Predicting the outcome of adductor tenotomy.
This study reviewed 57 hips in 30 children (18 girls and 12 boys) with cerebral palsy who had undergone an adductor tenotomy alone or in combination with an anterior obturator neurectomy (23 hips). Results were evaluated by the Reimers migration percentage (MP). The hips were split into three groups: group A (12 hips) a preoperative MP of less than 20%, group B (25 hips) between 20 and 40%, and group C (20 hips) more than 40%. The mean age at the time of surgery was 6 years and 1 month (range: 2.5-13 years). The mean period of review was 6 years and 3 months (2-20 years). The results were considered as "good" when radiographs at the longest follow-up showed a decrease of > 10% of the MP, as "bad" when they showed an increase of > 10%, and as "stable" when the MPs varied less than 10%. At the latest review of group A, 11 were stable (92%) and 1 was bad. In group B, 12 were stable (48%), 7 were good (28%), and 6 were bad (24%). In group C, 7 were stable (35%), and 13 were bad (65%). The preoperative migration percentage provided to be the only predictor of outcome. Age at the time of surgery had no constant significant effect on the outcome, neither had the addition of an anterior neurectomy. (+info
Can routine information systems be used to monitor serious disability?
OBJECTIVE: To determine whether reliable birth cohort prevalence rates of disabling conditions in early childhood can be obtained from child health information systems. DESIGN: Comparison of two sources of information on motor and sensory disabilities: from child health information systems held by health authorities, and a population register that uses multiple sources of ascertainment. SETTING: The counties of Oxfordshire, Buckinghamshire, and Northamptonshire. PARTICIPANTS: Children born to residents of the three counties between 1984 and 1989. RESULTS: Eight hundred and twenty children (6.0/1000 live births) were identified from the child health system as having one or more of the conditions, and 580 (4.2/1000 live births) were identified from the population register; however, only 284 children were identified by both sources. CONCLUSIONS: It is currently impossible to monitor trends in the prevalence rate of disabling disorders in childhood using the child health information systems. Agreement about ways of collecting, recording, and collating information on disability would be a useful step towards realising the full potential of these systems. (+info
Trends in incidence of cranial ultrasound lesions and cerebral palsy in very low birthweight infants 1982-93.
AIM: To evaluate the effects of changing perinatal practice on outcome in terms of cranial ultrasound appearances and subsequent cerebral palsy rates in survivors. METHODS: A tertiary neonatal centre based prospective cohort study was undertaken of very low birthweight infants, in three 4 year periods: 1982-5, 1986-9, 1990-3. Rates of survival, parenchymal cerebral haemorrhage (PH), and leucomalacia on cerebral ultrasound scans, and cerebral palsy (CP) at the age of 3 years were compared. Antenatal steroid prophylaxis and postnatal surfactant use were also compared. RESULTS: VLBW infants (1722) were admitted over the 12 years, of whom 1268 (73.6%) were discharged home. Neonatal survival increased significantly over the three periods (69.2%, 72.9%, 79.7%; p < 0.0001). PH declined from 14.9% to 10.5% (p = 0.032) after 1990 as did CP rate (10.9% to 7.3%; p = 0.046). The use of antenatal steroids and postnatal surfactant greatly increased during this period. Steroid use was significantly associated with increased survival (OR 3.34, 2.31-4.79), decreased PH (OR 0.44, 0.28-0.71), and decreased risk of CP in survivors (OR 0.47, 0.27-0.81) after standardising for gestation, birthweight, sex, place and mode of delivery. Similar effects for surfactant did not remain significant after steroid use had been accounted for. CONCLUSION: Improved survival in VLBW infants since 1990 has been accompanied by a fall in PH and subsequent CP rates in survivors. This change is most likely to be due to the greater use of antenatal steroid prophylaxis. (+info
Outcome of very severe birth asphyxia.
The aim of this study was to establish the outcome of very severe birth asphyxia in a group of babies intensively resuscitated at birth. 48 infants, born between 1966 and 1971 inclusive, were selected; 15 were apparently stillborn and 33 had not established spontaneous respirations by 20 minutes after birth. One-half of them died, but 3 to 7 years later three-quarters of the survivors are apparently normal. Later handicap was associated with factors leading to prolonged partial intrapartum asphyxia, while acute periods of more complete asphyxia were not necessarily harmful. (+info
Kinematic and qualitative analysis of lower-extremity movements in preterm infants with brain lesions.
BACKGROUND AND PURPOSE: The purposes of this study were to evaluate the effects of preterm birth, severe brain lesions, and postterm age on kicking movements of young infants and to compare the prognostic value of kinematic analysis of kicking with a qualitative assessment of infants' spontaneous movements. SUBJECTS: The subjects were 12 full-term infants without brain injury, 12 low-risk preterm infants without brain injury, and 11 preterm infants with severe brain lesions (periventricular leukomalacia). METHODS: Videotape recordings of each infant's motor behavior in a supine position were made at 1 and 3 months postterm age. Kicking frequency, temporal organization of the kick cycle, coordination among different joints, and interlimb coordination were measured. A qualitative assessment for lower-extremity movements and a Gestalt judgment of general movement quality according to Prechtl's method were made from the same videotape recordings. RESULTS: Kinematic analysis showed only mild differences among the 3 groups of infants. Qualitative assessment of the lower-extremity movements, however, showed that preterm infants with brain lesions, and particularly those who later were found to have cerebral palsy, consistently had fewer segmental movements of the foot and abnormal general movements at both ages. CONCLUSION AND DISCUSSION: The data suggest that the mechanisms responsible for kicking movements in newborns and young infants do not appear to be influenced by the extrauterine environment or by brain lesions, at least at the ages studied. Qualitative assessment of lower-extremity and general movements seems to be more appropriate for clinical purposes. (+info
Prospective evaluation of perinatal risk factors for cerebral palsy and delayed development in high risk infants.
