Antenatal and delivery risk factors and prevalence of cerebral palsy in Duzce (Turkey)

Religious Coping and Fatalism on Perception of Care Burden in Caregivers of Patients with Cerebral Palsy in Turkey: A Cross-Sectional and Correlational Study

Providing care to a patient with cerebral palsy can have many negative impacts upon caregivers. This study was carried out to define caregiving burden in the caregivers of cerebral palsy patients and determine the relationships between religious coping, fatalism, and burden of care. This cross-sectional and correlational study included 132 caregivers. Data were obtained using the Religious Coping Scale, the Fatalism Scale, and the Caregiver Burden Scale. It was determined that 18.9% of the participants experienced a heavy care burden. The luck and pessimism dimensions of the Fatalism Scale were positively and weakly correlated with caregiving burden (p < 0.01), while there was no correlation between caregiving burden and positive or negative religious coping styles (p > 0.05). Perception of fatalism explained 10% of the total variance in caregiving burden (R = 0.329, R² = 0.109, F = 5.195, p = 0.002). It is recommended that caregivers be supported by religious experts to strengthen positive religious coping styles and advisable fatalism perceptions.

At-Home Orthodontic Treatment for Severe Teeth Arch Malalignment and Severe Obstructive Sleep Apnea Syndrome in a Child with Cerebral Palsy

Children with cerebral palsy typically have severe teeth arch malalignment, causing swallowing and respiration dysfunction. Malalignment in cerebral palsy, especially in children, worsens dysphagia and respiratory disorders; sometimes, it is also noted with obstructive sleep apnea. However, no study has reported on the improvement in obstructive sleep apnea after at-home orthodontic treatment in children with cerebral palsy. We herein present a pediatric case of cerebral palsy wherein obstructive sleep apnea improved with at-home orthodontic treatment for malalignment. We administered at-home orthodontic treatment to a 15-year-old boy with quadriplegia, due to spastic-type cerebral palsy, having no oral intake, obstructive sleep apnea, and teeth arch malalignment. After treatment, a decline in the severity of sleep apnea was observed. Perioral muscle hypertension and oral intake difficulties cause maxillary protrusion, narrowed teeth arch, and tilting of teeth in children with cerebral palsy. We expanded the oral cavity volume by orthodontic treatment to relieve muscle hypertension and correct the tongue position, thereby remarkably improving obstructive sleep apnea. Our findings suggest that at-home orthodontic treatment for malalignment effectively improves perioral muscle hypertension, glossoptosis, and obstructive sleep apnea.

Preeclampsia and Cerebral Palsy in Offspring

The aim of this systematic review and meta-analysis is to examine the association between exposure to preeclampsia during pregnancy and the occurrence of cerebral palsy in offspring. For this reason, the authors searched PubMed/Medline, EMBASE, and Google Scholar databases (end-of-search: 22 November 2021) and identified the most relevant studies. Then, a meta-analysis of all the eligible studies was performed. Subgroup and meta-regression analyses by study design, degree of adjustment, and geographical region were also conducted. A total of 10 studies were finally included, and no statistical significance was noted in the association between preeclampsia and cerebral palsy (pooled OR = 1.16, 95% CI: 0.77–1.74). The subgroup of studies that provided adjusted odds ratios for any variable except for gestational age showed a statistically significant association (pooled OR = 1.62, 95% CI: 1.36–1.93), whereas the association dissipated in studies also adjusting for gestational age (pooled OR = 1.63, 95% CI: 0.48–5.50). In conclusion, it seems that preeclampsia is not associated with cerebral palsy independently of gestational age; however, further research is needed to shed light on this topic.

Maternal age as a risk factor for cerebral palsy

The relationship between maternal age and the occurrence of cerebral palsy is still highly controversial. The aim of the study was to examine the effect of maternal age on the risk of CP development, taking into account all significant risk factors and the division into single, twin, full-term, and pre-term pregnancies.

The survey covered 278 children with CP attending selected educational institutions in Poland. The control group consisted of data collected from the medical records of 435 children born at Limanowa county hospital, Poland. The analyses included socio-economic factors, factors related to pregnancy and childbirth, and factors related to the presence of comorbidities and diseases in the child. Constructed logistic regression models were used for statistical analyses.

