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Chen Y, Huang JY, Wei JCC, Lee SY, Huang YF. Risk factors for cerebral palsy in children in Taiwan. Dev Med Child Neurol 2024; 66:1062-1073. [PMID: 38263613 DOI: 10.1111/dmcn.15846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/25/2024]
Abstract
AIM To determine the significant risk factors of cerebral palsy (CP) in Taiwanese children and the associations between infant-related and parent-related factors. METHOD Data from 1 459 093 infants and their parents in Taiwan's national databases collected between 2009 and 2016 were used. The cohort with CP included children diagnosed with CP between birth and age 3 years; a total of 3254 children with CP were included in the final analysis. Hierarchical logistic regression models were used to estimate the odds ratio for the risk factors of CP. RESULTS The hierarchical logistic regression models indicated that significant risk factors associated with CP are suburban location, low income, maternal and paternal diabetes mellitus, paternal substance abuse, paternal seizure disorder, male sex, birth by Cesarean section, singleton birth, low birthweight, being born extremely and very preterm, intraventricular hemorrhage, and periventricular leukomalacia, as well as tube feeding, ventilator use, and dopamine administration within 6 months of age. INTERPRETATION In addition to common maternal and infant risk factors, we identified significant paternal risk factors associated with CP, including diabetes mellitus, seizure disorder, and substance abuse. The combination of maternal, paternal, and infant risk factors in CP holds great promise for early identification and intervention.
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Affiliation(s)
- Yuping Chen
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Department of Allergy, Immunology, and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
| | - Shih-Yu Lee
- College of Nursing, Hungkuang University, Taichung, Taiwan
| | - Ya-Fang Huang
- College of Nursing, Hungkuang University, Taichung, Taiwan
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Mohanty T, Joseph SD, Gunasekaran PK, Doreswamy SM, Saini L. Predictors of Risk for Cerebral Palsy: A Review. Pediatr Phys Ther 2023:00001577-990000000-00057. [PMID: 37126801 DOI: 10.1097/pep.0000000000001020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE To identify the earliest predictors of risk for diagnosis of cerebral palsy (CP). METHODS A comprehensive literature search was conducted using various databases. The publications were reviewed to identify risk factors for CP from conception to early infancy. Studies were critically appraised with Joanna Briggs Institute guidelines for quality appraisal and evaluated for risk of bias using the Agency for Health Care Research and Quality guidelines. RESULTS The initial search yielded 129 studies and 20 studies were included. Forty-seven risk factors for CP were extracted of which several were duplicate terms. The significant risk factors found to be indicative of CP were low birth weight (<1500 g), birth at less than 28 weeks of gestational age, periventricular leukomalacia, grade 3 or 4 intraventricular hemorrhage, preeclampsia, prematurity, an Apgar score of less than 4 at the first minute, birth asphyxia, preterm premature rupture of membrane, and absent fidgety movements. CONCLUSION Twenty-three factors were consistently reported as predictors of CP.
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Affiliation(s)
- Tanochni Mohanty
- Department of Pediatric Physiotherapy (Ms Mohanty), JSS College of Physiotherapy, Mysuru, Karnataka, India; Department of Musculoskeletal Physiotherapy (Dr Joseph), Lokmanya Tilak College of Physiotherapy, Navi Mumbai, Maharashtra, India; Department of Pediatrics (Drs Gunasekaran and Saini), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India; Department of Pediatrics (Dr Doreswamy), JSS Medical College and Hospital, Mysuru, Karnataka, India
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Risk factors for cerebral palsy and movement difficulties in 5-year-old children born extremely preterm. Pediatr Res 2023:10.1038/s41390-022-02437-6. [PMID: 36694025 DOI: 10.1038/s41390-022-02437-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/10/2022] [Accepted: 11/19/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Motor impairment is common after extremely preterm (EPT, <28 weeks' gestational age (GA)) birth, with cerebral palsy (CP) affecting about 10% of children and non-CP movement difficulties (MD) up to 50%. This study investigated the sociodemographic, perinatal and neonatal risk factors for CP and non-CP MD. METHODS Data come from a European population-based cohort of children born EPT in 2011-2012 in 11 countries. We used multinomial logistic regression to assess risk factors for CP and non-CP MD (Movement Assessment Battery for Children - 2nd edition ≤5th percentile) compared to no MD (>15th percentile) among 5-year-old children. RESULTS Compared to children without MD (n = 366), young maternal age, male sex and bronchopulmonary dysplasia were similarly associated with CP (n = 100) and non-CP MD (n = 224) with relative risk ratios (RRR) ranging from 2.3 to 3.6. CP was strongly related to severe brain lesions (RRR >10), other neonatal morbidities, congenital anomalies and low Apgar score (RRR: 2.4-3.3), while non-CP MD was associated with primiparity, maternal education, small for GA (RRR: 1.6-2.6) and severe brain lesions, but at a much lower order of magnitude. CONCLUSION CP and non-CP MD have different risk factor profiles, with fewer clinical but more sociodemographic risk factors for non-CP MD. IMPACT Young maternal age, male sex and bronchopulmonary dysplasia similarly increased risks of both cerebral palsy and non-cerebral palsy movement difficulties. Cerebral palsy was strongly related to clinical risk factors including severe brain lesions and other neonatal morbidities, while non-cerebral palsy movement difficulties were more associated with sociodemographic risk factors. These results on the similarities and differences in risk profiles of children with cerebral palsy and non-cerebral palsy movement difficulties raise questions for etiological research and provide a basis for improving the identification of children who may benefit from follow-up and early intervention.
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Tamura A, Yamaguchi K, Yanagida R, Miyata R, Tohara H. At-Home Orthodontic Treatment for Severe Teeth Arch Malalignment and Severe Obstructive Sleep Apnea Syndrome in a Child with Cerebral Palsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095333. [PMID: 35564726 PMCID: PMC9099996 DOI: 10.3390/ijerph19095333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Atsuko Tamura
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (A.T.); (R.Y.); (H.T.)
| | - Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (A.T.); (R.Y.); (H.T.)
