Cerebral Palsy CDC Expert Information : Seizures, Outcome, Prevalence in Preterm Birth

Early identification is important for early treatment in children under 1500g or born between 28-31 weeks. 

Optimally, neurology can help to guide early ECI, OT, PT, ST after a specialty neurologic exam of infants at risk. A discussion of a diagnostic AND functional / rehabilitative strategy should be part of this consultation.

JR

CDC Data & Statistics for Cerebral Palsy

Prevalence and Characteristics

• Cerebral palsy (CP) is the most common motor disability in childhood. (1)
• Population-based studies from around the world report prevalence estimates of CP ranging from 1.5 to more than 4 per 1,000 live births or children of a defined age range. (2, 3, 4, 5,6)
• About 1 in 323 children has been identified with CP according to estimates from CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network. [Read summary]

  [D]

• CDC tracks CP through the Autism and Developmental Disabilities Monitoring (ADDM) CP Network.
• In 2008, the ADDM CP Network included areas of Alabama, Georgia, Missouri, and Wisconsin. Based on children who were 8 years old and living in these four communities in 2008, the ADDM CP data showed that: [Read summary] [R ead Community Report ]
  • CP was more common among boys than among girls.
  • CP was more common among Black children than White children. Hispanic and White children were about equally likely to have CP.
  • Most (77.4%) of the children identified with CP had spastic CP.
  • Over half (58.2%) of the children identified with CP could walk independently.
  • Many of the children with CP also had at least one co-occurring condition—41% had co-occurring epilepsy and 6.9% had co-occurring ASD.

Walking Ability

• In 2008, 58.2% of children with CP could walk independently, 11.3% walked using a hand-held mobility device, and 30.6% had limited or no walking ability. [Read summary]

 [D] 

• According to 2006 data from the ADDM CP Network, Black children with cerebral palsy were 1.7 times more likely to have limited or no walking ability compared with White children. [Read summary]
  
• Another study found that 41% of children with CP were limited in their ability to crawl, walk, run, or play, and 31% needed to use special equipment such as walkers or wheelchairs. [Read article]

Co-Occurring Developmental Disabilities

• Almost half (41%) of the children identified with CP by the ADDM CP Network had co-occurring epilepsy. Co-occurring epilepsy frequency was highest among children with cerebral palsy who had limited or no waking ability. [Read summary]
  
• Some (6.9%) of the children identified with CP also had autism spectrum disorder (ASD). Co-occurring ASD frequency was higher among children with non-spastic CP, particularly hypotonic CP. [Read summary]
  • It is important to note that the overall identified prevalence of ASD among children in the US is about 1% (7). That means that the identified prevalence of ASD among children with CP is much higher than among their peers without CP.

 [D] 

• The ADDM site that tracks CP in metropolitan Atlanta is the Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP). MADDSP 2006 data show that:
  • Approximately 60% of 8-year-old children with CP had another developmental disability.
  • More than 40% of children with CP had intellectual disability, 35% had epilepsy, and more than 15% had vision impairment. Nearly 1 in 4 children with CP had both intellectual disability and epilepsy.

Risk Factors

Low Birthweight and Premature Birth

• A study in metropolitan Atlanta found that the prevalence of CP was 6.2 per 1,000 livebirths among children born weighing 1,500 to 2,499 grams (3⅓ to 5½ pounds) and 59.5 per 1,000 livebirths among children born weighing less than 1,500 grams, compared with 1.1 per 1,000 for children born weighing 2,500 grams or more. [Read article]
• In data from Europe and Australia, the prevalence of CP ranged from: (8)
  • 35.0 to 79.5 per 1,000 live births for children born at 28 to 31 weeks gestation
  • 1.1 to 1.7 per 1,000 live births for children born at 37 or more weeks gestation
• In data from Sweden, the prevalence of CP was: (8)
  • 43.7 per 1,000 live births for children born at 28 to 31 weeks gestation
  • 6.1 per 1,000 live births among children born at 32 to 36 weeks gestation
  • 1.4 per 1,000 live births for children born at 37 or more weeks gestation
• A study in Scotland found that children born as part of a multiple birth pregnancy such as being a twin were found to be almost five times more likely to have CP than children born as singletons. Part, but not all, of this increased risk is due to the fact that multiple birth children are more likely to be born prematurely or at low birthweight. [Read summary]
• A study in Denmark found that children born after in vitro fertilization (assisted conception) were 1.6 times as likely to have CP, due to the fact that they were more likely to be born prematurely or from a multiple pregnancy. [Read article]

Disruption of Blood and Oxygen Supply to the Developing Brain

• Ischemic stroke, when a blood clot blocks a blood vessel in the brain, is recognized to cause brain damage that can result in CP. It can occur in the developing fetal brain during pregnancy or shortly after birth. [Read summary]
• Disruption of the oxygen supply during birth (birth hypoxia) has been estimated to account for less than 10% of CP cases. [Read summary]

Infection Among Mothers

• Infection of the placental membranes (chorioamnionitis) or other signs of infection (blood infection in the mother or fever during labor) have been associated with an increased risk of CP for children born full-term. [Read article], [Read summary]
• Chorioamnionitis has been found to account for 12% of spastic CP among children born full-term and 28% of CP among children born prematurely. [Read article]
• Maternal genitourinary infection has been associated with an increased risk of CP among children born prematurely or at low birthweight. [Read article] 

Other Factors

• Birth defects of the central nervous system (brain) were found to be more common among children with CP than among those without CP. [Read summary]
• Data from metropolitan Atlanta showed that about 10% to 15% of CP was acquired in the early years of a child’s life. The most frequent causes were brain injuries from motor vehicle crashes or falls, and infections (such as meningitis). [Read article], [Read summary]

More HERE

Study: Preemies from Low-Income Families at High Risk for Dangerous Brain Bleeds

A study from Johns Hopkins shows that premies who are born to a low socioeconomic family are more likely to have dangerous hemorrhages.