For all age categories included in the estimated models (assessing the effect of demographic factors on the development of CP), only the category of ≤24 years of age (in the group of all children) was significant. It was estimated that in this mother’s age category, the risk of CP is lower (OR 0.6, 95% CI: 0.3–1.0) in comparison to mothers aged 25-29 (p = 0.03). However, estimation with the use of a complex logistic regression model did not show any significant effect of maternal age on the incidence of CP in groups from different pregnancies types.

It became apparent that maternal age is a weak predictor of CP, insignificant in the final logistic regression model. It seems correct to assume that the studies conducted so far, showing a significant effect of maternal age in this respect, may be associated with bias in the estimators used to assess the risk of CP due to the fact that other important risk factors for CP development were not included in the research.

The influence of neonatal infections on the development of cerebral palsy

One of the most significant biological factors predisposing to cerebral palsy (CP) are infections. The paper aims to analyze neonatal infections’ influence in the risk of CP development with consideration of all significant risk factors including single, twin, full-term and pre-term pregnancies.

278 children with CP attending the chosen school-educational centers in Poland were included in the questionnaire. The control group included data obtained from the medical documentation of 435 children born in Limanowa County Hospital, Poland. Socio-economic factors, factors connected with pregnancy, and the coexisting disorders and diseases in children were taken into consideration. Constructed models of logistic regression were applied in the statistical analysis.

Neonatal infections increase the risk of CP development in all children (odds ratio (OR) 5.1, 95% confidence interval (CI) 2.6–9.8), children from single pregnancies (OR 5.8, 95% CI: 3.0–11.29), full-term (OR 6.2, 95% CI: 3.2–12.3), and single full-term pregnancies (OR 6.0, 95% CI: 3.0–12.0). The influence of neonatal infections in the risk of CP development in children from pre-term and single premature pregnancies was not indicated.

Neonatal infections are an independent risk factor for CP development in newborns from full-term pregnancy (>37 weeks of pregnancy). The patho-mechanism of CP is different in children from full-term and premature pregnancy and results from interrelating factors are discussed in this paper.

Developmental anomalies and associated impairments in Saudi children with cerebral palsy: a registry-based, multicenter study

Background

There are few epidemiological data to support rehabilitation programs for cerebral palsy (CP). Scarce international studies described the developmental anomalies (DAs) among children with CP. To our knowledge, the Arab countries did not publish data regarding this topic. This study aimed to describe the percentage of DAs among children with CP and detect the association between clinical subtypes and impairment severity in children with various DAs. We collected registry data of 679 children with cerebral palsy, between 2014 and 2019, from Armed Forces Hospitals, Taif, Kingdom of Saudi Arabia (KSA). We recorded demographic, perinatal, postnatal, developmental anomalies, subtypes, and impairment characteristics. We utilized the chi-square test to calculate the differences between groups.

Results

We reported significant differences between the children with and without anomalies regarding the percentages of consanguinity, preterm labor, low birth weight, and neonatal intensive care unit admission (P = 0.001, 0.002, 0.003, 0.005, respectively). Congenital dysplasia of the hip and hydrocephalus was the most frequent skeletal and nervous anomalies among children with DAs (19.1% and 12.8%, respectively). The spastic bilateral pattern was significantly higher among children with skeletal anomalies than the central nervous system/other groups (P < 0.001). The nervous anomalies group had higher frequencies of severe intellectual, motor, speech, and visual disabilities and a higher percentage of seizures than all other groups.

Conclusions

The frequency of children with anomalies in this study was comparable to previous studies. Children with CP and nervous system anomalies had more severe motor disabilities and associated impairments.

Preeclampsia and Neurodevelopmental Outcomes: Potential Pathogenic Roles for Inflammation and Oxidative Stress?

