Intrauterine drug exposure as a risk factor for cerebral palsy

Benninger, Kristen; Purnell, Jessica; Conroy, Sara; Jackson, Kenneth W.; Batterson, Nancy; Neel, Mary Lauren; Hester, Mark E.; Maitre, Nathalie L.

doi:10.1111/dmcn.15050

Cited by 8 publications

(4 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Illicit substance exposure was an independent risk factor for CP. Intrauterine exposure to illicit drugs, such as barbiturates, cannabis, and stimulants, has been associated with a higher prevalence of CP in a large study of infants older than 32 weeks’ gestation . Support for pregnant people struggling with substance use is a crucial ongoing need …”

Section: Discussionmentioning

confidence: 99%

“…Intrauterine exposure to illicit drugs, such as barbiturates, cannabis, and stimulants, has been associated with a higher prevalence of CP in a large study of infants older than 32 weeks' gestation. 37 Support for pregnant people struggling with substance use is a crucial ongoing need. 38 Low 5-minute Apgar scores were associated with increased probability of CP.…”

Section: Significant Individual Risk Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Development of a Bedside Tool to Predict the Diagnosis of Cerebral Palsy in Term-Born Neonates

et al. 2023

View full text Add to dashboard Cite

ImportanceCerebral palsy (CP) is the most common abnormality of motor development and causes lifelong impairment. Early diagnosis and therapy can improve outcomes, but early identification of infants at risk remains challenging.ObjectiveTo develop a CP prognostic tool that can be applied to all term neonates to identify those at increased risk of developing CP.Design, Setting, and ParticipantsThis case-control study used data from the Canadian Cerebral Palsy Registry (data collected from January 2003 to December 2019) for children with CP and the Alberta Pregnancy Outcomes and Nutrition study (mothers enrolled from May 2009 to September 2012; data extracted in 2020) for controls. There were 2771 children with CP and 2131 controls evaluated; 941 and 144, respectively, were removed for gestational age less than 37 weeks at birth, 565 with CP removed for incomplete data, and 2 controls removed for a diagnosis of CP. Data were analyzed from April to August 2022.ExposuresPotential risk factors were selected a priori based on the literature, including maternal, intrapartum, and infant characteristics.Main Outcomes and MeasuresDiagnosis of CP, defined as a disorder of motor function due to a nonprogressive brain abnormality before age 1 year and classified by Gross Motor Function Classification System levels I to V.ResultsOf 3250 included individuals, 1752 (53.9%) were male, and the median (IQR) gestational age at birth was 39 (38-40) weeks. Encephalopathy was present in 335 of 1184 infants with CP (28%) and 0 controls. The final prediction model included 12 variables and correctly classified 75% of infants, with a sensitivity of 56% (95% CI, 52-60) and specificity of 82% (95% CI, 81-84). The C statistic was 0.74 (95% CI, 71-76). Risk factors were found to be additive. A proposed threshold for screening is probability greater than 0.3, with a sensitivity of 65% (95% CI, 61-68) and specificity of 71% (95% CI, 69-73). The prognostic tool identified 2.4-fold more children with CP than would have presented with encephalopathy (odds ratio, 13.8; 95% CI, 8.87-22.65; P &lt; .001).Conclusions and RelevanceIn this case-control study, a prognostic model using 12 clinical variables improved the prediction of CP compared with clinical presentation with encephalopathy. This tool can be applied to all term newborns to help select infants for closer surveillance or further diagnostic tests, which could improve outcomes through early intervention.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Significant Individual Risk Factorsmentioning

confidence: 99%

Development of a Bedside Tool to Predict the Diagnosis of Cerebral Palsy in Term-Born Neonates

et al. 2023

View full text Add to dashboard Cite

show abstract

“…2,11 Additional screening recommendations for infants with single risk factors including 5-minute Apgar scores less than 6, chorioamnionitis, and illicit drug use during pregnancy are likely to improve identification of highrisk infants. These latter recommendations have been made in previous publications 12,13 but have not yet been fully implemented within usual care. The population screening section added to the algorithm has not been tested or validated, and the next steps for the field to achieve universal screening would be to test the screening processes in a prospective cohort study.…”

mentioning

confidence: 99%

New Screening Tool for Term-Born Infants Enables Update to the Clinical Practice Guideline for Early Diagnosis of Cerebral Palsy