- Correspondence: ; Tel.: +81-3-5803-5587
| | - Ryosuke Yanagida
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (A.T.); (R.Y.); (H.T.)
| | - Rie Miyata
- Department of Pediatrics, Tokyo Kita-Medical Center, Tokyo 115-0053, Japan;
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (A.T.); (R.Y.); (H.T.)
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Osredkar D, Verdenik I, Gergeli AT, Gersak K, Lucovnik M. Apgar Score and Risk of Cerebral Palsy in Preterm Infants: A Population-Based Cohort Study. Neuropediatrics 2021; 52:310-315. [PMID: 34162009 DOI: 10.1055/s-0041-1729181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A low Apgar score is associated with increased risk of cerebral palsy (CP) in term infants, while such association remains controversial in preterm neonates. The objective of this study was to assess association between 5-minute Apgar scores and CP in different subcategories of preterm birth based on gestational age. The Slovenian National Perinatal Information System was used to identify singleton children without congenital malformations live-born at 22 to 37 weeks of gestation between 2002 and 2010. Data were linked to the Slovenian Registry of Cerebral Palsy in children born between 2002 and 2010. CP was diagnosed at a minimum of 5 years of age. Of 11,924 children included, 241 (2.0%) died before discharge and 153 (1.3%) were diagnosed with CP. Five-minute Apgar scores <7 were significantly associated with higher risk of death or CP (compared with scores ≥9) at all preterm gestations. CP alone was associated with Apgar scores <7 only at moderately or late preterm gestation (32-36 weeks) (adjusted relative risk [aRR]: 8.27; 95% confidence interval [CI]: 1.87-36.64 for scores 0-4 and aRR: 4.96; 95% CI 1.89-13.06 for scores 5-6). In conclusion, a low 5-minute Apgar score was associated with combined outcome of neonatal death or CP in all preterm births, while in surviving preterm infants at >32 weeks a low 5-minute Apgar score was associated with CP.
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Affiliation(s)
- Damjan Osredkar
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Anja Troha Gergeli
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Ksenija Gersak
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Lucovnik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center Ljubljana, Ljubljana, Slovenia
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Abstract
Abstract
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.
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Abstract
OBJECTIVE To investigate the association between bronchopulmonary dysplasia (BPD) and the risk of cerebral palsy (CP) in children. DATA SOURCES We used EMBASE, PubMed and Web of Science to conduct a meta-analysis of studies published before 1 September 2017, written in English whose titles or abstracts discussed an association between BPD and CP. STUDY SELECTION Observational studies, for example, case-control and cohort studies were included. DATA EXTRACTION AND SYNTHESIS All review stages were conducted by two reviewers independently. Data synthesis was undertaken via meta-analysis of available evidence. MAIN OUTCOMES AND MEASURES The prevalence of developing CP was measured after exposure to BPD. RESULTS Among 1234 initially identified studies, we selected those that addressed an association between BPD and CP according to our preselected inclusion criteria. Our meta-analysis included 11 studies. According to a random effect model, BPD was significantly associated with CP (ORs 2.10; 95% CI 1.57 to 2.82) in preterm infants. Factors explaining differences in the study results included study design, the definition of BPD, the time of diagnosis of CP and whether the studies adjusted for potential confounders. CONCLUSION This study suggests that BPD is a risk factor for CP. Further studies are required to confirm these results and to detect the influence of variables across studies.
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Affiliation(s)
- Xiaoyun Gou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Lei Yang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Lingli Pan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Dongqiong Xiao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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Korzeniewski SJ, Slaughter J, Lenski M, Haak P, Paneth N. The complex aetiology of cerebral palsy. Nat Rev Neurol 2018; 14:528-543. [PMID: 30104744 DOI: 10.1038/s41582-018-0043-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
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.
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Affiliation(s)
- Steven J Korzeniewski
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Jaime Slaughter
- Department of Health Systems and Sciences Research and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, USA
| | - Madeleine Lenski
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Peterson Haak
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Shepherd E, Salam RA, Middleton P, Han S, Makrides M, McIntyre S, Badawi N, Crowther CA. Neonatal interventions for preventing cerebral palsy: an overview of Cochrane Systematic Reviews. Cochrane Database Syst Rev 2018; 6:CD012409. [PMID: 29926474 PMCID: PMC6513209 DOI: 10.1002/14651858.cd012409.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cerebral palsy is an umbrella term that encompasses disorders of movement and posture attributed to non-progressive disturbances occurring in the developing foetal or infant brain. As there are diverse risk factors and aetiologies, no one strategy will prevent cerebral palsy. Therefore, there is a need to systematically consider all potentially relevant interventions for prevention. OBJECTIVES PrimaryTo summarise the evidence from Cochrane Systematic Reviews regarding effects of neonatal interventions for preventing cerebral palsy (reducing cerebral palsy risk).SecondaryTo summarise the evidence from Cochrane Systematic Reviews regarding effects of neonatal interventions that may increase cerebral palsy risk. METHODS We searched the Cochrane Database of Systematic Reviews (27 November 2016) for reviews of neonatal interventions reporting on cerebral palsy. Two review authors assessed reviews for inclusion, extracted data, and assessed review quality (using AMSTAR and ROBIS) and quality of the evidence (using the GRADE approach). Reviews were organised by topic; findings were summarised in text and were tabulated. Interventions were categorised as effective (high-quality evidence of effectiveness); possibly effective (moderate-quality evidence of effectiveness); ineffective (high-quality evidence of harm); probably ineffective (moderate-quality evidence of harm or lack of effectiveness); and no conclusions possible (low- to very low-quality evidence). MAIN RESULTS Forty-three Cochrane Reviews were included. A further 102 reviews pre-specified the outcome cerebral palsy, but none of the included randomised controlled trials (RCTs) reported this outcome. Included reviews were generally of high quality and had low risk of bias, as determined by AMSTAR and ROBIS. These reviews involved 