Preeclampsia (PE) is a common and serious hypertensive disorder of pregnancy that occurs in approximately 3-5% of first-time pregnancies and is a well-known leading cause of maternal and neonatal mortality and morbidity. In recent years, there has been accumulating evidence that in utero exposure to PE acts as an environmental risk factor for various neurodevelopmental disorders, particularly autism spectrum disorder and ADHD. At present, the mechanism(s) mediating this relationship are uncertain. In this review, we outline the most recent evidence implicating a causal role for PE exposure in the aetiology of various neurodevelopmental disorders and provide a novel interpretation of neuroanatomical alterations in PE-exposed offspring and how these relate to their sub-optimal neurodevelopmental trajectory. We then postulate that inflammation and oxidative stress, two prominent features of the pathophysiology of PE, are likely to play a major role in mediating this association. The increased inflammation in the maternal circulation, placenta and fetal circulation in PE expose the offspring to both prenatal maternal immune activation-a risk factor for neurodevelopmental disorders, which has been well-characterised in animal models-and directly higher concentrations of pro-inflammatory cytokines, which adversely affect neuronal development. Similarly, the exaggerated oxidative stress in the mother, placenta and foetus induces the placenta to secrete factors deleterious to neurons, and exposes the fetal brain to directly elevated oxidative stress and thus adversely affects neurodevelopmental processes. Finally, we describe the interplay between inflammation and oxidative stress in PE, and how both systems interact to potentially alter neurodevelopmental trajectory in exposed offspring.

The effect of increased bilirubin level on the risk of cerebral palsy

Increased bilirubin level in blood is mentioned among the potential factors with causal effect on cerebral palsy. The objective of the study was the analysis of its effect on the risk of cerebral palsy, considering all the significant risk factors as well as division into singleton, twin, term and preterm births. The research included a group of 278 children with cerebral palsy from selected educational-therapeutic institutions in Poland. The control group consisted of data from medical records of 435 neonates born in God’s Mercy Hospital in Limanowa, Poland. The analysis considered socio-economic factors, factors associated with pregnancy and parturition as well as accompanying disturbances and diseases of the children. Constructed models of logistic regression were used in statistcal analysis. The results were presented as the odds ratio (OR) with 95% confidence interval (CI). Testing the effect of increased bilirubin level in blood showed that the increased level of bilirubin is a significant predictor of CP in the categories of all children (OR 2.52, 95% CI: 1.47–4.33), children from singleton births (OR 2.66, 95% CI: 1.55–4.57), term births (OR 2.18, 95% CI: 1.24–3.84), term singleton births (OR 2.35, 95% CI: 1.31–4.21), preterm births (4.87, 95% CI: 1.56–15.21) and preterm singleton births (OR 3.62, 95% CI: 1.24–10.58). Increased bilirubin level is an independent risk factor in the development of cerebral palsy.

Paternal age and the risk of cerebral palsy

In the literature there are no unequivocal assessments of the effect of paternal age on the risk of cerebral palsy (CP). The objective of the studies was the analysis of the influence of paternal age on this risk, considering all the important risk factors and division into singleton and twin, as well as term- and preterm-born infants. The inquiry included a group of 278 children with cerebral palsy from selected education-therapeutic institutions in Poland. The control group consisted of the data from medical records of 435 neonates born in God’s Mercy Hospital in Limanowa, Poland. The data were based on a questionnaire designed to obtain information which would make it possible to ascertain the probable etiological factors. Constructed models of logistic regression were used in statistical analysis. The results were presented as the odds ratio (OR) with 95% confidence interval (CI). Though the estimation with a complex model of logistic regression showed no significant effect of paternal age on the occurrence of cerebral palsy, it confirmed it as a stronger predictor compared to maternal age. Disregarding paternal of age while considering maternal age and other risk factors may lead to a bias in the estimations of the risk cerebral palsy.

Prevalence of cerebral palsy with Gross Motor Function Classification System levels IV and V in children in Israel: a cross-cultural comparison

PURPOSE

Cerebral palsy is the most common physical disability in childhood. Our aim was to study the prevalence of wheelchair-dependent cerebral palsy (equivalent to gross motor function classification system level IV/V) among Jewish and Arab children in Israel and to investigate differences between the children of the two population groups.

