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

Abstract

Aim To investigate temporal trends in birth prevalence, disability severity, and motor type for singletons with prenatal or perinatally acquired cerebral palsy (CP). Method Numerator data, number of children with CP born a singleton between 1995 and 2014, confirmed at 5 years of age, were drawn from three state registers with population‐level ascertainment. Birth prevalence estimates and 95% confidence intervals (CI) were calculated per 1000 singleton live births for the three states combined, overall, by gestational age group, by dichotomized disability severity, and spastic laterality. Poisson regression models were used to analyse trends. Using data from all eight registers, trends in the proportional distribution of CP subtypes overall and stratified by gestational age were examined. Results Birth prevalence of CP declined from 1.8 (95% CI 1.6–2.0) in 1995 to 1996 to 1.2 (95% CI 1.1–1.4) in 2013 to 2014 (average 5% per 2‐year epoch, p < 0.001). Declines in birth prevalence were observed across all gestational age groups with the largest decline in children born at <28 weeks (average 8% per epoch, p < 0.001). Prevalence of moderate‐severe disability declined for children born at <28 and ≥37 weeks (average 11% and 7% per epoch respectively, p < 0.001). The proportions of bilateral spastic CP declined (p < 0.001) at <28 weeks (p = 0.014) and ≥37 weeks (p < 0.001). The proportion of children with dyskinesia increased (28–31 weeks: p = 0.021, 32–36 weeks: p = 0.001, and ≥37 weeks: p < 0.001). Interpretation Birth prevalence of CP and moderate‐severe disability (<28 and ≥37 weeks) declined in Australian singletons between 1995 and 2014, reflecting changes in prenatal and perinatal care over time. What this paper adds Declines in birth prevalence of prenatal or perinatally acquired cerebral palsy were observed for singletons born in Australia between 1995 and 2014. These declines were evident across all gestational age groups. Declines in birth prevalence of moderate‐severe disability were observed for children born at <28 weeks and ≥37 weeks.

Associated Impairments among Children with Cerebral Palsy in Rural Bangladesh—Findings from the Bangladesh Cerebral Palsy Register

“…The study participants are children with confirmed CP aged < 18 years, registered in the BCPR as per the strict clinical definition adopted from the Surveillance of Cerebral Palsy in Europe (SCPE) and Australian Cerebral Palsy Register (ACPR), and a standard protocol published previously [ 9 , 15 , 16 ]. Children included in this study were recruited from 18 sub-districts of Bangladesh.…”

Changing trends in cerebral palsy prevalence: an opportunity to consider etiological pathways

“…2 Further investigation into how health beliefs might influence access to therapy is warranted as motor impairment does not just influence motor skill performance, but has negative implications for physical activity participation (and health outcomes associated with inactivity), quality of life, education, and mental health. 3 Motor skills play an important role in facilitating participation in a range of activities, including self-care, educational-related tasks (such as handwriting), and play with friends. This is an important consideration for children born extremely preterm who are at increased risk of a range of poor outcomes across diverse domains, including cognitive, social, and behavioural outcomes, 1 which may compound the negative effects of motor impairment.…”

“…Intervention has shown promise for improving motor outcomes for young children with DCD. 3 However, children born extremely preterm with non-CP motor impairment likely present with more complex health and developmental outcomes compared with children with non-CP motor impairment who were born at term. For example, individuals born extremely preterm are at greater risk of impaired lung function throughout their lifespan, as well as poor cardiometabolic health and low bone density as they reach late adolescence and adulthood.…”

“…Smithers-Sheedy et al provide such evidence in a comprehensive description of pre-and perinatally acquired CP trends in Australia. 3 Capitalizing on an excellent resource, the nationwide Australian Cerebral Palsy Register, the authors report a one-third reduction in the prevalence of CP at 5 years of age between 1995 and 2014 in singleton children. The decline was evident in all gestational age groups, although it was somewhat more pronounced in children born extremely preterm.…”

What's New in Orthopaedic Management in Neuromuscular Disorders

“…Advances in maternal and perinatal care in Europe and Australia have led to a decrease in prenatal and perinatal cerebral palsy. [1][2][3] The decrease may change the landscape of cerebral palsy care. Prenatal and perinatal cerebral palsy is often associated with higher proportion of spastic diplegic cerebral palsy and higher Gross Motor Functional Classification System (GMFCS) levels (IV and V).…”