454 RCTs; data for cerebral palsy were available from 96 (21%) RCTs involving 15,885 children. Review authors considered interventions for neonates with perinatal asphyxia or with evidence of neonatal encephalopathy (3); interventions for neonates born preterm and/or at low or very low birthweight (33); and interventions for other specific groups of 'at risk' neonates (7). Quality of evidence (GRADE) ranged from very low to high.Interventions for neonates with perinatal asphyxia or with evidence of neonatal encephalopathyEffective interventions: high-quality evidence of effectivenessResearchers found a reduction in cerebral palsy following therapeutic hypothermia versus standard care for newborns with hypoxic ischaemic encephalopathy (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.54 to 0.82; seven trials; 881 children).No conclusions possible: very low-quality evidenceOne review observed no clear differences in cerebral palsy following therapeutic hypothermia versus standard care.Interventions for neonates born preterm and/or at low or very low birthweightPossibly effective interventions: moderate-quality evidence of effectivenessResearchers found a reduction in cerebral palsy with prophylactic methylxanthines (caffeine) versus placebo for endotracheal extubation in preterm infants (RR 0.54, 95% CI 0.32 to 0.92; one trial; 644 children).Probably ineffective interventions: moderate-quality evidence of harmResearchers reported an increase in cerebral palsy (RR 1.45, 95% CI 1.06 to 1.98; 12 trials; 1452 children) and cerebral palsy in assessed survivors (RR 1.50, 95% CI 1.13 to 2.00; 12 trials; 959 children) following early (at less than eight days of age) postnatal corticosteroids versus placebo or no treatment for preventing chronic lung disease in preterm infants.Probably ineffective interventions: moderate-quality evidence of lack of effectivenessTrial results showed no clear differences in cerebral palsy following ethamsylate versus placebo for prevention of morbidity and mortality in preterm or very low birthweight infants (RR 1.13, 95% CI 0.64 to 2.00; three trials, 532 children); volume expansion versus no treatment (RR 0.76, 95% CI 0.48 to 1.20; one trial; 604 children); gelatin versus fresh frozen plasma (RR 0.94, 95% CI 0.52 to 1.69; one trial, 399 children) for prevention of morbidity and mortality in very preterm infants; prophylactic indomethacin versus placebo for preventing mortality and morbidity in preterm infants (RR 1.04, 95% CI 0.77 to 1.40; four trials; 1372 children); synthetic surfactant versus placebo for respiratory distress syndrome in preterm infants (RR 0.76, 95% CI 0.55 to 1.05; five trials; 1557 children); or prophylactic phototherapy versus standard care (starting phototherapy when serum bilirubin reached a pre-specified level) for preventing jaundice in preterm or low birthweight infants (RR 0.96, 95% CI 0.50 to 1.85; two trials; 756 children).No conclusions possible: low- to very low-quality evidenceNo clear differences in cerebral palsy were observed with interventions assessed in 21 reviews.Interventions for other specific groups of 'at risk' neonatesNo conclusions possible: low- to very low-quality evidenceReview authors observed no clear differences in cerebral palsy with interventions assessed in five reviews. AUTHORS' CONCLUSIONS This overview summarises evidence from Cochrane Systematic Reviews regarding effects of neonatal interventions on cerebral palsy, and can be used by researchers, funding bodies, policy makers, clinicians, and consumers to aid decision-making and evidence translation. To formally assess other benefits and/or harms of included interventions, including impact on risk factors for cerebral palsy, review of the included Reviews is recommended.Therapeutic hypothermia versus standard care for newborns with hypoxic ischaemic encephalopathy can prevent cerebral palsy, and prophylactic methylxanthines (caffeine) versus placebo for endotracheal extubation in preterm infants may reduce cerebral palsy risk. Early (at less than eight days of age) postnatal corticosteroids versus placebo or no treatment for preventing chronic lung disease in preterm infants may increase cerebral palsy risk.Cerebral palsy is rarely identified at birth, has diverse risk factors and aetiologies, and is diagnosed in approximately one in 500 children. To date, only a small proportion of Cochrane Systematic Reviews assessing neonatal interventions have been able to report on this outcome. There is an urgent need for long-term follow-up of RCTs of such interventions addressing risk factors for cerebral palsy (through strategies such as data linkage with registries) and for consideration of the use of relatively new interim assessments (including the General Movements Assessment). Such RCTs must be rigorous in their design and must aim for consistency in cerebral palsy outcome measurement and reporting to facilitate pooling of data and thus to maximise research efforts focused on prevention.
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Affiliation(s)
- Emily Shepherd
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Rehana A Salam
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan74800
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Shanshan Han
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Sarah McIntyre
- University of SydneyResearch Institute, Cerebral Palsy Alliance187 Allambie Road, Allambie HeightsSydneyAustralia2100
| | - Nadia Badawi
- University of SydneyResearch Institute, Cerebral Palsy Alliance187 Allambie Road, Allambie HeightsSydneyAustralia2100
- The Children's Hospital at WestmeadGrace Centre for Newborn CareSydneyAustralia
| | - Caroline A Crowther
- The University of AucklandLiggins InstitutePrivate Bag 9201985 Park RoadAucklandNew Zealand
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Reese J, Scott TA, Patrick SW. Changing patterns of patent ductus arteriosus surgical ligation in the United States. Semin Perinatol 2018; 42:253-261. [PMID: 29954594 PMCID: PMC6512985 DOI: 10.1053/j.semperi.2018.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids' Inpatient Database (2000-2012) to determine if PDA ligation rates: (1) changed over time, (2) varied geographically, or (3) influenced surgical complication rates. In 2012, 47,900 infants <1500g birth weight were born in the United States, including 2,800 undergoing PDA ligation (5.9%). Ligation was more likely in infants <1000g (85.9% vs. 46.2%), and associated with necrotizing enterocolitis (59.2% vs. 37.5%), BPD (54.6% vs. 15.2%), severe intraventricular hemorrhage (16.4% vs. 5.3%), and hospital transfer (37.6% vs. 16.4%). Ligation rates peaked in 2006 at 87.4 per 1000 hospital births, dropping to 58.8 in 2012, and were consistently higher in Western states. Infants undergoing ligation were more likely to experience comorbidities. Rates of ligation-associated vocal cord paralysis increased over time (1.2-3.9%); however, mortality decreased (12.4-6.5%). Thus, PDA ligation has become less frequent, although infants being ligated are smaller and more medically complex. Despite increase in some complications, mortality rates improved perhaps reflecting advances in care.