METHODS

Children diagnosed with cerebral palsy born in the years 2005-2006 were located through the Israel National Insurance Institute database. Demographic and clinical data were retrieved from children's records.

RESULTS

Overall prevalence in Israel was 0.8 (0.7-0.9) per 1000 live births. The prevalence was significantly higher among Arabs (1.2:1000) than Jews (0.6:1000; OR = 1.6, 95% CI 1.2-2.1, p = 0.001) and was highest among Arabs in the South (Bedouins) (2.8:1000). Consanguinity among parents and low socioeconomic status were significantly more common among Arab children with wheelchair- dependent cerebral palsy compared with Jews. Higher rates of children with cerebral palsy following term pregnancy were found in Arabs. Extreme preterm births, very low birth weight, and emergent cesarean section were more common among Jews compared with Arabs.

CONCLUSIONS

This study revealed population group differences of cerebral palsy with Gross Motor Function Classification System levels IV and V. Higher rates of cerebral palsy, especially following term pregnancy in the Arab population, may be attributed to consanguinity and genetic factors. There is a need to tailor services to underserved population based on etiology: preterm births and genetic causes for the Jewish and Arab populations, respectively.

The complex aetiology of cerebral palsy

Cerebral palsy (CP) is the most prevalent, severe and costly motor disability of childhood. Consequently, CP is a public health priority for prevention, but its aetiology has proved complex. In this Review, we summarize the evidence for a decline in the birth prevalence of CP in some high-income nations, describe the epidemiological evidence for risk factors, such as preterm delivery and fetal growth restriction, genetics, pregnancy infection and other exposures, and discuss the success achieved so far in prevention through the use of magnesium sulfate in preterm labour and therapeutic hypothermia for birth-asphyxiated infants. We also consider the complexities of disentangling prenatal and perinatal influences, and of establishing subtypes of the disorder, with a view to accelerating the translation of evidence into the development of strategies for the prevention of CP.

Burden of severe neonatal jaundice: a systematic review and meta-analysis

CONTEXT

To assess the global burden of late and/or poor management of severe neonatal jaundice (SNJ), a common problem worldwide, which may result in death or irreversible brain damage with disabilities in survivors. Population-based data establishing the global burden of SNJ has not been previously reported.

OBJECTIVE

Determine the burden of SNJ in all WHO regions, as defined by clinical jaundice associated with clinical outcomes including acute bilirubin encephalopathy/kernicterus and/or exchange transfusion (ET) and/or jaundice-related death.

DATA SOURCES

PubMed, Scopus and other health databases were searched, without language restrictions, from 1990 to 2017 for studies reporting the incidence of SNJ.

STUDY SELECTION/DATA EXTRACTION

Stratification was performed for WHO regions and results were pooled using random effects model and meta-regression.

RESULTS

Of 416 articles including at least one marker of SNJ, only 21 reported estimates from population-based studies, with 76% (16/21) of them conducted in high-income countries. The African region has the highest incidence of SNJ per 10 000 live births at 667.8 (95% CI 603.4 to 738.5), followed by Southeast Asian, Eastern Mediterranean, Western Pacific, Americas and European regions at 251.3 (132.0 to 473.2), 165.7 (114.6 to 238.9), 9.4 (0.1 to 755.9), 4.4 (1.8 to 10.5) and 3.7 (1.7 to 8.0), respectively. The incidence of ET per 10 000 live births was significantly higher for Africa and Southeast Asian regions at 186.5 (153.2 to 226.8) and 107.1 (102.0 to 112.5) and lower in Eastern Mediterranean (17.8 (5.7 to 54.9)), Americas (0.38 (0.21 to 0.67)), European (0.35 (0.20 to 0.60)) and Western Pacific regions (0.19 (0.12 to 0.31). Only 2 studies provided estimates of clear jaundice-related deaths in infants with significant jaundice [UK (2.8%) and India (30.8%).

CONCLUSIONS

Limited but compelling evidence demonstrates that SNJ is associated with a significant health burden especially in low-income and middle-income countries.

Risk of cerebral palsy in Chinese children: A N:M matched case control study

AIM

To estimate epidemiological risk factors for cerebral palsy (CP) in children.

