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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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Hu G, Zhao Y, Fu X, Hu D, Liang X. Maternal body mass index and cerebral palsy in children: A systematic review and dose-response meta-analysis. Paediatr Perinat Epidemiol 2024; 38:345-356. [PMID: 38146616 DOI: 10.1111/ppe.13033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/20/2023] [Accepted: 12/07/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Accumulating studies indicate that maternal obesity is associated with the risk of cerebral palsy (CP); however, their conclusions have been inconsistent. OBJECTIVES To quantitatively estimate the association between maternal body mass index (BMI) and CP in offspring. DATA SOURCES PubMed, Embase and Web of Science. STUDY SELECTION AND DATA EXTRACTION Articles published up to 18 September 2022 were searched that reported the correlation between maternal BMI and CP in children. Two reviewers independently extracted data and critically assessed articles. SYNTHESIS Pooled relative risks (RR) and 95% confidence intervals (CI) were estimated by the random-effects model. Subgroup analysis and meta-regression were performed to explore sources of heterogeneity. RESULTS In total, 11 articles (8,407,668 participants) were identified for inclusion in our meta-analysis. For maternal underweight, no significant association was found with CP risk (RR 1.11, 95% CI 0.90, 1.38). The risk of CP was increased by 25% (RR 1.25, 95% CI 1.06, 1.47), 38% (RR 1.38, 95% CI 1.18, 1.61) and 127% (RR 2.27, 95% CI 1.82, 2.83) for maternal overweight, obesity and obesity grade 3, respectively. In addition, we observed a positive linear dose-response relationship, with the pooled risk of cerebral palsy in offspring increasing by 3% with each unit increase in maternal BMI. CONCLUSION This meta-analysis indicates that the risk of CP in offspring grew with maternal overweight or obesity grades increasing, and was positively correlated with maternal BMI.
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Affiliation(s)
- Guomin Hu
- The Second Department of pediatrics, The First People's Hospital of Nanyang City, Nanyang, Henan, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Xueru Fu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Xin Liang
- Administration Department of Nursing Affairs, The First People's Hospital of Nanyang City, Nanyang, Henan, People's Republic of China
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Vilhelmsson A, Rylander L, Jöud A, Lindh CH, Mattsson K, Liew Z, Guo P, Ritz B, Källén K, Thacher JD. Exposure to per- and polyfluoroalkyl substances in early pregnancy and risk of cerebral palsy in children. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 899:165622. [PMID: 37474063 DOI: 10.1016/j.scitotenv.2023.165622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/30/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Most cerebral palsy (CP) cases have an unexplained etiology, but a role for environmental exposures has been suggested. One purported environmental risk factor is exposure to endocrine-disrupting pollutants specifically per- and polyfluoroalkyl substances (PFAS). OBJECTIVES We investigated the association between prenatal PFAS exposures and CP in Swedish children. METHODS In this case-control study, 322 CP cases, 343 population controls, and 258 preterm controls were identified from a birth registry in combination with a CP follow-up program from 1995 to 2014 and linked to a biobank which contains serum samples from week 10-14 of pregnancy. Maternal serum concentrations of four PFAS compounds: perfluorohexane sulfonate (PFHxS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorooctane sulfonate (PFOS) were analyzed using liquid chromatography-tandem-mass-spectrometry. We estimated odds ratios (ORs) and 95 % confidence intervals (CIs) for CP and each PFAS in quartiles and as continuous variables controlling for various sociodemographic and lifestyle factors. RESULTS In crude and adjusted analyses, we did not find consistent evidence of associations between serum PFHxS, PFOA, PFNA, PFOS and concentrations in early pregnancy and CP, except in preterm infants. The ORs comparing the highest PFAS quartiles to the lowest were 1.05 (95 % CI: 0.63-1.76), 0.96 (95 % CI: 0.55-1.68), 0.71 (95 % CI: 0.41-1.25), and 1.17 (95 % CI: 0.61-2.26), for PFHxS, PFOA, PFNA, and PFOS, respectively. Some positive associations were observed for preterm infants, but the results were imprecise. Similar patterns were observed in analyses treating PFAS as continuous variables. CONCLUSIONS In this study, we found little evidence that early pregnancy prenatal exposure to PFHxS, PFOA, PFNA, or PFOS increases the risk of CP. However, some positive associations were observed for preterm cases and warrant further investigation.