Prematurity, intrauterine infection and perinatal brain injury have been reported to be significant risk factors of cerebral palsy (CP). We examined the perinatal predictors of cerebral palsy and delayed development (DD) in 184 high risk infants. Thirty-five infants were diagnosed as cerebral palsy and delayed development at 12 months corrected age. Antenatal, intrapartum, and neonatal factors were prospectively evaluated in 2 groups of high risk infants compared with controls; Group A (n = 79), infants weighing less than 2,000 g; Group B (n = 43), infants weighing 2,000 g or more. In univariate analysis, there were no significant antenatal and intrapartum factors associated with cerebral palsy and delayed development in either group. We found that significant postnatal risk factors of CP in group A included sepsis (p = 0.008), BPD (bronchopulmonary dysplasia) (p = 0.028), IVH (intraventricular hemorrhage) (p = 0.042), ventriculomegaly (VM) (p = 0.001) and a longer duration of mechanical ventilation (p = 0.001); while in group B, sepsis (p = 0.047) and neonatal seizure (p = 0.027) were significant risk factors. In multivariate analysis, sepsis in group B was a moderate risk factor of CP (OR (odds ratio) 1.47; 95% CI (confidence interval) 1.02-2.13). In conclusion, neonatal sepsis may contribute to the development of cerebral palsy and delayed development. We suggest that high risk infants who have sepsis should be carefully followed for cerebral palsy and delayed development. The prevention of cerebral palsy may be feasible by decreasing neonatal risk factors such as sepsis during the neonatal period. (+info
Cause of death in cerebral palsy: a descriptive study.
BACKGROUND: Cause specific research on death certification in chronic disease has rarely involved cerebral palsy. AIMS: To evaluate cause of death information in people known to have cerebral palsy by: describing the cause of death distribution; determining case ascertainment using death certification as the data source; and analysing the choice of wording and its arrangement in the "cause of death statement". STUDY CASES AND SETTING: People with early or late impairment cerebral palsy who died by 30 June 1998, on the population based Mersey Cerebral Palsy Register born 1966-91 to mothers resident locally. STUDY DESIGN: Descriptive study of the multiply coded cause of death statements from National Health Service Central Register flagging. RESULTS: Death certificate copies were acquired for all 282 (13.4%) of the 2102 registered cases who died. Cerebral palsy was the most common "underlying cause of death" (95 of 282; 33.7%) and was mentioned in a further 61 cases. The underlying cause of death was more likely to be cerebral palsy with increasingly severe disability and was derived from Part II in 16 of 95 cases. CONCLUSIONS: The potential of death certification for case ascertainment of cerebral palsy is important, but limited, even with multiple cause coding. Mortality data need careful interpretation as a proxy source for examining trends and patterns in cerebral palsy. (+info
Prevalence of cerebral palsy in China.
BACKGROUND: A population-based study on the prevalence of cerebral palsy has not been previously carried out in China. The purpose of the present paper was to determine the overall and birthweight-specific prevalence of cerebral palsy. METHODS: A cross-sectional study of cerebral palsy was carried out among 388192 children aged <7 years in seven cities of Jiangsu province in China from May to July 1997. Information about birthweight was obtained from routine health care records. Doctors from township and city hospitals examined all eligible children and doctors at city level finally diagnosed all cases. All the doctors involved had taken part in a training programme held by Beijing Medical University in April 1997. RESULTS: The total prevalence of cerebral palsy was 1.6 per 1000 children and the birthweight-adjusted prevalence 2.8 per 1000 children (using Australia's neonatal survivors 1994 as a standard population). The overall neonatal mortality rate was 6.8 per 1000 live births, being highest (581.1 per 1000) in the 1000-1499 g birthweight group. The birthweight-specific cerebral palsy prevalence ranged from 0.8 per 1000 children in children weighing 3750-3999 g to 67.3 in children weighing 1500-1749 g. Children weighing 3500-3999 g at birth were at the lowest risk of cerebral palsy. In a given low birthweight group the prevalence of cerebral palsy in China was higher than that in developed countries even though this study was unable to include those who died at risk of, or with cerebral palsy. However, the prevalence of cerebral palsy at normal birthweight was almost the same as that in developed countries. In all, about 2% of all children were of low birthweight (<2500 g), with those weighing <1500 g accounting for about 0.02%. Children weighing <2500 g at birth contributed 24% of all cerebral palsy cases with 99% in the group 1500-2499 g. CONCLUSIONS: The prevalence of cerebral palsy for children aged <7 years is 1.6 per 1000 children. It is estimated that there are 310000 children with cerebral palsy in China and as the survival of low birthweight infants improves the prevalence of cerebral palsy will rise. Survival of low birthweight infants is lower in China than in developed countries and our findings suggest the survival quality of these Chinese children needs to be improved and that intrapartum and neonatal antecedents might play an important role in the aetiology of cerebral palsy compared to developed countries. (+info