METHODS

A N:M matched case control study was conducted in 114 persons with CP and 1286 controls. Relevant data were collected using a maternal self-design questionnaire. Univariate logistic regression and multivariate conditional logistic regression analyses were performed using SPSS.

RESULTS

Univariate analysis has yielded 20 significant risk factors for CP. Advanced maternal age (30 years or older) at childbirth (adjusted odds ratio (OR) 1.63, 95% confidence interval (CI) 0.98-2.72), alcohol consumption during pregnancy (adjusted OR 4.17, 95% CI 1.23-14.08), living in the countryside (adjusted OR 1.71, 95% CI 1.18-2.48), father's occupational exposure to harmful substances (adjusted OR 3.34, 95% CI 1.61-6.93) and multiple births (adjusted OR 3.10, 95% CI 1.65-5.84) were found to be risk factors for CP by multivariate analysis. On the other side, high mother's education level (adjusted OR 0.60, 95% CI 0.46-0.76), folic acid supplements (adjusted OR 0.50, 95% CI 0.30-0.82), and high birth hospital level (adjusted OR 0.68, 95% CI 0.52-0.90) were found to be protective factors.

CONCLUSION

Although the important risk factors of CP focus on gestation at birth and perinatal events, the incidence could probably be further lowered, if potential risk factors identified in this study are considered.

Cerebral palsy and perinatal mortality after pregnancy-induced hypertension across the gestational age spectrum: observations of a reconstructed total population cohort

AIM

Pregnancy-induced hypertension/pre-eclampsia (PIH/PE) is associated with cerebral palsy (CP) in term births but if sufficiently severe to necessitate preterm delivery predicts a lower risk of CP than observed in gestational peers. We investigated whether this apparent 'protection' was attributable to inappropriately chosen comparison groups and/or an increased risk of perinatal death.

METHOD

Perinatal information was collected from medical records of children with CP, individually matched neonatal survivors without CP, and representative samples of perinatal deaths of Western Australian birth cohorts from 1980 to 1995. Compared with these data, the sensitivity of statutorily collected PIH/PE data was assessed for each outcome group. Using these sensitivities, the estimated risks of death and CP in births to all women with and without PIH/PE were compared.

RESULTS

Sensitivity of statutory PIH/PE data decreased with increasingly poor outcome. Reconstructed cohorts showed that PIH/PE increased the risks both of CP and of perinatal death in births at lower gestations except in births <27 weeks, where the risk of perinatal death only increased greatly.

INTERPRETATION

PIH/PE does not protect against poor outcome at any gestational age. Previously reported protective effects originate from inappropriate control for gestational age and not from higher gestation-specific perinatal mortality.

Disproportionate fetal growth and the risk for congenital cerebral palsy in singleton births

OBJECTIVE

To investigate the association between proportionality of fetal and placental growth measured at birth and the risk for congenital cerebral palsy (CP).

STUDY DESIGN

We identified all live-born singletons born in Denmark between 1995 and 2003 and followed them from 1 year of age until December 31st, 2008. Information on four indices of fetal growth: ponderal index, head circumference/ abdominal circumference ratio, cephalization index and birth weight/ placenta weight ratio was collected. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). All measurements were evaluated as gestational age and sex specific z-scores and in z-score percentile groups, adjusted for potential confounders, and stratified on gestational age groups (<32, 32-36, 37-38, 39, 40, ≥ 41 weeks).

RESULTS

We identified 503,784 singleton births, of which 983 were confirmed cases of CP. Head/ abdominal circumference ratio (aHR:1.12; 95%CI:1.07-1.16) and cephalization index (aHR:1.14; 95%CI:1.11-1.16) were associated with the risk of CP irrespective of gestational age. Birth weight-placental weight ratio was also associated with CP in the entire cohort (aHR:0.90; 95%CI:0.83-0.97). Ponderal index had a u-shaped association with CP, where both children with low and high ponderal index were at higher risk of CP.

CONCLUSIONS

CP is associated with disproportions between birth weight, birth length, placental weight and head circumference suggesting pre and perinatal conditions contribute to fetal growth restriction in children with CP.

