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Risk factors for cerebral palsy
S Suvanand1, S K Kapoor, V P Reddaiah
1Center for Community Medicine, All Indian Institute of Medical Sciences (AIIMS), New Delhi.
Insights
Birth asphyxia, low birth weight, and neonatal complications are key risk factors for cerebral palsy in children under five. Understanding these factors is crucial for prevention and early intervention strategies.
Area of Science:
- Pediatrics
- Neurology
- Public Health
Background:
- Cerebral palsy (CP) is a leading cause of childhood disability with complex and often poorly understood etiology.
- Identifying modifiable risk factors is essential for developing effective prevention and intervention strategies for CP.
Purpose of the Study:
- To investigate and assess the association between various antenatal, natal, and postnatal factors and the risk of developing cerebral palsy in children.
- To determine the prevalence of different types and subtypes of cerebral palsy in the studied population.
Main Methods:
- A case-control study involving 125 children diagnosed with cerebral palsy and 125 age- and sex-matched controls under five years old in Delhi, India.
- Data on potential risk factors were collected through maternal interviews and hospital records, covering the antenatal, natal, and postnatal periods.
Main Results:
- Spastic cerebral palsy (88%) and quadriplegia (86.4%) were the most common types and topographical subtypes observed.
- Significant risk factors associated with cerebral palsy included birth asphyxia (OR 36.1), low birth weight (OR 13.8), neonatal convulsions (OR 37.4), neonatal jaundice (OR 23), neonatal infection (OR 14.4), instrument-assisted delivery (OR 24.9), and antepartum hemorrhage (OR 15.4).
- Factors such as precipitate labor, cesarean section, twins, toxemia, breech delivery, and head injury were not found to be significantly associated with CP in this study.
Conclusions:
- Birth asphyxia, low birth weight, neonatal convulsions, jaundice, infection, instrument-assisted delivery, and antepartum hemorrhage are identified as significant risk factors for cerebral palsy.
- The findings underscore the importance of addressing these specific risk factors in clinical practice and public health initiatives to reduce the incidence of cerebral palsy.
Abstract:
Cerebral palsy is a major cause of crippling in children, but it's etiology is poorly understood. This case control study was done to assess some of the identified risk factors for cerebral palsy, 125 cerebral palsy cases selected from hospital clinic and 125 age and sex matched neighbourhood controls, all aged less than 5 years and residing in Delhi (India) were studied. Information regarding antenatal, natal and postnatal period was collected by mother's interview, and wherever available, from hospital records with the study subjects. Most common type of cerebral palsy was spastic (88%). Quadriplegia was the commonest topographical subtype (86.4%). Birth asphyxia was found to be present in only 25.6% of cases. The commonest risk factor amongst cases was low birth weight (28.8%). The multivariate odds ratios (confidence limits) for the risk factors found to be significantly associated with cerebral palsy were 36.1 (7.76-160) for birth asphyxia, 13.8 (4.95-38.3) for low birth weight, 37.4 (4.47-313) for neonatal convulsion, 23 (4.7-112) for neonatal jaundice, 14.4 (3.69-56.4) for neonatal infection, 24.9 (2.78-223) for instrument assisted delivery and 15.4 (1.57-152) for antepartum hemorrhage. Precipitate labour, caesarean section, twins, toxemia, breech delivery and head injury were not found to be significantly associated with cerebral palsy. Thus birth asphyxia, low birth weight, neonatal convulsions, neonatal jaundice, neonatal infection, instrument assisted delivery and antepartum hemorrhage are significant risk factors for cerebral palsy.