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Intrauterine growth and spastic cerebral palsy II. The association with morphology at birth
1Western Australian Research Institute for Child Health, Princess Margaret's Hospital, Subiaco.
Insights
Children with spastic cerebral palsy often exhibit abnormal birth morphologies, including being small for their gestational age, which correlates with more severe conditions. Some also show enlarged head circumferences, linked to milder cerebral palsy.
Area of Science:
- Pediatrics
- Neurology
- Developmental Biology
Background:
- Spastic cerebral palsy (CP) is a significant developmental disorder.
- Previous research linked low birth weight for gestational age to CP in infants over 34 weeks gestation.
- Birth morphology variations may offer further insights into CP etiology.
Purpose of the Study:
- To investigate if children with spastic CP have distinct birth morphologies compared to the general liveborn population.
- To identify specific abnormal birth measurements associated with spastic CP.
- To explore the relationship between abnormal birth measurements and CP severity.
Main Methods:
- Compared birth measurements (weight, length, head circumference, ponderal index, length-to-head circumference ratio) of 104 spastic CP cases against a total liveborn population.
- Defined 'abnormal' measurements as those outside the 10th-90th percentile range.
- Analyzed the prevalence of abnormal measurement combinations in spastic CP cases versus the general population.
Main Results:
- 44.4% of spastic CP cases exhibited combinations of abnormal birth measurements, exceeding expected population proportions.
- Over half of these excess cases were small for gestational age, suggesting early-term growth deficits.
- These small-for-gestation cases often presented with more severe forms of spastic CP.
- An additional 7.4% of spastic CP cases had head circumferences above the 90th percentile, typically associated with milder CP.
Conclusions:
- Abnormal birth morphology is significantly associated with spastic cerebral palsy.
- Being small for gestational age at birth is a key indicator linked to increased risk and severity of spastic CP.
- Enlarged head circumference at birth may indicate a distinct subgroup of milder spastic CP.
Abstract:
This study tests the hypothesis that children with spastic cerebral palsy had different birth morphologies, defined in terms of their weight, length, head circumference, ponderal index and length to head circumference ratio, from that of the normal liveborn population. An earlier study showed a highly significant association of spastic cerebral palsy with low birthweight for gestational age in infants over 34 weeks gestation at delivery. This analysis defines morphological measurements as "abnormal" if not within the 10th-90th percentile ranges of appropriate total liveborn populations. The proportions with combinations of such measurements in 104 cases of spastic cerebral palsy from a population register of cerebral palsy are compared with those in a total liveborn population. Categories of 'abnormal' measurements associated with increased risk contained 44.4% of cases in excess of the proportion observed in the total population. More than half these excess cases were short for their gestation (suggesting size deficits originating before the 3rd trimester) and tended to have more severe forms of cerebral palsy. A further excess of 7.4% of cases had a head circumference above their 90th percentile: these generally developed mild cerebral palsy.