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Affiliation(s)
- Andreas Vilhelmsson
- Division of Occupational and Environmental Medicine, Lund University, Sweden
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Lund University, Sweden
| | - Anna Jöud
- Division of Occupational and Environmental Medicine, Lund University, Sweden; Department of Clinical Sciences Lund, Orthopaedics, Lund University, Faculty of Medicine, Sweden; Health Technology Assessment Skåne, Skåne University Hospital, Sweden
| | - Christian H Lindh
- Division of Occupational and Environmental Medicine, Lund University, Sweden
| | - Kristina Mattsson
- Division of Occupational and Environmental Medicine, Lund University, Sweden
| | - Zeyan Liew
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, USA; Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, USA
| | - Pengfei Guo
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, USA; Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, USA
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, UCLA, Los Angeles, USA; Department of Neurology, School of Medicine, UCLA, Los Angeles, USA
| | - Karin Källén
- Division of Occupational and Environmental Medicine, Lund University, Sweden; Tornblad Institute, Lund University, Sweden
| | - Jesse D Thacher
- Division of Occupational and Environmental Medicine, Lund University, Sweden.
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Dhondt E, Dan B, Plasschaert F, Degelaen M, Dielman C, Dispa D, Ebetiuc I, Hasaerts D, Kenis S, Lombardo C, Pelc K, Wermenbol V, Ortibus E. Prevalence of cerebral palsy and factors associated with cerebral palsy subtype: A population-based study in Belgium. Eur J Paediatr Neurol 2023; 46:8-23. [PMID: 37364404 DOI: 10.1016/j.ejpn.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023]
Abstract
AIM To report on the prevalence, neuroimaging patterns, and function of children with cerebral palsy (CP) in Belgium for birth years 2007-2012, and identify distinctive risk indicators and differences in outcome between CP subtypes. METHODS Antenatal and perinatal/neonatal factors, motor and speech function, associated impairments, and neuroimaging patterns were extracted from the Belgian Cerebral Palsy Register. Prevalence was estimated per 1000 (overall, ante/perinatal, spastic, dyskinetic CP) or 10,000 (post-neonatal, ataxic CP) live births. Multinomial logistic regression analyses were performed to ascertain the effects of antenatal/perinatal/neonatal factors and neuroimaging patterns on the likelihood of dyskinetic or ataxic CP relative to spastic CP, and test the likelihood of the occurrence of impaired motor and speech function and associated impairments in dyskinetic or ataxic CP relative to spastic CP. RESULTS In total, 1127 children with CP were identified in Belgium. The birth prevalence of overall CP was 1.48 per 1000 live births. The likelihood of dyskinetic CP increases if the child was born to a mother aged ≥35 years, mechanically ventilated, and had predominant grey matter injury, while an increased likelihood of ataxic CP is associated with ≥2 previous deliveries. Children with dyskinetic and ataxic CP are more likely to function with impairments in motor, speech, and intellectual abilities. CONCLUSION Distinctive risk indicators and differences in outcome between CP subtypes were identified. These factors can be incorporated into clinical practice to facilitate early, accurate, and reliable classification of CP subtype, and may lead to individually tailored neonatal care and other (early) intervention options.
