Cerebral palsy in the West of Ireland and the application of the international criteria for the identification of acute intrapartum hypoxia: a cohort study.

Abstract

Abstract Background Cerebral palsy is one of the most severe disabilities in childhood and occurs in 1-3 per 1,000 live births in Europe. This epidemiological study looked at a cohort of children with cerebral palsy to establish if their demographics, clinical characteristics and risk profiles are similar to those of other children with cerebral palsy described in the literature. The prevalence of variables associated with intrapartum hypoxia was also explored.

Methods A retrospective cohort study was conducted. Data were extracted from maternal and neonatal records using a standardised data extraction form. Data analysis was conducted using SPSS (Statistical Package for the Social Sciences) version 18 and the Cochrane Review Manager Software (RevMan) (The Nordic Cochrane Centre, 2008).

Findings One hundred children with cerebral palsy participated in the study. Singleton births accounted for 89% of the cohort and 11% were from multiple births. The gestational ages ranged from 24 to 42 weeks with 61% of the children being born at term and 39% born prematurely. Birth weights ranged from 780 grams to 4990 grams with 60% of the children having a normal birth weight and 40% being low birth weight. 84% of the children had a spastic subtype of cerebral palsy including, 34% with a spastic hemiplegia, 26% with a spastic diplegia and 24% with a spastic quadriplegia. Dyskinetic cerebral palsy occurred in 10% of the children and ataxic cerebral palsy in the remaining 6%. Many of the children had other impairments in addition to their motor difficulties. Among those additional impairments are, walking impairments (84%), intellectual impairments (62%), feeding difficulties (56%), epilepsy (44%), visual impairments (20%) and hearing impairments (13%). The likely time of origin of the cerebral damage was not classifiable in 13% of cases, antenatal in 38%, related to prematurity in 28%, neonatal and post-neonatal in 6% and followed intrapartum hypoxia in 15% of cases.

Conclusion The distribution of antenatal, intrapartum and neonatal factors associated with cerebral palsy are similar to that found in other populations of children with cerebral palsy. The children have a distribution of cerebral palsy subtypes and associated impairments similar to other cerebral palsy cohorts. The study also found that the ACOG criteria for identifying acute intrapartum hypoxia sufficient to cause cerebral palsy were deficient.