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Affiliation(s)
- Jeff Reese
- Mildred T. Stahlman Division of Neonatology, Vanderbilt University Medical Center, 11111 Doctor’s Office Tower, 2200 Children’s Way, Nashville 37232–9544, TN
| | - Theresa A. Scott
- Mildred T. Stahlman Division of Neonatology, Vanderbilt University Medical Center, 11111 Doctor’s Office Tower, 2200 Children’s Way, Nashville 37232–9544, TN
| | - Stephen W. Patrick
- Mildred T. Stahlman Division of Neonatology, Vanderbilt University Medical Center, 11111 Doctor’s Office Tower, 2200 Children’s Way, Nashville 37232–9544, TN,Center for Health Services Research, Vanderbilt Center for Child Health Policy, Nashville, TN,Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN,Corresponding author. (S.W. Patrick)
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Ascherl R, Sorge I, Thome U, Hirsch FW, Bläser A, Kiess W, Merkenschlager A. Severe gyration and migration disorder in fetofetal transfusion syndrome: two case reports and a review of the literature on the neurological outcome of children with lesions on neuroimaging. Childs Nerv Syst 2018; 34:155-163. [PMID: 28971247 DOI: 10.1007/s00381-017-3595-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Fetofetal transfusion syndrome is a dreaded cause of morbidity and mortality in monochorionic pregnancies. CASE REPORTS We present two pairs of twins one of which we have followed for more than 6 years. The donors suffer from cerebral palsy, orofacial, and motor problems, and both are significantly smaller than their recipient twins. Interestingly, cranial MRI revealed medial frontal lobe polymicrogyria, ventriculomegaly, and decreased thickness in both parietal lobes in both donors. We suggest this as a possible feature of fetofetal transfusion syndrome. REVIEW A minireview of the literature on neuroimaging and neurodevelopmental outcome in fetofetal transfusion syndrome is presented. CONCLUSION While the close resemblance of the imaging features of both cases is likely incidental further study of a connection between migration and gyration disorders and fetofetal transfusion syndrome is warranted.
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Affiliation(s)
- Rudolf Ascherl
- Hospital for Children and Adolescents, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany.
| | - Ina Sorge
- Department of Imaging and Radiotherapy, Section Pediatric Radiology, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Ulrich Thome
- Division of Neonatology, Hospital for Children and Adolescents, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Franz Wolfgang Hirsch
- Department of Imaging and Radiotherapy, Section Pediatric Radiology, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Annett Bläser
- Division of Neonatology, Hospital for Children and Adolescents, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Andreas Merkenschlager
- Division of Neuropediatrics, Hospital for Children and Adolescents, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
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Zhao M, Dai H, Deng Y, Zhao L. SGA as a Risk Factor for Cerebral Palsy in Moderate to Late Preterm Infants: a System Review and Meta-analysis. Sci Rep 2016; 6:38853. [PMID: 27958310 PMCID: PMC5153647 DOI: 10.1038/srep38853] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/11/2016] [Indexed: 11/09/2022] Open
Abstract
Small for gestational age (SGA) is an established risk factor for cerebral palsy (CP) in term infants. However, there is conflicting data on the association between SGA and CP in moderate to late preterm infants. The aim of the article was to explore the relationship between SGA and CP in the moderate to late preterm infants and its strength by meta-analysis. We performed a system search in OVID (EMBASE and MEDLINE) and WANFANG from inception to May 2016. The study-specific risk estimates were pooled using the random-effect model. A total of seven studies were included in the meta-analysis, consisting of three cohort and four case-control studies. A statistically significant association was found between SGA and CP in moderate to late premature infants (OR: 2.34; 95% CI: 1.43-3.82). The association were higher in the several subgroups: 34-36 week gestational age (OR: 3.47; 95% CI: 1.29-9.31), SGA < 2SDs (OR: 3.48; 95% CI: 1.86-6.49), and malformation included in CP (OR: 3.00; 95% CI: 1.71-5.26). In moderate to late premature infants, SGA is a convenient and reliable predictor for CP. More studies are needed to explore the underlying mechanisms between SGA and CP association.
