Congenital Anomalies in Children With Cerebral Palsy: A Systematic Review

Hunt

2020

Self Cite

Birth prevalence of cerebral palsy (CP) is declining in high-income countries, to as low as 1.4 per 1000 live births in the most recent international reports. This represents a 35% reduction in birth prevalence over a 15-year period. This reduction is underpinned by a heightened focus of attention towards all aspects of CP, including: increased awareness, better data collection, development of national networks and registries, an explosion of research in basic science, perinatal care, neonatal neurology, public health, early detection, and targeted early intervention. Quick uptake of evidence into practice has ensued and overall improvements in clinical care occurred concurrently. It is anticipated that with continued partnerships with families, ongoing research driving further clinical improvement and vice versa, birth prevalence and severity of CP will further decline and the focus will shift to prevention in low-and middle-income countries.

Section: What About the Future?mentioning

confidence: 99%

Section: Tackling the 'Unpreventable'mentioning

confidence: 99%

Perinatal care with a view to preventing cerebral palsy

Badawi

Hunt

2020

Self Cite

“…5 Advancements in this field have stalled because of insufficient sample sizes and variation in study methods. 5 Extensive investigations of subgroups of children with similar types of anomalies is required to understand specific pathways to CP. 6 The Comprehensive CA-CP Study is a multicentre data linkage study, using international collaboration and standardized methods to sufficiently power a new investigation of congenital anomalies in CP.…”

mentioning

confidence: 99%

Congenital anomalies in children with pre‐ or perinatally acquired cerebral palsy: an international data linkage study

Goldsmith

Andersen

et al. 2020

Self Cite

Aim To describe the frequency and types of major congenital anomalies present in children with pre‐ or perinatally acquired cerebral palsy (CP), and compare clinical outcomes for children with and without anomalies. Method This multi‐centre total population collaborative study between Surveillance of Cerebral Palsy in Europe, Australian Cerebral Palsy Register, and European Surveillance of Congenital Anomalies (EUROCAT) involved six European and three Australian regions. Data were linked between each region’s CP and congenital anomaly register for children born between 1991 and 2009, and then pooled. Children were classified into mutually exclusive categories based on type of anomaly. Proportions of children with congenital anomalies were calculated, and clinical outcomes compared between children with and without anomalies. Results Of 8201 children with CP, 22.8% (95% confidence interval [CI] 21.9, 23.8) had a major congenital anomaly. Isolated cerebral anomalies were most common (45.2%), with a further 8.6% having both cerebral and non‐cerebral anomalies. Cardiac anomalies only were described in 10.5% of children and anomalies associated with syndromes were also reported: genetic (8.0%), chromosomal (5.7%), and teratogenic (3.0%). Clinical outcomes were more severe for children with CP and congenital anomalies, particularly cerebral anomalies. Interpretation This large, international study reports major congenital anomalies in nearly one‐quarter of children with pre‐ or perinatally acquired CP. Future research must focus on aetiological pathways to CP that include specific patterns of congenital anomalies. What this paper adds Congenital anomalies were reported in 23% of children with pre‐ or perinatally acquired cerebral palsy. A higher proportion of children born at or near term had anomalies. The most common type of anomalies were isolated cerebral anomalies. Clinical outcomes were more severe for children with congenital anomalies (particularly cerebral).

“…However for other children the congenital anomaly may be unrelated to the pathway to postneonatally acquired CP, for example a child born with a cleft palate sustaining a brain injury during a motor vehicle accident. No other total population studies have described congenital anomalies in children with postneonatally acquired CP 5 …”

mentioning

confidence: 99%

“…No other total population studies have described congenital anomalies in children with postneonatally acquired CP. 5 Given the scarcity of literature, we sought to verify and further explore the occurrence of congenital anomalies in children with postneonatally acquired CP in a larger population of nearly 3.8 million live births, using data from our multicentre Comprehensive CA-CP Study. 6,7 Specifically, in children with postneonatally acquired CP, we aimed to: (1) describe the frequency and proportion of congenital anomalies (stratified by sex, birth plurality, and gestational age) and specific congenital anomalies present, (2) compare clinical outcomes of the children with and without congenital anomalies, (3) compare the causes of postneonatally acquired CP between children with and without congenital anomalies, and (4) describe the likelihood of the congenital anomalies being on causal pathways to postneonatally acquired CP.…”

mentioning

confidence: 99%

Congenital anomalies in children with postneonatally acquired cerebral palsy: an international data linkage study

Goldsmith

Scott

et al. 2021

Self Cite

Aim To describe the major congenital anomalies present in children with postneonatally acquired cerebral palsy (CP), and to compare clinical outcomes and cause of postneonatally acquired CP between children with and without anomalies. Method Data were linked between total population CP and congenital anomaly registers in five European and three Australian regions for children born 1991 to 2009 (n=468 children with postneonatally acquired CP; 255 males, 213 females). Data were pooled and children classified into mutually exclusive categories based on type of congenital anomaly. The proportion of children with congenital anomalies was calculated. Clinical outcomes and cause of postneonatally acquired CP were compared between children with and without anomalies. Results Major congenital anomalies were reported in 25.6% (95% confidence interval [CI] 21.7–29.9) of children with postneonatally acquired CP. Cardiac anomalies, often severe, were common and present in 14.5% of children with postneonatally acquired CP. Clinical outcomes were not more severe in children with congenital anomalies than those without anomalies. Cause of postneonatally acquired CP differed with the presence of congenital anomalies, with cerebrovascular accidents predominating in the anomaly group. Congenital anomalies were likely associated with cause of postneonatally acquired CP in 77% of children with anomalies. Interpretation In this large, international study of children with postneonatally acquired CP, congenital anomalies (particularly cardiac anomalies) were common. Future research should determine specific causal pathways to postneonatally acquired CP that include congenital anomalies to identify opportunities for prevention. What this paper adds One‐quarter of children with postneonatally acquired cerebral palsy (CP) have a major congenital anomaly. Cardiac anomalies, often severe, are the most common anomalies. Causes of postneonatally acquired CP differ between children with and without congenital anomalies.