Cerebral palsy in Al-Quseir City, Egypt: prevalence, subtypes, and risk factors

Cerebral palsy (CP) is the most frequent cause of motor handicap. The present door-to-door survey was conducted in Al-Quseir City, Egypt, to investigate the epidemiology of CP. All inhabitants were screened by three neurologists. Medical and neurological examinations were performed for all residents and suspected cases of CP were confirmed by meticulous neurological assessment, brain magnetic resonance imaging, electroencephalography, and testing with the Stanford-Binet Intelligence Scale. Forty-six of 12,788 children aged ≤18 years were found to have CP, yielding a childhood prevalence of 3.6 (95% confidence interval 1.48-2.59) per 1,000 live births. Five adults (aged 19-40 years) among 13,056 inhabitants had CP, giving an adult prevalence of 0.4 (95% confidence interval 0.04-0.72) per 1,000. The risk factors for CP identified in this study were premature birth, low birth weight, neonatal jaundice, neonatal seizures, and recurrent abortion in mothers of children with CP.

Epileptic and cognitive changes in children with cerebral palsy: an Egyptian study

BACKGROUND

Cerebral palsy (CP) is the most frequent cause of motor handicap among children.

AIM OF THE STUDY

We aim to study the relation of epilepsy in children with CP to various risk factors that affect the development of seizures.

PATIENTS AND METHODS

In a cross-sectional, descriptive, population-based, case-control study, 98 children with CP (48 children with CP with epilepsy, and 50 children with CP without epilepsy) were compared with 180 children without CP or seizures. The children lived in two regions in Egypt: the Al-Kharga District-New Valley and El-Quseir city-Red Sea. These cases were subjected to meticulous neurological assessment, brain magnetic resonance imaging, electroencephalography, and Stanford-Binet (4th edition) examination. Multinomial logistic regression was used to assess the risk factors.

RESULTS

Epilepsy was diagnosed in 48.9% of all cases of CP. Mental subnormality was observed more frequently in children with epilepsy than in those without epilepsy (84.6% versus 66.7%). The frequency of epilepsy was highest in patients with the spastic quadriplegic type of illness (58.3%). Multinomial logistic regression revealed that prematurity (<32 weeks of pregnancy), low birth weight (<2.5 kg at birth), neonatal seizures, jaundice, and cyanosis were significantly associated with CP with epilepsy.

CONCLUSION

CP is associated with a high percentage of seizure disorders. Prematurity, low birth weight, neonatal seizures, cyanosis, and jaundice are significant risk factors among patients with CP with epilepsy compared to patients with CP without epilepsy or a healthy control group.

Congenital cerebral palsy and prenatal exposure to self-reported maternal infections, fever, or smoking

OBJECTIVE

The objective of the study was to investigate the association between maternal self-reported infections, fever, and smoking in the prenatal period and the subsequent risk for congenital cerebral palsy (CP).

STUDY DESIGN

We included the 81,066 mothers of singletons born between 1996 and 2003 who participated in the Danish National Birth Cohort. Children were followed up through December 2008. Information on maternal infections, fever, smoking, and other demographic and lifestyle factors during pregnancy were reported by mothers in computer-assisted telephone interviews in early and midgestation. We identified 139 CP cases including 121 cases of spastic CP (sCP) as confirmed by the Danish National Cerebral Palsy Register. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).

RESULTS

Self-reported vaginal infections were associated with an increased risk of CP and sCP (aHR, 1.52; 95% CI, 1.04-2.24; and aHR, 1.73; 95% CI, 1.16-2.60, respectively) and particularly untreated vaginal infections were associated with an increased risk of sCP (aHR, 1.95; 95% CI, 1.16-3.26). Fever was associated with the risk of CP (aHR, 1.53; 95% CI, 1.06-2.21). Smoking 10 or more cigarettes per day during pregnancy was also associated with sCP (aHR, 1.80; 95% CI, 1.10-2.94). There was a modest excess in risk for children exposed to both heavy smoking and vaginal infections. No other self-reported infections were significantly associated with CP.