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Affiliation(s)
- Mengwen Zhao
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hongmei Dai
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yuanying Deng
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lingling Zhao
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
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Shepherd E, Middleton P, Makrides M, McIntyre S, Badawi N, Crowther CA. Neonatal interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews. Hippokratia 2016. [DOI: 10.1002/14651858.cd012409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Emily Shepherd
- The University of Adelaide; ARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology; Adelaide South Australia Australia 5006
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute; Women's and Children's Hospital 72 King William Road Adelaide South Australia Australia 5006
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute; Women's and Children's Hospital 72 King William Road Adelaide South Australia Australia 5006
| | - Sarah McIntyre
- University of Sydney; Research Institute, Cerebral Palsy Alliance; 187 Allambie Road, Allambie Heights Sydney Australia 2100
| | - Nadia Badawi
- University of Sydney; Research Institute, Cerebral Palsy Alliance; 187 Allambie Road, Allambie Heights Sydney Australia 2100
- The Children's Hospital at Westmead; Grace Centre for Newborn Care; Sydney Australia
| | - Caroline A Crowther
- The University of Auckland; Liggins Institute; Private Bag 92019 85 Park Road Auckland New Zealand
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van Lieshout P, Candundo H, Martino R, Shin S, Barakat-Haddad C. Onset factors in cerebral palsy: A systematic review. Neurotoxicology 2016; 61:47-53. [PMID: 27045882 DOI: 10.1016/j.neuro.2016.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 12/31/2022]
Abstract
Studies have noted several factors associated with the occurrence of Cerebral Palsy (CP), yet considerable uncertainty remains about modifiable factors related to disease onset. A systematic review was performed to identify existing systematic reviews and primary studies pertaining to targeted factors associated with the onset of CP. The following databases were searched: MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, Scopus, Web of Science, Cochrane Database of Systematic Reviews, CINHAL, ProQuest Dissertations & Theses, Huge Navigator, AARP Ageline. Variations of MeSH and keyword search terms were used. Critical appraisal was conducted on selected articles. Data extraction targeted reported factors, risk estimates, and 95% confidence intervals (CI). Findings identified two systematic reviews and three meta- analyses, as well as 83 studies of case control, cohort, and cross-sectional methodological designs. Selected studies indicated that lower gestational age was associated with the onset of CP. Medical diagnoses for the mother, in particular chorioamnionitis, was found to be positively associated with onset of CP. Preeclampsia was reported to be either inconclusive or positively associated with CP onset. Low birth weight predominantly indicated a positive association with the onset of CP, while male gender showed mixed findings. The combination of male gender with pre-term or low birth weight was also found to be positively associated with CP. Evidence was identified in the literature pertaining to specific factors relating to the onset of CP, in particular showing positive associations with lower gestational age and low birth weight.
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Affiliation(s)
- Pascal van Lieshout
- Department of Speech Language Pathology, University of Toronto, Canada; Department of Psychology, University of Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Canada; Toronto Rehabilitation Institute, University Health Network, Canada.
| | - Hamilton Candundo
- Faculty of Health Sciences, University of Ontario Institute of Technology, Canada
| | - Rosemary Martino
- Department of Speech Language Pathology, University of Toronto, Canada; Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Canada; Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Sabina Shin
- Faculty of Health Sciences, University of Ontario Institute of Technology, Canada; Department of Pediatrics, McMaster University, Canada
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Reese J, Laughon MM. The Patent Ductus Arteriosus Problem: Infants Who Still Need Treatment. J Pediatr 2015; 167:954-6. [PMID: 26316368 PMCID: PMC5666689 DOI: 10.1016/j.jpeds.2015.08.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/06/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Jeff Reese
- Department of Pediatrics and Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
| | - Matthew M. Laughon
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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16
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Gomes Neto O, Marins M, Botelho RD, Nivoloni RC, Saura GE, Vessoni Arias A, Barini R, Peralta CFA. Feasibility and reproducibility of diffusion-weighted magnetic resonance imaging of the fetal brain in twin-twin transfusion syndrome. Prenat Diagn 2014; 34:1182-8. [DOI: 10.1002/pd.4449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 06/25/2014] [Accepted: 06/28/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Orlando Gomes Neto
- Department of Obstetrics and Gynecology, Professor José Aristodemo Pinotti Hospital, Center for Integral Assistance to Women's Health; State University of Campinas (UNICAMP); Campinas SP Brazil
| | - Marcos Marins
- Centro Radiológico Campinas (CRC); Vera Cruz Hospital; Campinas SP Brazil
| | - Rafael D. Botelho
- Department of Obstetrics and Gynecology, Professor José Aristodemo Pinotti Hospital, Center for Integral Assistance to Women's Health; State University of Campinas (UNICAMP); Campinas SP Brazil
| | | | - Glauco E. Saura
- Centro Radiológico Campinas (CRC); Vera Cruz Hospital; Campinas SP Brazil
| | - Amábile Vessoni Arias
- Department of Neurology, Clinics Hospital; State University of Campinas (UNICAMP); Campinas SP Brazil
| | - Ricardo Barini
- Department of Obstetrics and Gynecology, Professor José Aristodemo Pinotti Hospital, Center for Integral Assistance to Women's Health; State University of Campinas (UNICAMP); Campinas SP Brazil
| | - Cleisson F. A. Peralta
- Department of Obstetrics and Gynecology, Professor José Aristodemo Pinotti Hospital, Center for Integral Assistance to Women's Health; State University of Campinas (UNICAMP); Campinas SP Brazil
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Tsai WH, Hwang YS, Hung TY, Weng SF, Lin SJ, Chang WT. Association between mechanical ventilation and neurodevelopmental disorders in a nationwide cohort of extremely low birth weight infants. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1544-1550. [PMID: 24769371 DOI: 10.1016/j.ridd.2014.03.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/25/2014] [Indexed: 06/03/2023]
Abstract
Mechanical ventilation for preterm infants independently contributes to poor neurodevelopmental performance. However, few studies have investigated the association between the duration of mechanical ventilation and the risk for various developmental disorders in extremely low birth weight (ELBW) (<1000g) infants. Using a large nationwide database, we did a 10-year retrospective follow-up study to explore the effect of mechanical ventilation on the incidence of cerebral palsy (CP), autism spectrum disorder (ASD), intellectual disability (ID), and attention-deficit/hyperactivity disorder (ADHD) in ELBW infants born between 1998 and 2001. Seven hundred twenty-eight ELBW infants without diagnoses of brain insults or focal brain lesions in the initial hospital stay were identified and divided into three groups (days on ventilator: ≦2, 3-14, ≧15 days). After adjusting for demographic and medical factors, the infants in the ≧15 days group had higher risks for CP (adjusted hazard ratio: 2.66; 95% confidence interval: 1.50-4.59; p<0.001) and ADHD (adjusted hazard ratio: 1.95; 95% confidence interval: 1.02-3.76; p<0.05), than did infants in the ≦2 days group. The risk for ASD or ID was not significantly different between the three groups. We conclude that mechanical ventilation for ≧15 days increased the risk for CP and ADHD in ELBW infants even without significant neonatal brain damage. Developing a brain-protective respiratory support strategy in response to real-time cerebral hemodynamic and oxygenation changes has the potential to improve neurodevelopmental outcomes in ELBW infants.