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Affiliation(s)
- Evy Dhondt
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| | - Bernard Dan
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium; Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Frank Plasschaert
- Cerebral Palsy Reference Centre, University Hospital Ghent, Ghent, Belgium; Human Structure and Repair, Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marc Degelaen
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium; Department of Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Charlotte Dielman
- Cerebral Palsy Reference Centre Antwerp (CePRA), Ziekenhuis Netwerk Antwerpen Queen Paola Children's Hospital, Wilrijk, Belgium
| | - Delphine Dispa
- Reference Centre for Cerebral Palsy (IMOC), Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Iulia Ebetiuc
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), Hospital De La Citadelle, Liege, Belgium
| | - Danielle Hasaerts
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), University Hospital Brussels, Brussels, Belgium
| | - Sandra Kenis
- Cerebral Palsy Reference Centre Antwerp (CePRA), Antwerp University Hospital, Belgium
| | - Costanza Lombardo
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), Queen Fabiola Children's University Hospital (QFCUH), Brussels, Belgium
| | - Karine Pelc
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Vanessa Wermenbol
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), Erasmus Hospital, Brussels, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Cerebral Palsy Reference Centre, University Hospital Leuven, Leuven, Belgium
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Awale A, Banskota B, Yadav P, Shakya G, Banskota AK. Cerebral Palsy among Children Visiting the Outpatient Department of Pediatric Orthopaedics in a Tertiary Care Centre. JNMA J Nepal Med Assoc 2023; 61:626-629. [PMID: 38289819 PMCID: PMC10566608 DOI: 10.31729/jnma.8232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Cerebral palsy is a group of neurological disorders that appear in infancy or early childhood and occur as a result of anomalies in the developing brain that impair the brain's capacity to regulate movement, maintain posture, and maintain balance. Healthcare professionals can better predict the need for the medical, rehabilitative, and support services needed by people with cerebral palsy by using accurate prevalence statistics. The aim of the study was to find out the prevalence of cerebral palsy among children visiting the Outpatient Department of Pediatric Orthopaedics in a tertiary care centre. Methods A descriptive cross-sectional study was conducted among patients visiting the Outpatient Department of Pediatric Orthopaedics in a tertiary care centre. Data from 1 January 2018 to 31 December 2019 was collected between 25 April 2023 to 5 May 2023 from medical records after obtaining ethical approval from the Institutional Review Committee. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results Among 6984 children, the prevalence of cerebral palsy was 545 (7.80%) (7.17-8.43, 95% Confidence Interval). The most common type of cerebral palsy was found to be spastic diplegia 219 (40.18%). Conclusions The prevalence of cerebral palsy among children visiting the Outpatient Department of Pediatric Orthopaedic was found to be higher than in other studies done in similar settings. Keywords cerebral palsy; prevalence; spastic diplegia.
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Affiliation(s)
- Ayushi Awale
- Hospital and Rehabilitation Center for Disabled Children, Banepa, Kavrepalanchok, Nepal
| | - Bibek Banskota
- Department of Orthopedics, Hospital and Rehabilitation Center for Disabled Children, Banepa, Kavrepalanchok, Nepal
| | - Prakash Yadav
- Hospital and Rehabilitation Center for Disabled Children, Banepa, Kavrepalanchok, Nepal
| | - Ganga Shakya
- Hospital and Rehabilitation Center for Disabled Children, Banepa, Kavrepalanchok, Nepal
| | - Ashok Kumar Banskota
- Department of Orthopedics, Hospital and Rehabilitation Center for Disabled Children, Banepa, Kavrepalanchok, Nepal
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Tegegne KT. Determinants of cerebral palsy in children: systematic review. Sudan J Paediatr 2023; 23:126-144. [PMID: 38380410 PMCID: PMC10876278 DOI: 10.24911/sjp.106-1670589241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/26/2023] [Indexed: 02/22/2024]
Abstract
Cerebral palsy (CP) is a group of disorders of movement and postural control caused by a nonprogressive defect or lesion of the developing brain. Several prepregnancy risk factors have been described including maternal age, parity and maternal diseases including epilepsy, diabetes and thyroid disease. There are few in-depth studies on the causes of CP. In the present systematic review, databases searched were Google Scholar and PubMed to identify data on determinants of CP in the world. Studies were included if they specifically mentioned CP as an outcome, the study objective is to identify factors associated with CP in children and all quantitative observational studies. JBI Critical Appraisal Tools were used to assess the methodological quality of a study. Papers that meet the inclusion criteria were rigorously appraised by two critical appraisers. 40 consistent determinants of CP in children from 95 research articles that meet inclusion criteria are included in the review. The majority of studies (24 articles) showed that premature babies and low weight were determinants of CP in children, whereas 15 studies showed that low Apgar scores were determinants of CP in children. The commonest determinants of CP in children are premature babies and low weight, low Apgar scores, intrauterine infection, congenital brain malformations, thyroid disease, premature rupture of membrane (PROM) and placental abruption. Preventing preterm delivery, low birth weight and intrauterine infection as well as immediate neonatal resuscitation for newborns with low Apgar scores may help to prevent CP in children.