CONCLUSION

Self-reported vaginal infections, fever, and smoking 10 or more cigarettes per day during pregnancy were associated with a higher risk of overall CP and/or sCP.

An update on the prevalence of cerebral palsy: a systematic review and meta-analysis

AIMS

The aim of this study was to provide a comprehensive update on (1) the overall prevalence of cerebral palsy (CP); (2) the prevalence of CP in relation to birthweight; and (3) the prevalence of CP in relation to gestational age.

METHOD

A systematic review and meta-analysis was conducted and reported, based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Population-based studies on the prevalence of CP in children born in 1985 or after were selected. Statistical analysis was carried out using computer package R, version 2.14.

RESULTS

A total of 49 studies were selected for this review. The pooled overall prevalence of CP was 2.11 per 1000 live births (95% confidence interval [CI] 1.98-2.25). The prevalence of CP stratified by gestational age group showed the highest pooled prevalence to be in children weighing 1000 to 1499g at birth (59.18 per 1000 live births; 95% CI 53.06-66.01), although there was no significant difference on pairwise meta-regression with children weighing less than 1000g. The prevalence of CP expressed by gestational age was highest in children born before 28 weeks' gestation (111.80 per 1000 live births; 95% CI 69.53-179.78; p<0.0327).

INTERPRETATION

The overall prevalence of CP has remained constant in recent years despite increased survival of at-risk preterm infants.

The association of cerebral palsy with birth asphyxia: a definitional quagmire

AIM

The aim of this study was to investigate whether current literature provides a useful body of evidence reflecting the proportion of cerebral palsy (CP) that is attributable to birth asphyxia.

METHOD

We identified 23 studies conducted between 1986 and 2010 that provided data on intrapartum risks of CP.

RESULTS

The proportion of CP with birth asphyxia as a precursor (case exposure rate) varied from less than 3% to over 50% in the 23 studies reviewed. The studies were heterogeneous in many regards, including the definitions for birth asphyxia and the outcome of CP.

INTERPRETATIONS

Current data do not support the belief, widely held in the medical and legal communities, that birth asphyxia can be recognized reliably and specifically, or that much of CP is due to birth asphyxia. The very high case exposure rates linking birth asphyxia to CP can probably be attributed to several factors: the fact that the clinical picture at birth cannot specifically identify birth asphyxia; the definition of CP employed; and confusion of proximal effects - results - with causes. Further research is needed.

Prevalence and risk factors of neurological impairment among children aged 6-9 years: from population based cross sectional study in western Kenya

Background

The burden of disability is more severe among children in low income countries. Moreover, the number of children with disabilities (CWDs) in sub-Saharan Africa is predicted to increase with reduction in child mortality. Although the issue on CWDs is important in sub-Saharan Africa, there are few researches on risk factors of disabilities. The purpose of this study was to evaluate the risk factors of neurological impairment (NI) among children in western Kenya.

Methods

The present study was conducted in Mbita district (which has high HIV infectious prevalence), Kenya from April 2009 to December 2010. The study consisted of two phases. In phase 1, the Ten Question Questionnaire (TQQ) was administered to all 6362 caregivers of children aged 6–9 years. In phase two, all 413 children with TQQ positive and a similar number of controls (n=420) which were randomly selected from children with TQQ negative were examined for physical and cognitive status. In addition, a structured questionnaire was also conducted to their caregivers.

Results

The prevalence was estimated to be 29/1000. Among the types of impairments, cognitive impairment was the most common (24/1000), followed by physical impairment (5/1000). In multivariate analysis, having more than five children [adjusted odds ratio (AOR): 2.85; 95%IC: 1.25 – 6.49; p=0.013], maternal age older than 35 years old [AOR: 2.31; 95%IC: 1.05 – 5.07; p=0.036] were significant factors associated with NI. In addition, monthly income under 3000 ksh [AOR: 2.79; 95%IC: 1.28 – 6.08; p=0.010] and no maternal tetanus shot during antenatal care [AOR: 5.17; 95%IC: 1.56 – 17.14; p=0.007] were also significantly related with having moderate/severe neurological impairment.

Conclusion

It was indicated that increasing coverage of antenatal care including maternal tetanus shot and education of how to take care of neonatal children to prevent neurological impairment are important.