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Affiliation(s)
- Wen-Hui Tsai
- Institute of Clinical Medicine, National Cheng Kung University College of Medicine, Tainan 701, Taiwan; Division of Neonatology, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Yea-Shwu Hwang
- Department of Occupational Therapy, National Cheng Kung University College of Medicine, Tainan 701, Taiwan
| | - Te-Yu Hung
- Department of Pediatrics, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Shih-Feng Weng
- Department of Medical Research, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Shio-Jean Lin
- Department of Pediatrics, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Wen-Tsan Chang
- Department of Biochemistry and Molecular Biology, National Cheng Kung University College of Medicine, Tainan 701, Taiwan; Institute of Basic Medical Sciences, National Cheng Kung University College of Medicine, Tainan 701, Taiwan.
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McIntyre S, Morgan C, Walker K, Novak I. Cerebral Palsy-Don't Delay. ACTA ACUST UNITED AC 2013; 17:114-29. [DOI: 10.1002/ddrr.1106] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/05/2012] [Indexed: 11/08/2022]
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19
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Gray PH, Cincotta R, Chan FY, Soong B. Perinatal Outcomes With Laser Surgery for Twin–Twin Transfusion Syndrome. Twin Res Hum Genet 2012. [DOI: 10.1375/twin.9.3.438] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe aim of this tertiary hospital–based cohort study was to determine and compare perinatal outcome and neonatal morbidities of pregnancies with twin–twin transfusion syndrome (TTTS) before and after the introduction of a treatment program with laser ablation of placental communicating vessels. Twenty-seven pregnancies with Stage II–IV TTTS treated with amnioreduction were identified (amnioreduction group). The data were compared with that obtained from the first 31 pregnancies with Stage II–IV TTTS managed with laser ablation of placental communicating vessels (laser group). Comparisons were made for perinatal survival and neonatal morbidities including abnormalities on brain imaging. The median gestation at therapy was similar between the two groups (20 vs. 21 weeks, p = .24), while the median gestation at delivery was significantly greater in the laser treated group (34 vs. 28 weeks, p = .002). The perinatal survival rate was higher in the laser group (77.4% vs. 59.3%, p = .03). Neonatal morbidities including acute respiratory distress, chronic lung disease, requirement for ventilatory assistance, patent ductus arteriosus, hypotension, and oliguric renal failure had a lower incidence in the laser group. On brain imaging, ischemic brain injury was seen in 12% of the amnioreduction group and none of the laser group of infants (p = .01). In conclusion, these findings indicate that perinatal outcomes are improved with less neonatal morbidity for monochorionic pregnancies with severe TTTS treated by laser ablation of communicating placental vessels when compared to treatment by amnioreduction.
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Lie KK, Grøholt EK, Eskild A. Association of cerebral palsy with Apgar score in low and normal birthweight infants: population based cohort study. BMJ 2010; 341:c4990. [PMID: 20929920 PMCID: PMC2952090 DOI: 10.1136/bmj.c4990] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the association of Apgar score 5 minutes after birth with cerebral palsy in both normal weight and low birthweight children, and also the association with the cerebral palsy subdiagnoses of quadriplegia, diplegia, and hemiplegia. DESIGN Population based cohort study. SETTING The Medical Birth Registry of Norway was used to identify all babies born between 1986 and 1995. These data were linked to the Norwegian Registry of Cerebral Palsy in Children born 1986-95, which was established on the basis of discharge diagnoses at all paediatric departments in Norway. POPULATION All singletons without malformations born in Norway during 1986-95 and who survived the first year of life (n=543 064). MAIN OUTCOME MEASURE Cerebral palsy diagnosed before the age of 5 years. RESULTS 988 children (1.8 in 1000) were diagnosed with cerebral palsy before the age of 5 years. In total, 11% (39/369) of the children with Apgar score of less than 3 at birth were diagnosed with cerebral palsy, compared with only 0.1% (162/179 515) of the children with Apgar score of 10 (odds ratio (OR) 53, 95% CI 35 to 80 after adjustment for birth weight). In children with a birth weight of 2500 g or more, those with an Apgar score of less than 4 were much more likely to have cerebral palsy than those who had an Apgar score of more than 8 (OR 125, 95% confidence interval 91 to 170). The corresponding OR in children weighing less than 1500 g was 5 (95% CI 2 to 9). Among children with Apgar score of less than 4, 10-17% in all birthweight groups developed cerebral palsy. Low Apgar score was strongly associated with each of the three subgroups of spastic cerebral palsy, although the association was strongest for quadriplegia (adjusted OR 137 for Apgar score <4 v Apgar score >8, 95% CI 77 to 244). CONCLUSIONS Low Apgar score was strongly associated with cerebral palsy. This association was high in children with normal birth weight and modest in children with low birth weight. The strength of the association differed between subgroups of spastic cerebral palsy. Given that Apgar score is a measure of vitality shortly after birth, our findings suggest that the causes of cerebral palsy are closely linked to factors that reduce infant vitality.