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Affiliation(s)
- Kaleab Tesfaye Tegegne
- Department of Public Health, College of Health Science, Debark University, Debark, Ethiopia
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Chen D, Wu Y, Li H, Pan X, Zhou J. Treatment on patients with spastic cerebral palsy in the past 30 years: A systematic review and bibliometric analysis. Medicine (Baltimore) 2022; 101:e30535. [PMID: 36397367 PMCID: PMC9666139 DOI: 10.1097/md.0000000000030535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over the past 30 years, treatments from different disciplines have been applied to spastic cerebral palsy (SCP). However, few bibliometric studies have been conducted to date. This study explored the knowledge base, emerging hotspots, and future trends related to SCP treatment research using bibliometric analysis. METHODS Publications on SCP treatment included in the Web of Science Core Collection database between 1990 and 2020 were retrieved, and Medical Subject Headings terms were extracted from PubMed. Online bibliometric analysis website (http://bibliometric.com/), 2 pieces of software called "CiteSpace" and "VOSViewer" were used for quantitative analysis and knowledge map establishment. RESULTS A total of 1668 papers were retrieved from 1990 to 2020. The number of publications has increased annually. Developmental Medicine and Child Neurology is the most productive and the highest co-cited journal. The United States has been the largest contributor. Vrije Universiteit Amsterdam ranked first in the number of papers published among institutions that have conducted correlational research. Becher JG and Graham HK should be considered scholars who have made outstanding contributions. The knowledge base of the SCP treatment research field is thoughtfully constructed to promote understanding of the field. CONCLUSION This bibliometric study identified global achievements, research hotspots, and trends of SCP treatment. They provide insights into the research field and valuable information for future scientific research and clinical treatment.
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Affiliation(s)
- Dingfang Chen
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Yuefeng Wu
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - HaiYing Li
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Xue Pan
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Jin Zhou
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
- *Correspondence: Jin Zhou, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China (e-mail: )
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Kavcic A. Is it time to rename hereditary cases of cerebral palsy? Brain 2022; 145:e82-e83. [PMID: 35776103 DOI: 10.1093/brain/awac230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anamarija Kavcic
- Health Care Authority Aschaffenburg, Aschaffenburg 63739, Germany
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Perinatal Risks of Neonatal and Infant Mortalities in a Sub-provincial Region of China: A Livebirth Population-based Cohort Study. BMC Pregnancy Childbirth 2022; 22:338. [PMID: 35440021 PMCID: PMC9020038 DOI: 10.1186/s12884-022-04653-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 04/01/2022] [Indexed: 12/05/2022] Open
Abstract
