Temporal trends, clinical characteristics, and sociodemographic profile of post‐neonatally acquired cerebral palsy in Australia, 1973–2012: A population‐based observational study

Abstract

Aim: To describe post-neonatally acquired (PNN) cerebral palsy (CP) in terms of temporal trends in prevalence, clinical and sociodemographic profiles, known causes and associations between causes, and sociodemographic variables. Method: Numerator data, a count of children with PNN-CP confirmed at 5 years of age (n = 523), was drawn from two Australian state CP registers (birth years 1973-2012). Poisson regression was used to investigate temporal trends in the prevalence of PNN-CP by 5-year intervals, calculated per 10 000 live births. Using data from all state and territory Australian CP registers (n = 469), distributions of clinical characteristics, PNN-CP causes, and sociodemographic factors were tabulated (birth years 1995-2012). χ 2 and logistic regression analyses were used to assess associations between sociodemographic profile, Australian reference data, and known causes. Results: A significant temporal decline in PNN-CP in Victoria (p = 0.047) and Western Australia (p = 0.033) was observed. The most common proximal causes of PNN-CP were cerebrovascular accidents (34%, n = 158), infection (25%, n = 117), and non-accidental injuries (12%, n = 58). Children born to teenage mothers, Aboriginal

Post‐neonatal cerebral palsy in Australia: Through the lens of intersectionality

“…Waight et al suggest these declines may be due to improvements in vaccination coverage, mandatory child safety seats, and other public health measures in these two states. For the more recent birth years of 1995 to 2012, the registers cover all states and territories of Australia and demonstrate that: (1) the leading causes of post‐neonatal CP include cerebral vascular accidents, brain infections, and traumatic brain injuries; (2) compared to those with pre‐ and perinatal CP, children with post‐neonatal CP have greater functional limitations and are more likely to have co‐occurring epilepsy and intellectual disability; and (3) the risk of post‐neonatal CP appears to be more than three times greater in Indigenous than non‐Indigenous populations, and more than four times greater among geographically remote than less remote populations in Australia 1 …”

“…For the more recent birth years of 1995 to 2012, the registers cover all states and territories of Australia and demonstrate that: (1) the leading causes of post-neonatal CP include cerebral vascular accidents, brain infections, and traumatic brain injuries; (2) compared to those with pre-and perinatal CP, children with post-neonatal CP have greater functional limitations and are more likely to have co-occurring epilepsy and intellectual disability; and (3) the risk of post-neonatal CP appears to be more than three times greater Indigenous than non-Indigenous populations, and more than four times greater among geographically remote than less remote populations in Australia. 1 In their commentary on recent evidence that hospitalization rates are elevated for children with developmental disabilities in Indigenous and low-income immigrant populations in Australia, 4 Slaughter-Acey and Saintil advocate for interpreting the findings within an 'intersectionality' framework. 5 In this framework, inequalities in health affecting individuals belonging to more than one disadvantaged group are seen as interlocking and a consequence of historical systems of oppression or of inequities in power and access to quality health care.…”

“…Information on the epidemiology of post‐neonatally acquired cerebral palsy (CP) is critically important because, as Waight et al point out in their new analysis of data from Australia's state CP registers, the causes of post‐neonatal CP should be largely preventable 1 . Yet many epidemiological studies of CP exclude cases attributed to post‐neonatal causes, and even when studies include these cases, the numbers are often too small to allow evaluation of trends over time or of risk factors or health disparities 2 .…”

“…Information on the epidemiology of post‐neonatally acquired cerebral palsy (CP) is critically important because, as Waight et al point out in their new analysis of data from Australia's state CP registers, the causes of post‐neonatal CP should be largely preventable. 1 Yet many epidemiological studies of CP exclude cases attributed to post‐neonatal causes, and even when studies include these cases, the numbers are often too small to allow evaluation of trends over time or of risk factors or health disparities. 2 For example, studies of the prevalence of CP in the United States conducted by the Center for Disease Control and Prevention in selected states and years have found approximately 7% of CP cases to be due to post‐neonatal causes, but the numbers from these studies are insufficient for stratified or multivariable analyses to confirm whether trends and disparities seen for CP overall apply to the sub‐group of cases with a post‐neonatal etiology.…”

“… 5 In this framework, inequalities in health affecting individuals belonging to more than one disadvantaged group are seen as interlocking and a consequence of historical systems of oppression or of inequities in power and access to quality health care. 6 Waight et al note that Indigenous populations in Australia are more likely than others to reside in remote areas, that access to health care is limited in remote areas, and that ‘decades of unsafe health care has had detrimental effects on how First Nations families expect to experience the health care system and on [their] subsequent health and wellbeing.’ Further, the authors are careful to point out that being born to Indigenous parents should not be seen as a risk factor for post‐neonatal CP but rather that ‘being treated unsafely is the actual risk factor.’ 1 …”