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Affiliation(s)
- Kari Kveim Lie
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
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21
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Gilboa A, Roginsky E. Examining the dyadic music therapy treatment (DUET): the case of a CP child and his mother. NORDIC JOURNAL OF MUSIC THERAPY 2010. [DOI: 10.1080/08098131.2010.500742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Himpens E, Oostra A, Franki I, Vansteelandt S, Vanhaesebrouck P, den Broeck CV. Predictability of cerebral palsy in a high-risk NICU population. Early Hum Dev 2010; 86:413-7. [PMID: 20542648 DOI: 10.1016/j.earlhumdev.2010.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 05/17/2010] [Accepted: 05/18/2010] [Indexed: 10/19/2022]
Abstract
AIM This study aims to create a predictive model for the assessment of the individual risk of developing cerebral palsy in a large cohort of selected high-risk infants. PATIENTS AND METHODS 1099 NICU-admitted high-risk infants were assessed up to the corrected age of at least 12 months. CP was categorized relative to subtype, distribution and severity. Several perinatal characteristics (gender, gestational age, multiple gestation, small for gestational age, perinatal asphyxia and duration of mechanical ventilation), besides neonatal cerebral ultrasound data were used in the logistic regression model for the risk of CP. RESULTS Perinatal asphyxia, mechanical ventilation>7 days, white matter disease except for transient echodensities<7 days, intraventricular haemorrhage grades III and IV, cerebral infarction and deep grey matter lesions were recognized as independent predictors for the development of CP. 95% of all children with CP were correctly identified at or above the cut-off value of 4.5% probability of CP development. Higher gestational age, perinatal asphyxia and deep grey matter lesion are independent predictors for non-spastic versus spastic CP (OR=1.1, 3.6, and 7.5, respectively). Independent risk factors for prediction of unilateral versus bilateral spastic CP are higher gestational age, cerebral infarction and parenchymal haemorrhagic infarction (OR=1.2, 31, and 17.6, respectively). Perinatal asphyxia is the only significant variable retained for the prediction of severe CP versus mild or moderate CP. CONCLUSION The presented model based on perinatal characteristics and neonatal US-detected brain injuries is a useful tool in identifying specific infants at risk for developing CP.
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23
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Kusters CDJ, Chen ML, Follett PL, Dammann O. ''Intraventricular'' hemorrhage and cystic periventricular leukomalacia in preterm infants: how are they related? J Child Neurol 2009; 24:1158-70. [PMID: 19745088 PMCID: PMC3695711 DOI: 10.1177/0883073809338064] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intraventricular hemorrhage and cystic periventricular leukomalacia are often co-occurring characteristics of brain damage in preterm infants. Using data from 1016 infants born before 30 completed weeks' gestational age, we sought to clarify the relationship between severe intraventricular hemorrhage and cystic periventricular leukomalacia, with special emphasis on common antecedents and potential confounding. After comparing risk factors for intraventricular hemorrhage grades 1 through 4 and cystic periventricular leukomalacia, it appears the risk patterns for intraventricular hemorrhage grade 3, intraventricular hemorrhage grade 4, and cystic periventricular leukomalacia differ. The association between intraventricular hemorrhage grade 3 and cystic periventricular leukomalacia differs appreciably from the association between intraventricular hemorrhage grade 4 and cystic periventricular leukomalacia, supporting the notion that intraventricular hemorrhage grade 3 and intraventricular hemorrhage grade 4 are different entities. The presence of intraventricular hemorrhage grade 3 and intraventricular hemorrhage grade 4 increases the risk of cystic periventricular leukomalacia, even after adjusting for potential confounders. This raises the possibility that intraventricular hemorrhage grade 3 and intraventricular hemorrhage grade 4 cause cystic periventricular leukomalacia.
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Affiliation(s)
- Cynthia D. J. Kusters
- Department of Epidemiology and Biostatistics, Radboud University, Nijmegen, The Netherlands, , Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | - Minghua L. Chen
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | - Pamela L. Follett
- Pediatric Neurology, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | - Olaf Dammann
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts, Perinatal Neuroepidemiology Unit, Hannover Medical School, Hannover, Germany, Neuroepidemiology Unit, Children's Hospital, Boston, Massachusetts
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CINCOTTA RB, GRAY PH, GARDENER G, SOONG B, CHAN FY. Selective fetoscopic laser ablation in 100 consecutive pregnancies with severe twin-twin transfusion syndrome. Aust N Z J Obstet Gynaecol 2009; 49:22-7. [DOI: 10.1111/j.1479-828x.2008.00942.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Proteomics- and metabolomics-based neonatal diagnostics in assessing and managing the critically ill neonate. Clin Perinatol 2008; 35:695-716, vi. [PMID: 19026335 DOI: 10.1016/j.clp.2008.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The use of proteomic-based neonatal screening has been relatively limited until the present era and has focused primarily on the evaluation of newborns for inborn errors of metabolism. The future of proteomic-based screening seems to be much more encompassing, however. Tandem mass spectrometry and other related technologies are highly likely to be used in the evaluation of acute disease processes. Proteomics has the advantage over genomics of permitting a more direct look at an evolving disease process, because genomics primarily relates only the potential for a disease or abnormality to express itself. This article reviews the current uses of proteomics-based newborn evaluation and evaluates how this rapidly evolving area of medicine may be used to assess the fetus and the neonate in the near future.
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Himpens E, Van den Broeck C, Oostra A, Calders P, Vanhaesebrouck P. Prevalence, type, distribution, and severity of cerebral palsy in relation to gestational age: a meta-analytic review. Dev Med Child Neurol 2008; 50:334-40. [PMID: 18355333 DOI: 10.1111/j.1469-8749.2008.02047.x] [Citation(s) in RCA: 180] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this review is to determine the relationship between gestational age (GA) and prevalence, type, distribution, and severity of cerebral palsy (CP). Epidemiological studies with cohorts expressed by GA were assessed. A comprehensive meta-analysis and meta-regression was performed on four fetal age categories. Studies of children with CP as a target population were added. Twenty-six articles met the inclusion criteria. The prevalence of CP decreases significantly with increasing GA category: 14.6% at 22 to 27 weeks' gestation, 6.2% at 28 to 31 weeks, 0.7% at 32 to 36 weeks, and 0.1% in term infants. Interestingly, a significant decrease in prevalence of CP starts only from a GA of 27 weeks onwards. In preterm infants, spastic CP is predominant. In term infants, the non-spastic form of CP is more prevalent than in preterm infants. Bilateral spastic CP is most prevalent in both preterm and term infants. However, the proportion of unilateral spastic CP in term infants is substantial. No relationship could be detected between severity of CP and GA. There is a strong need for an international, well-described, and generally accepted classification system for subtypes and severity of CP.
