestational age for singleton births over a 25‐year period in north‐east England. The gestational ages of numerators and denominators are of high accuracy back to 1970 because academic units in paediatrics and obstetrics were studying the assessment of gestational age in individual infants, and the distribution of gestational age across all births in the north‐east from the 1960s. The rate of CP rose between 1970–75 and 1990–94 from 1.6 to 2.3 per 1000 singleton neonatal survivors, a rise of 0.7/1000 [95% CI 0.2, 1.3]. There was little change in the rate of CP in term infants whereas in preterm infants (<37 weeks) it rose from 5.5 to 16.8, a rise of 11.3/1000 [95% CI 5.9, 16.8]. Rises occurred in the three preterm gestational age bands <28, 28–31, 32–36 weeks with the most marked rise in those <28 weeks from 0 to 112.7. The proportion of all cases of CP arising in the preterm group rose from 19% to 45%; and the proportion of the severest cases arising in the preterm group rose from 8% to 55%. In those born after 32 weeks, there is a preponderance of small‐for‐gestation infants, with 10% more than two standard deviations below the mean. All types of CP are more common in infants below average weight for gestation and this is most marked for the non‐spastic types that are almost only seen in term, small‐for‐gestation infants. Gestational age is the crucial determinant of rate of CP and the increase in prevalence seen over the past 25 years is due to increased rates in preterm infants, not term infants. Both conclusions, suspected from birthweight analyses, are now demonstrated conclusively, with the contribution coming from those 32–36 weeks gestation as well as very preterm infants.

RETIRED: Magnesium Sulphate for Fetal Neuroprotection

“…9 The gestational age-related risk is associated, in part, with very low birth weight (i.e., < 1500 g) and intraventricular hemorrhage. [10][11][12] Multiples are also at heightened CP risk. 13 Temporal trends in the prevalence of CP among infants born very preterm are a matter of controversy.…”

“…13 Temporal trends in the prevalence of CP among infants born very preterm are a matter of controversy. Rates have been reported to be both falling 14,15 and rising, 10,16 possibly because perinatal mortality rates are decreasing, so that the rate of "death or CP" among infants born at < 30 weeks has appeared to be stable. 6 What is agreed upon, however, is that the economic burden associated with CP is enormous.…”

“…When magnesium sulphate is given for fetal neuroprotection, maternity care providers should use existing protocols to monitor women who are receiving magnesium sulphate for preeclampsia/ eclampsia . (III-A) 10 . Indications for fetal heart rate monitoring in women receiving antenatal magnesium sulphate for neuroprotection should follow the fetal surveillance recommendations of the SOGC 2007 Fetal Health Surveillance: Antepartum and Intrapartum Consensus Guideline .…”

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

“…[12,13] Most of them reported stable prevalence rates from the 1970s to the 1990s. [4,[14][15][16][17] However, a small increase was reported in USA between 1975 and 1991 [18] while in Sweden the monitoring from the 1950s to the 1990s showed an increase in prevalence from the beginning of the 1970s to the mid 1980s followed by a decrease. [19] Also, in Iceland a decrease in prevalence for term babies was observed in 1997-2003 in comparison with [1990][1991][1992][1993][1994][1995][1996].…”

Maternal Infection and Risk of Cerebral Palsy in Term and Preterm Infants

“…2 Prevalence of CP in term infants has remained about 1.3 to 1.5 per 1000 live births. 3 The etiology of CP remains poorly understood. Although commonly assumed associated with asphyxia, CP does not follow most cases of perinatal asphyxia, and most cases of CP are not associated with severe intrapartum asphyxia.…”