Intra-partum fever and cerebral palsy in Khartoum, Sudan

Cerebral palsy in African paediatric populations: A scoping review

AIM

To review the epidemiology and outcomes of African children with cerebral palsy (CP) over a 21-year period.

METHOD

The PubMed, Scopus, and Web of Science online databases were searched for original research on African children with CP aged 18 years and younger published from 2000 to 2021.

RESULTS

A total of 1811 articles underwent review against explicit criteria; 93 articles were selected for inclusion in the scoping review. The reported prevalence of CP ranged from 0.8 to 10 per 1000 children. Almost half had perinatal risk factors, but up to 26% had no identifiable risk factor. At least one-third of children with CP had one or more comorbidities, most commonly epilepsy, intellectual disability, and malnutrition. African children with CP demonstrated excess premature mortality approximately 25 times that of the general population, predominantly from infections. Hospital-based and younger populations had larger proportions of children with severe impairments. African children with CP had inadequate access to care and education, yet showed functional improvements compared to controls for all evaluated interventions.

INTERPRETATION

The prevalence of CP in Africa remains uncertain. African children with CP have different risk profiles, greater premature mortality, and more severe functional impairments and comorbidities compared to the Global North. Several barriers prevent access to optimal care. Larger African studies on validated and effective interventions are needed.

Epidemiology of Cerebral Palsy among Children and Adolescents in Arabic-Speaking Countries: A Systematic Review and Meta-Analysis

BACKGROUND

Studies on cerebral palsy among children and adolescents in Arabic-speaking countries are scarce. In this systematic review, we aimed to describe the epidemiology of cerebral palsy among children and adolescents in Arabic-speaking countries in terms of prevalence, risk factors, motor types, and rehabilitation.

METHODS

Six key bibliographic databases were searched for relevant literature published to 17 July 2021. Titles and abstracts were screened for potential inclusion and two independent reviewers screened the full texts of potential articles following pre-defined inclusion/exclusion criteria. The included studies were evaluated independently by three reviewers. The risk of bias was assessed, and data were extracted and analysed.

RESULTS

A total of 32 studies from 7 countries met our inclusion criteria. The prevalence of cerebral palsy in Arabic-speaking countries was 1.8/1000 live births (95% CI: 1.2-2.5). Spastic cerebral palsy was the most common motor type, representing 59.8% (95% CI: 46.2-72.7) of pooled estimates. This included children with spastic quadriplegia, diplegia, and hemiplegia; 25.1% (95% CI: 18.2-32.8), 16.2% (95% CI: 11.4-23.3), and 10.4% (95% CI: 7.3-13.8), respectively. Consanguinity was high and represented 37.7% (95% CI: 29.3-46.6). Only one included study reported the types of rehabilitation received (e.g., physiotherapy and assistance devices).

CONCLUSIONS

This paper provides a summary of the epidemiology of cerebral palsy in Arabic-speaking countries and highlights areas for future research. There is still a substantial knowledge gap on the epidemiology of cerebral palsy in these regions. Countries in the Arab region should follow examples of countries that have successfully established cerebral palsy registries to generate evidence on epidemiology of cerebral palsy and opportunities for prevention.

Potential impact of epidural labor analgesia on the outcomes of neonates and children

This review summarizes recent evidences regarding the potential influences of epidural labor analgesia (ELA) on the outcomes of neonates and children. Terms and relevant words including “ELA,” “ELA and neonatal outcomes,” “ELA and children's development,” and “ELA and children's neurocognitive development” were used to search articles published in PubMed database up to October 2019. Original articles and reviews regarding potential influences of ELA on neonates and children were identified. Relevant references of the selected articles were also screened. The anesthetics used during ELA can be absorbed, enter the fetus, and produce neonatal depression; however, these effects are less severe than those during systematic opioid analgesia. The impact of anesthetic exposure during ELA on children's neurodevelopment has not been fully studied, but would be mild if any. ELA increases the risk of intrapartum maternal fever; the latter may be harmful to neonatal outcomes. The use of ELA may increase birth injury by increasing instrumental delivery, although long-term adverse events are rare. On the other hand, ELA may reduce maternal depression and, thus, produce favorable effects on neurocognitive development in childhood; but evidences are still lacking in this aspect. ELA may produce both favorable and unfavorable effects on neonates and children. These effects should be discussed with parturient women before making decisions. The potential harmful effects should be carefully managed. The overall impacts of ELA on neonatal and children's outcomes need to be studied further.