Background Current vital statistics of birth population and neonatal outcome in China lacked information and definition of deaths at delivery and during hospitalization, especially for extreme preterm (EPT) birth. This study aims to delineate the prevalence of neonatal hospitalization, neonatal and infant mortality rates (NMR, IMR) and associated perinatal risks based on all livebirths in Huai’an, an evolving sub-provincial region in eastern China. Methods This retrospective cohort study established a comprehensive database linking information of whole regional livebirths and neonatal hospitalization in 2015, including deaths at delivery and EPT livebirths. The primary outcomes were NMR and IMR stratified by gestational age (GA) and birthweight (BW) with 95% confidence intervals. Causes of the neonatal and infant deaths were categorized according to the International Statistical Classification of Diseases 10th version, and population attributable fractions of GA and BW strata were analyzed. Perinatal risks of infant mortalities in continuum periods were estimated by Cox regression models. Results Among the whole livebirth population (59056), 7960 were hospitalized (prevalence 13.5%), with 168 (2.8‰) in-hospital deaths. The NMR was 3.6 (3.2, 4.1)‰ and IMR 4.9 (1.4, 4.5)‰, with additionally 35 (0.6‰) deaths at delivery. The major causes of infant deaths were perinatal conditions (2.6‰, mainly preterm-related), congenital anomalies (1.5‰), sudden unexpected death in infancy (0.6‰) and other causes (0.2‰). The deaths caused by preterm and low BW (LBW) accounted for 50% and 40% of NMR and IMR, with 20-30% contributed by EPT or extremely LBW, respectively. Multivariable Cox regression analysis revealed that peripartum factors and LBW strata had strong association with early- and late-neonatal deaths, whereas those of GA < 28 weeks were highly associated with postneonatal deaths. Congenital anomalies and neonatal hospitalization remained high death risks over the entire infancy, whereas maternal co-morbidities/complications were modestly associated with neonatal but not postneonatal infant mortality. Conclusions The NMR, IMR, major causes of deaths and associated perinatal risks in continuum periods of infancy, denote the status and quality improvement of the regional perinatal-neonatal care associated with socioeconomic development. The study concept, applicability and representativeness may be validated in other evolving regions or countries for genuine comparison and better maternal-infant healthcare. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04653-8.
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Tharaldsen G, Hollung SJ, Vik T, Andersen GL. High occurrence of perinatal risk factors and more severe impairments in children with postneonatal cerebral palsy in Norway. Acta Paediatr 2022; 111:812-819. [PMID: 34967050 DOI: 10.1111/apa.16240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/08/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022]
Abstract
AIM To describe causal events, perinatal risk factors and clinical characteristics in children with postneonatal cerebral palsy (PNCP). METHODS Population-based registry study of Norwegian children born 1999-2013. Prevalence, causal events and clinical characteristics of PNCP were described. The occurrence of perinatal risk factors for CP was compared with the general population. RESULTS Among 1710 children with CP, 67 had PNCP (3.9%; 0.75 per 10,000 livebirths [95%CI: 0.59-0.96]). The prevalence of PNCP decreased during the study period. Leading causal events were cerebrovascular events (32.8%), head injuries/other accidents (22.4%), infections (19.4%) and hypoxic events (14.9%). Spastic hemiplegic (53.7%) or spastic quadriplegic/dyskinetic CP (31.3%) was more common in children with PNCP than non-PNCP (42.3% and 20.1%, respectively; p < 0.001). Children with PNCP had more severe motor and associated impairments. Perinatal risk factors for CP were more common in children with PNCP than in the general population. CONCLUSION The prevalence of PNCP among Norwegian children was low and decreasing. The main causes were cerebrovascular events and head injuries/other accidents. Although spastic hemiplegic CP was the dominating subtype, children with PNCP had more severe motor and associated impairments than children with non-PNCP, as well as a higher occurrence of perinatal risk factors than in the general population.