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Affiliation(s)
- E Himpens
- Rehabilitation Sciences and Physiotherapy Ghent, Artevelde University College - Ghent University, Ghent, Belgium.
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27
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Drougia A, Giapros V, Krallis N, Theocharis P, Nikaki A, Tzoufi M, Andronikou S. Incidence and risk factors for cerebral palsy in infants with perinatal problems: a 15-year review. Early Hum Dev 2007; 83:541-7. [PMID: 17188824 DOI: 10.1016/j.earlhumdev.2006.10.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 10/17/2006] [Accepted: 10/18/2006] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Cerebral palsy (CP) is associated with prenatal, perinatal and postnatal factors. This is a retrospective case-control study aiming to determine the frequency of CP and examine risk factors for CP among infants cared for in the Neonatal Intensive Care Unit (NICU) covering Northwest Greece. DESIGN AND PATIENTS All neonates who were admitted to the NICU during the period 1989-2003 inclusive, and subsequently developed CP, were enrolled in the study, with matched controls. The incidence of CP was evaluated according to gestational age (GA): GA<34 weeks (group A) and GA>34 (group B), and study period: 1989-1996 (period I) and 1997-2003 (period II, during which intrauterine transfer and prenatal steroids were used). RESULTS CP was diagnosed in 78 children, 55 in group A and 23 in group B. The incidence of CP increased significantly with decreasing GA. Survival without CP increased significantly in children of GA<34 weeks during period II. The main factors associated with CP, identified by multivariate analysis, were (odds ratios, confidence interval), for group A: being small for gestational age (SGA) (2.5, 1.2-4.5) and patent ductus arteriosus (PDA) (3.4, 1.3-9.2) in period I, periventricular leucomalacia (PVL) (27, 4.8-209), prolonged rupture of membranes (PROM) (5.6, 1.8-18) and duration of mechanical ventilation (1.1, 1.05-1.2) in period II, and for group B: SGA (3.6, 1.3-9.9), neonatal transfer (3.06, 1.2-7.6), duration of mechanical ventilation (1.1, 1.06-1.25) and sepsis-meningitis (4.3, 1.2-16). CONCLUSION Improvement in survival without CP was observed in infants of GA<34 weeks during the later period of the study, and risk factors for CP in preterm infants depended on the study period. PVL, PROM and PDA were the most powerful independent predictors of CP in children of GA<34 weeks and SGA, neonatal transfer and sepsis/meningitis in children of GA>34 weeks.
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Affiliation(s)
- A Drougia
- Neonatal Intensive Care Unit (NICU), University Hospital of Ioannina, Greece
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28
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Gray PH, Chan FY, Cincotta R. Comparing cranial ultrasound results in twin-to-twin transfusion syndrome treated with laser surgery. Am J Obstet Gynecol 2007; 196:e14; author reply e14-5. [PMID: 17403389 DOI: 10.1016/j.ajog.2006.10.881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 10/21/2006] [Indexed: 11/28/2022]
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Nakagawa A, Furuhashi M, Kidokoro K, Yoshida K, Kuno N, Ishikawa K. Maternal excessive vomiting: association with periventricular leukomalacia. J Matern Fetal Neonatal Med 2006; 19:675-7. [PMID: 17118745 DOI: 10.1080/14767050600850316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Antenatal corticosteroid therapy to enhance fetal lung maturation in pregnancies at risk for preterm delivery is used commonly, based on the assumption that its established benefits outweigh associated risks. Corticosteroid treatment does confer some risks, particularly with respect to restricted brain growth and disordered neuronal development. These alterations have the potential for long-term effects on health. They deserve further study, and should not be undervalued. Corticosteroid therapy should be applied selectively in those situations in which the risk of preterm birth is very high and the likelihood of severe respiratory distress syndrome substantial.
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Affiliation(s)
- Ralph L Cavalieri
- Department of Obstetrics and Gynecology, Jamaica Hospital Medical Center and the Weill-Cornell Medical College, New York, NY, USA.
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31
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Spitzer AR, Chace D. Mass spectrometry in neonatal medicine and clinical diagnosis--the [corrected] potential use of mass spectrometry in neonatal brain [corrected] monitoring. Clin Perinatol 2006; 33:729-44, viii. [PMID: 16950322 DOI: 10.1016/j.clp.2006.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article discusses the application of mass spectroscopy, a technology that may have great potential for screening neonatal brain injury. This approach is anticipated to become increasingly important in neonatal and perinatal research and newborn care during the next few years.
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Affiliation(s)
- Alan R Spitzer
- Pediatrix Medical Group, 1301 Concord Terrace, Sunrise, FL 33323, USA.
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32
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Abstract
PURPOSE OF REVIEW Cerebral palsy is the most common and visible motor disability of childhood. Its aetiology remains a topic of hot debate between those who see it as a reflection of medical mismanagement of an avoidable complication and those who see its origins in the development of the fetal brain affected at many points along a causal pathway to damage. This review outlines the themes of research publications over the year 2004/2005. RECENT FINDINGS The review looks at recent findings relating to epidemiology, infection and inflammation, prematurity, multiple pregnancy, thrombophilias, genetics, placenta, neuroimaging and rescue therapies in cerebral palsy. SUMMARY Papers this year have helped clarify risk groups and identify some areas (e.g. the management of thrombophilias and the potential of induced hypothermia) with the potential to be rapidly introduced into clinical practice. In this enigmatic and multifactorial condition, however, progress remains slow. New tools such as magnetic resonance imaging are providing valuable insights into the lesions that result in cerebral palsy but the pathways to injury remain unclear. The future of cerebral palsy research lies in understanding the complex interactions of multiple factors on the road to cerebral palsy or in looking for final common pathways such as inflammation which may be amenable to manipulation.
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Affiliation(s)
- John M Keogh
- Hornsby Ku-Ring Gai Hospital, University of Sydney, Sydney, New South Wales, Australia
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