2023

View full text Add to dashboard Cite

Rouabhi et al 1 present a novel prognostic tool for identifying the risk of cerebral palsy (CP) in a "low-risk" term newborn, using a large sample of population register data from Canadian infants. Selected clinical variables based on published risk factors were used to build and test a model. Variables not contributing to the model were removed, enabling development of a streamlined prognostic tool. The authors identified 12 clinical variables for inclusion within the tool, all of which are routinely collected clinical information about pregnancy and maternal history (eg, preeclampsia, tobacco use), labor and delivery history (eg, prolonged rupture of membranes, Apgar scores), and infant characteristics (eg, sex, birth weight). The tool calculates a prediction value for risk of CP and gives corresponding ranges from lower than normal to much higher than normal. Importantly, there are recommendations for the additional screening needed at each risk range. This enables streamlined resource use, from routine developmental screening by primary care professionals to referral for specialized assessments such as the General Movements Assessment (GMA) and Hammersmith Neurological Examination (HINE). Term infants with highest risk for CP (those with neonatal encephalopathy and seizures) were not included in the model as it was assumed these infants meet criteria for routine developmental screening as per clinical guideline recommendations. 2 Early screening for CP, the most common physical disability of childhood, has received significant attention over the last 5 years following publication of the International Clinical Practice Diagnostic Guidelines. 2 A large, matched case-control study subsequently demonstrated more than 97% predictive accuracy when 3 gold-standard tools' (Brain Magnetic Resonance Imaging; GMA; and HINE) scores all triangulate to indicate CP. 3 Early and accurate diagnosis of CP before 12 months of age is now well established to be both possible and feasible in realworld settings based on screening high-risk populations. 4,5 Earlier diagnosis expedites access to earlier CP-specific intervention with aims of optimizing infant neuroplasticity, preventing complications, and enhancing parent and caregiver well-being. 6 However, over 50% of children with CP are born at term, meaning many have no readily identifiable neonatal risk factors, 7 making early diagnosis of these infants a major challenge. 2 A case-control study previously identified that research on term-born singletons with CP not admitted to neonatal intensive care units (NICUs) was scarce but showed that almost 40% of the cases were not admitted to the NICU or special care and were considered neurologically normal at discharge. 8 The implications are that these "neurologically normal" infants are not referred to "high-risk" follow-up services and consequently diagnosis for these children occurs even later, often prompted by parental concerns. Late diagnosis of Related article page 177Editorial Opinion jamapediatrics.com (Reprinted) JAMA

show abstract

“…Although elevated, CP diagnosis among infants with PDE is around 5%, 2 suggesting most of the exposed infants are still resilient. This is similar to other domains of developmental outcomes so the identification of those at true risk remains critical to better focus our limited resources on targeted/individualized intervention.…”

mentioning

confidence: 99%

Prenatal drug exposure as a risk factor for cerebral palsy and other developmental deficits

Gao

2021

Develop Med Child Neuro

View full text Add to dashboard Cite

show abstract

Intrauterine drug exposure as a risk factor for cerebral palsy

Cited by 8 publications

References 26 publications

Development of a Bedside Tool to Predict the Diagnosis of Cerebral Palsy in Term-Born Neonates

Development of a Bedside Tool to Predict the Diagnosis of Cerebral Palsy in Term-Born Neonates

New Screening Tool for Term-Born Infants Enables Update to the Clinical Practice Guideline for Early Diagnosis of Cerebral Palsy

Prenatal drug exposure as a risk factor for cerebral palsy and other developmental deficits

Contact Info

Product

Resources

About