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Affiliation(s)
- Guro Tharaldsen
- Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
| | - Sandra J. Hollung
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) Vestfold Hospital Trust Tønsberg Norway
| | - Torstein Vik
- Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
| | - Guro L. Andersen
- Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) Vestfold Hospital Trust Tønsberg Norway
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Battin MR, Williams SA, Mackey A, Alzaher W, Sorhage A, Stott NS. Neonatal Neuroimaging in Neonatal Intensive Care Graduates Who Subsequently Develop Cerebral Palsy. J Clin Med 2022; 11:jcm11071866. [PMID: 35407475 PMCID: PMC9000159 DOI: 10.3390/jcm11071866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
Cerebral palsy is a common cause of physical disability. The New Zealand Cerebral Palsy Register (NZCPR) was established in 2015 and reports national data. Internationally, an early CP diagnosis has been a focus, with imaging and clinical tools used to enable early accurate detection. Accordingly, guidelines are being developed for New Zealand, including a specific pathway for high-risk neonatal intensive care (NICU) graduates, reflecting the high rate of CP in this group. To inform this work, we reviewed imaging data from a retrospective NICU cohort identified from the NZCPR. In these 140 individuals with CP and a confirmed NICU admission during 2000–2019 inclusive, imaging frequency, modality, and rate of abnormality was determined. Overall, 114 (81.4%) had imaging performed in the NICU, but the frequency and modality used varied by gestational subgroup. For infants born at less than 32 weeks gestation, 53/55 had routine imaging with ultrasound, and IVH was graded as none or mild (grade 1–2) in 35 or severe (grade 3–4) in 18 infants. For the 34 infants born between 32–36 weeks gestation, only 13/19 imaged in the NICU were reported as abnormal. For 51 term-born infants, 41/42 imaged in the NICU with MRI had abnormal results.
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Affiliation(s)
- Malcolm R. Battin
- Newborn Services, Auckland City Hospital, Park Road, Grafton, Auckland 1023, New Zealand
- Correspondence:
| | - Sîan A. Williams
- Liggins Institute, University of Auckland, Park Road, Grafton, Auckland 1142, New Zealand;
| | - Anna Mackey
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (A.M.); (W.A.); (A.S.)
| | - Woroud Alzaher
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (A.M.); (W.A.); (A.S.)
| | - Alexandra Sorhage
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (A.M.); (W.A.); (A.S.)
| | - N. Susan Stott
- Department of Paediatric Orthopaedics, Starship Child Health, Auckland 1023, New Zealand;
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand
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Hayakawa H, Pincott E, Ali U. Anaesthesia and cerebral palsy. BJA Educ 2022; 22:26-32. [PMID: 34992798 PMCID: PMC8703146 DOI: 10.1016/j.bjae.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
| | | | - U. Ali
- Great Ormond Street Hospital, London, UK
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Yang R, Zuo H, Han S, Zhang X, Zhang Q. Computer-Aided Diagnosis of Children with Cerebral Palsy under Deep Learning Convolutional Neural Network Image Segmentation Model Combined with Three-Dimensional Cranial Magnetic Resonance Imaging. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1822776. [PMID: 34804446 PMCID: PMC8598324 DOI: 10.1155/2021/1822776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/14/2021] [Accepted: 10/21/2021] [Indexed: 01/29/2023]
Abstract
In this paper, we analyzed the application value and effect of deep learn-based image segmentation model of convolutional neural network (CNN) algorithm combined with 3D brain magnetic resonance imaging (MRI) in diagnosis of cerebral palsy in children. 3D brain model was segmented based on CNN algorithm to obtain the segmented MRI images of brain tissue, and the validity was verified. Then, 70 children with cerebral palsy were rolled into the observation group (n = 35), which received MRI for diagnosis after segmentation of brain tissue, and control group (n = 35), which were diagnosed by computed tomography (CT). The diagnosis results of the two groups were compared. The validity experiment verified that the image segmentation method based on CNN algorithm can obtain effective style graphics. In clinical trials, the diagnostic accuracy of 88.6% in the observation group was evidently superior to that of 80% in the control group (P < 0.05). In the observation group, one patient was diagnosed as normal, four patients had white matter lesions, 17 patients had corpus callosum lesions, and five patients had basal ganglia softening foci. In the control group, two patients were diagnosed as normal, two patients had white matter lesions, 19 patients had corpus callosum lesions, and four patients had basal ganglia softening foci. No notable difference was found between the two groups (P > 0.05). According to the research results, in the diagnosis of cerebral palsy in children, the image segmentation of brain 3D model based on CNN to obtain the MRI image of segmented brain tissue can effectively improve the detection accuracy. Moreover, the specific symptoms can be diagnosed clearly. It can provide the corresponding diagnostic basis for clinical diagnosis and treatment and was worthy of clinical promotion.