While interesting, I never know how to apply this data in the office, the NICU or my cerebral palsy clinics.... JR

Babies born prematurely to low-income parents have a disproportionately high risk for developing dangerous brain bleeds that require multiple surgeries and extensive follow-up, according to a small Johns Hopkins Children's Center study.

The findings -- published online Sept. 28 in the journal Pediatric Neurosurgery and based on an analysis of 38 patients referred to Johns Hopkins for treatment of brain hemorrhages related to premature birth -- offer a sobering reminder of the role socio-economic factors can play in health outcomes, the researchers say.

The link between poverty and premature birth has been well-documented, the investigators say, but the new findings go a step further and focus on the consequences of one particularly dire and fairly common complication of prematurity -- brain hemorrhages.

"Our study shows just how detrimental and far-reaching the effects of prematurity can be, medically and otherwise, highlighting the critical need to better identify high-risk pregnancies and reduce the number of premature births," says Edward Ahn, M.D., pediatric neurosurgeon and senior author on the research.

"Brain hemorrhages can have a lifelong impact on a child's neurological and cognitive development, but also create a financial burden on the families, many of whom in our study were already economically challenged," Ahn adds.

The premature brain's blood vessels are highly vulnerable to rapid changes in blood and brain pressure that occur around birth. While some brain bleeds are small and contained within the blood vessel, others can spread further and significantly damage the brain, particularly if not diagnosed and treated promptly. Serious hemorrhages require surgery, intensive follow-up and, often, long-term care to deal with the neurological and developmental after-effects of the condition.

The study tracked 38 babies treated at Hopkins Children's between 2007 and 2010 for complications of brain hemorrhages they had suffered during preterm birth. Most infants in the study (65 percent) were from low-income families and received public health insurance(63 percent). Household income is not part of a standard medical record, but the researchers used zip code and Medicaid status as proxies for income. Medicaid is the public health insurance program for low-income children.

In addition to the higher risk for brain bleeds, the study showed babies from lower-income homes and those with public health insurance had fewer scheduled follow-up appointments and more emergency room visits, compared with babies with private health insurance and with those from higher income homes. The researchers note the differences were clear, even though they didn't reach statistical significance due to the small number of patients in the study.

"If a family foregoes a scheduled follow-up and instead ends up in the ER with a serious, yet likely preventable complication, the medical and financial consequences can be far worse not only for the family but for the health care system as a whole because ER care is more expensive than routine check-ups," Ahn says.

The investigators said their findings need to be replicated on a wider scale in order to further tease out the reasons behind the disproportionate risk.

Read more here

Did you know that one quarter of babies born by normal vaginal birth will have an asymptomatic brain hemorrhage?

Intracranial Hemorrhage in Asymptomatic Neonates: Prevalence on MR Images and Relationship to Obstetric and Neonatal Risk Factors1

Christopher B. Looney, BS, J. Keith Smith, MD, PhD, Lisa H. Merck, MD, MPH, Honor M. Wolfe, MD, Nancy C. Chescheir, MD, Robert M. Hamer, PhD and John H. Gilmore, MD

+ Author Affiliations

1From the Department of Psychiatry, CB No. 7160, 7025A Neurosciences Hospital, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7160. From the 2005 RSNA Annual Meeting. Received January 23, 2006; revision requested March 23; revision received June 7; accepted June 21; final version accepted August 21. J.H.G. supported by National Institute of Mental Health grant 1 P50 MH064065. C.B.L. supported by a Distinguished Medical Scholarship from UNC School of Medicine.

Address correspondence to

J.H.G. (e-mail: jgilmore@med.unc.edu).

Next SectionAbstract

Purpose: To retrospectively evaluate the prevalence of neonatal intracranial hemorrhage (ICH) and its relationship to obstetric and neonatal risk factors.

Materials and Methods: Pregnant women were recruited for a prospective study of neonatal brain development; the study was approved by the institutional review board and complied with HIPAA regulations. After informed consent was obtained from a parent, neonates were imaged with 3.0-T magnetic resonance (MR) imaging without sedation. The images were reviewed by a neuroradiologist with 12 years of experience for the presence of ICH. Medical records were prospectively and retrospectively reviewed for selected risk factors, which included method of delivery, duration of labor, and evidence of maternal or neonatal birth trauma. Risk factors were assessed for relationship to ICH by using Fisher exact test statistics.

Results: Ninety-seven neonates (mean age at MR imaging, 20.8 days ± 6.9 [standard deviation]) underwent MR imaging between the ages of 1 and 5 weeks. Eighty-eight (44 male and 44 female) neonates (65 with vaginal delivery and 23 with cesarean delivery) completed the MR imaging evaluation. Seventeen neonates with ICHs (16 subdural, two subarachnoid, and six parenchymal hemorrhages) were identified. Seven infants had two or more types of hemorrhages. All neonates with ICH were delivered vaginally, with a prevalence of 26% in vaginal births. ICH was significantly associated with vaginal birth (P < .005) but not with prolonged duration of labor or with traumatic or assisted vaginal birth.

Conclusion: Asymptomatic ICH following vaginal birth in full-term neonates appears to be common, with a prevalence of 26% in this study.


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