Assessment of Anxiety and Depression in Polish Primary Parental Caregivers of Children with Cerebral Palsy Compared to a Control Group, as well as Identification of Selected Predictors

Background: Taking care of a child with Cerebral Palsy (CP) may be linked with adverse effects in the parents’ physical and mental health. The causes of anxiety and depression symptoms associated with childcare are still not fully understood. Aim: To assess the intensity of anxiety and depression symptoms in parents of children with CP compared to a control group and to identify selected mental health predictors. Design and Methods: Data were collected from 301 respondents, including 190 parents of children with CP (study group) and 111 parents taking care of children developing normally (control group). Intensity of anxiety and depression was rated using the Hospital Anxiety and Depression Scale (HADS) scale. Gross Motor Function Classification System for Cerebral Palsy (GMFCS), Sense of Coherence Scale (SOC-29), Berlin Support Social Scales (BSSS) scales and a specially designed questionnaire were used to assess the predictors. The investigated variables included the children’s and the parents’ characteristics, as well as environmental factors. The analyses applied Spearman’s rank correlation coefficient, M(SD) as well as multiple regression. Results: The level of anxiety and depression was clearly higher in the parents of children with CP–the mean levels of anxiety and depression in the study group and the controls amounted to 8.1 vs. 4.7 and 6.8 vs. 3.7, respectively. The factors associated with intensity of anxiety and depression in the parents of children with CP included lack of social support, mainly perceived and received support, unsatisfying parental health status, poor economic status of the family, as well as difficult living conditions, sense of coherence, loneliness, the parent’s gender, and the child’s intellectual disability. Conclusions: Identification of significant anxiety and depression predictors, understood as modifiable factors, should be considered in determining and planning comprehensive support for a child with CP and his/her primary parental caregiver.

The Quality of Life of Polish Children with Cerebral Palsy and the Impact of the Disease on the Family Functioning

PURPOSE

Care and upbringing of a child with cerebral palsy (CP) may affect the functioning of parents and the whole family. This study aimed to evaluate the quality of life (QOL) of children with CP in parents' opinion and the impact of disease on family functioning.

DESIGN AND METHODS

This cross-sectional study was conducted among 100 parents of children with CP. Survey instruments used included an Authors-Designed Questionnaire (ADQ) to collect sociodemographic and educational background data as well as four standardized questionnaires for pediatric QOL (PedsQL-GC, PedsQL-CPM, PedsQL-FIM) and for life satisfaction (SWLS).

RESULTS

Teenagers were characterised by a higher QOL compared to other age groups. The lowest scores were observed in the PedsQL-CPM domain of daily and school activities and in the physical functioning domain of the PedsQL. It was shown that family functioning is affected by the children's age and place of residence as well as the level of parental education. It was also shown that men, parents in a relationship, those living in the city and those with vocational education were characterised by a higher level of satisfaction with life than other groups.

CONCLUSIONS

The QOL of children with CP is reduced compared to the QOL of healthy children and their condition has a significant impact on family functioning. Therefore, learning about the factors that influence QOL will allow health care providers to properly plan actions aimed at minimising the negative impact of CP on children's QOL and improving the functioning of their families.

The complex aetiology of cerebral palsy

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

Multivariate Analysis and Machine Learning in Cerebral Palsy Research

Cerebral palsy (CP), a common pediatric movement disorder, causes the most severe physical disability in children. Early diagnosis in high-risk infants is critical for early intervention and possible early recovery. In recent years, multivariate analytic and machine learning (ML) approaches have been increasingly used in CP research. This paper aims to identify such multivariate studies and provide an overview of this relatively young field. Studies reviewed in this paper have demonstrated that multivariate analytic methods are useful in identification of risk factors, detection of CP, movement assessment for CP prediction, and outcome assessment, and ML approaches have made it possible to automatically identify movement impairments in high-risk infants. In addition, outcome predictors for surgical treatments have been identified by multivariate outcome studies. To make the multivariate and ML approaches useful in clinical settings, further research with large samples is needed to verify and improve these multivariate methods in risk factor identification, CP detection, movement assessment, and outcome evaluation or prediction. As multivariate analysis, ML and data processing technologies advance in the era of Big Data of this century, it is expected that multivariate analysis and ML will play a bigger role in improving the diagnosis and treatment of CP to reduce mortality and morbidity rates, and enhance patient care for children with CP.

Quality of life of cerebral palsy patients and their caregivers: A cross sectional study in a rehabilitation center Khartoum-Sudan (2014 - 2015)

Background:

Cerebral palsy (CP) is group of disorders characterized by long-term disabilities that affect the quality of life (QoL) of both patients and those caring for them.

Objective:

The objective of this study was to measure the QoL of CP patients and their caregivers and determine the factors affecting both of them.

Methods:

This was a cross-sectional facility-based study. 65 caregivers of children with CP aged 4–18 years completed a self-structured questionnaire. Descriptives of the samples were displayed, and logistic regression was used in the analysis.

Results:

The scores of overall QoL of both children and caregivers were low, however, variations were observed among different domains. Both health-related and sociodemographic factors were found to affect the QoL of children and caregivers. The increase in the degree of disability and presence of complications decreased the children QoL while the availability of health insurance improved it. Whereas the QoL of the caregiver was affected by his/her occupation, the degree of child disability did not affect it.

Conclusions:

This study showed that many feasible changes can be adopted to improve the QoL of CP patients and their caregivers.