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Affiliation(s)
- Rui Yang
- Children's Rehabilitation Department, Cang Zhou Women and Children's Healthcare Hospital, Cangzhou, Hebei 061000, China
| | - Haoran Zuo
- Children's Rehabilitation Department, Cang Zhou Women and Children's Healthcare Hospital, Cangzhou, Hebei 061000, China
| | - Shusheng Han
- Paediatric Internal Medicine Department, Cang Zhou Women and Children's Healthcare Hospital, Cangzhou, Hebei 061000, China
| | - Xiaoping Zhang
- Paediatric Internal Medicine Department, Cang Zhou Women and Children's Healthcare Hospital, Cangzhou, Hebei 061000, China
| | - Qian Zhang
- Neonatology Department, Cang Zhou Women and Children's Healthcare Hospital, Cangzhou, Hebei 061000, China
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Analysis of Selected Risk Factors Depending on the Type of Cerebral Palsy. Brain Sci 2021; 11:brainsci11111448. [PMID: 34827447 PMCID: PMC8615573 DOI: 10.3390/brainsci11111448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Cerebral palsy (CP) is not a defined, separate disease classification, but a set of etiologically diverse symptoms that change with the child's age. According to the up-to-date definition, CP is a group of permanent but not unchanging disorders of movement and/or posture and motor function, which are due to a nonprogressive interference, lesion, or abnormality of the developing/immature brain. CP is one of the most frequent causes of motor disability in children. The aim of the present study was to analyze whether selected risk factors may vary depending on particular types of CP. Methods: 181 children with CP (aged 4-17 years), hospitalized at the Department of Pediatrics and Developmental Age Neurology in Katowice in the years 2008-2016 were retrospectively analyzed in the present study. The assumed risk factors of CP were divided into two groups: 1-pre-conception and prenatal (mother's age, family history of epilepsy, burdened obstetric history, mother's systemic diseases, pregnancy order, multiple pregnancy, duration of pregnancy, bleedings from the genital tract during gestation, arterial hypertension during pregnancy, infections during pregnancy, preterm contractions, maintained pregnancy, premature rupture of membranes, abruptio placentae, and others), 2-perinatal and postnatal (mode of delivery, birth weight, Apgar score at the first and fifth minute, neonatal convulsions, respiratory failure, infections in neonatal and infant period, and intraventricular bleeding). The division into particular CP types was based on Ingram's classification. Results: The following risk factors were the most frequent in the total group: respiratory failure, infections, intraventricular bleeding, and prematurity. Among the analyzed preconception and prenatal factors, the duration of pregnancy and preterm contractions during pregnancy significantly differentiated the subgroups of patients depending on the type of CP. The prevalence of almost all analyzed perinatal, neonatal, and infant-related risk factors (i.e., birth weight, Apgar score at the first and fifth minute, neonatal convulsions, respiratory failure, infections in neonatal and infant period, and intraventricular bleeding) significantly differed between CP types, apart from the mode of delivery. However, in multivariate regression, only intraventricular bleeding was an independent predictor for tetraplegic CP type when compared to joined extrapyramidal and ataxic types (OR = 2.801, p = 0.028). Conclusions: As CP is a syndrome of multifactorial etiology, the identification of CP risk factors entails the need for careful observation and comprehensive care of children in the risk group. The presence of certain risk factors may be a prognostic indicator for particular types of CP. The knowledge about the association between the risk factor(s) and the CP type could be a very useful tool for pediatricians looking after the child at risk of developmental disorders.