Uncovering the complex relationship between pre-eclampsia, preterm birth and cerebral palsy

Pre-eclampsia is a leading cause of preterm birth, which is strongly associated with cerebral palsy (CP). However, there is controversy about whether pre-eclampsia is associated with increased risk of CP. We evaluated the association between pre-eclampsia and CP in 122,476 mother-child pairs insured by the South Carolina Medicaid programme, with births between 1996 and 2002. Prenatal billing records were linked to the children's Medicaid billing records after birth until December 2008. The odds of CP were modelled using logistic regression with generalised estimating equations. There were 337 children (0.28%) diagnosed with CP by at least two different health care providers, and 4226 (3.5%) women were diagnosed with pre-eclampsia at least twice during pregnancy. Children whose mothers had pre-eclampsia were almost twice as likely to have CP compared with children of mothers without pre-eclampsia [odds ratio (OR)=1.94, 95% confidence interval (CI) 1.25, 2.97]. The association was only significant for pre-eclampsia diagnosed prior to 37 weeks' gestation. Full term (gestational age ≥ 37 weeks) infants whose mothers were diagnosed with pre-eclampsia prior to 37 weeks had increased odds of CP compared with full term children whose mothers did not have pre-eclampsia (OR=3.41, 95% CI 1.40, 8.31). Preterm infants whose mothers had pre-eclampsia were at significantly increased risk of CP compared with full term infants whose mothers did not have pre-eclampsia (OR=5.88, 95% CI 3.40, 10.17). The greatest risk for CP was in preterm infants whose mothers did not have pre-eclampsia (OR=8.12, 95% CI 6.49, 10.17 compared with full term infants without exposure to pre-eclampsia). We conclude that pre-eclampsia with onset before 37 weeks' gestation is a significant risk factor for CP. Some of the association is probably attributable to high risk of preterm birth because of early pre-eclampsia, while a 'direct' effect of pre-eclampsia on fetal brain development also seems likely.

Is breech presentation a risk factor for cerebral palsy? A Norwegian birth cohort study

AIM

To study whether breech presentation is a risk factor for cerebral palsy (CP).

METHODS

Perinatal data from 177 272 children born in breech or vertex presentation in Norway during 1996 to 1998 were retrieved from the Medical Birth Registry of Norway. Data were collected between 1 January 2003 and 31 March 2006. Data on 245 children with CP were recorded in the Norwegian Cerebral Palsy Registry. Odds ratios (OR) with 95% confidence intervals (CI) for CP among children born in breech compared with vertex presentation were calculated. Confounding was addressed in logistic regression and stratified analyses.

RESULTS

Among the 245 children with CP (46.5% females and 53.5% males), 31% had unilateral, 49% bilateral, 7% dyskinetic, and 5% the ataxic subtype, and 8% of cases were unclassified. Among children born in breech, the OR for CP was 3.6 (95% CI 2.4-5.3). The increased risk was reduced when adjusted for preterm birth, plurality, and smallness for gestational age. Among singletons born in breech by vaginal delivery at term, the OR for CP was 3.9 (95% CI 1.6-9.7). Severity or subtype of CP did not differ between breech and vertex presentation.

INTERPRETATION

Breech delivery is a significant risk factor for CP, in particular among singletons born by vaginal delivery at term.

Factors influencing women's decision to have a home birth in rural Turkey

OBJECTIVE

to ascertain the reasons why mothers choose to have a home birth and the factors that influence these reasons.

METHODS

this cross-sectional study involved 392 women and was conducted between June and September 2003 in a rural setting in Turkey. The data were collected using a questionnaire developed by the authors. The questionnaire included demographic information, obstetric background, the reasons for deciding to give birth at home as well as questions on who encouraged the decision to give birth at home and who assisted in the home births.

FINDINGS

the decision to have a home birth is related to economic difficulties and the desire to benefit from the assistance of neighbours. Women who had experienced both planned and unplanned home births reported that home birth was unsafe.

CONCLUSION

preliminary information is provided about women having home births that may inform practitioners' educational efforts and future research.