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van Eijk L, Seidel M, Pannek K, George JM, Fiori S, Guzzetta A, Coulthard A, Bursle J, Ware RS, Bradford D, Rose S, Colditz PB, Boyd RN, Fripp J. Automating Quantitative Measures of an Established Conventional MRI Scoring System for Preterm-Born Infants Scanned between 29 and 47 Weeks' Postmenstrual Age. AJNR Am J Neuroradiol 2021; 42:1870-1877. [PMID: 34413061 DOI: 10.3174/ajnr.a7230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/03/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Conventional MR imaging scoring is a valuable tool for risk stratification and prognostication of outcomes, but manual scoring is time-consuming, operator-dependent, and requires high-level expertise. This study aimed to automate the regional measurements of an established brain MR imaging scoring system for preterm neonates scanned between 29 and 47 weeks' postmenstrual age. MATERIALS AND METHODS This study used T2WI from the longitudinal Prediction of PREterm Motor Outcomes cohort study and the developing Human Connectome Project. Measures of biparietal width, interhemispheric distance, callosal thickness, transcerebellar diameter, lateral ventricular diameter, and deep gray matter area were extracted manually (Prediction of PREterm Motor Outcomes study only) and automatically. Scans with poor quality, failure of automated analysis, or severe pathology were excluded. Agreement, reliability, and associations between manual and automated measures were assessed and compared against statistics for manual measures. Associations between measures with postmenstrual age, gestational age at birth, and birth weight were examined (Pearson correlation) in both cohorts. RESULTS A total of 652 MRIs (86%) were suitable for analysis. Automated measures showed good-to-excellent agreement and good reliability with manual measures, except for interhemispheric distance at early MR imaging (scanned between 29 and 35 weeks, postmenstrual age; in line with poor manual reliability) and callosal thickness measures. All measures were positively associated with postmenstrual age (r = 0.11-0.94; R2 = 0.01-0.89). Negative and positive associations were found with gestational age at birth (r = -0.26-0.71; R2 = 0.05-0.52) and birth weight (r = -0.25-0.75; R2 = 0.06-0.56). Automated measures were successfully extracted for 80%-99% of suitable scans. CONCLUSIONS Measures of brain injury and impaired brain growth can be automatically extracted from neonatal MR imaging, which could assist with clinical reporting.
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Affiliation(s)
- L van Eijk
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia.,Faculty of Medicine (L.V.E., M.S.), The University of Queensland, Brisbane, Australia
| | - M Seidel
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia.,Faculty of Medicine (L.V.E., M.S.), The University of Queensland, Brisbane, Australia
| | - K Pannek
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - J M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre (J.M.G., R.N.B.), Centre for Children's Health Research, The University of Queensland, Brisbane, Australia
| | - S Fiori
- Department of Developmental Neuroscience (S.F., A.G.), Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, Italy
| | - A Guzzetta
- Department of Developmental Neuroscience (S.F., A.G.), Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine (A.G.), University of Pisa, Pisa, Italy
| | - A Coulthard
- Department of Medical Imaging (A.C., J.B.), Royal Brisbane and Women's Hospital, Brisbane, Australia.,Discipline of Medical Imaging (A.C.), The University of Queensland, Brisbane, Australia
| | - J Bursle
- Department of Medical Imaging (A.C., J.B.), Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - R S Ware
- Menzies Health Institute Queensland (R.S.W.), Griffith University, Brisbane, Australia
| | - D Bradford
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - S Rose
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - P B Colditz
- Perinatal Research Centre (P.B.C.), University of Queenland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Perinatal Research Centre, Brisbane and Women's Hospital (P.B.C.), Brisbane, Australia
| | - R N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre (J.M.G., R.N.B.), Centre for Children's Health Research, The University of Queensland, Brisbane, Australia
| | - J Fripp
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
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