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Intrauterine growth and survival in cerebral palsy
K Hemming1, J L Hutton, S Bonellie
1Department of Statistics, University of Warwick, Warwick, UK. karla@stats.warwick.ac.uk
Insights
Birth weight deviations impact cerebral palsy severity and survival. Lighter infants face more severe impairment but longer life, while heavier infants have shorter lifespans, especially with severe impairments.
Area of Science:
- Neurology
- Perinatal Medicine
- Public Health
Background:
- Deviations from optimal birth weight increase cerebral palsy (CP) risk and severity.
- The impact of birth weight variations on survival in CP is not well understood.
Purpose of the Study:
- To investigate how deviations from average birth weight for gestational age influence survival duration in individuals with cerebral palsy.
- To analyze the relationship between birth weight, CP severity, and long-term survival outcomes.
Main Methods:
- Utilized a large, well-defined UK cohort of individuals with cerebral palsy, followed from birth for nearly 25 years.
- Examined survival duration in relation to deviations from average birth weight for gestational age, controlling for impairment severity.
Main Results:
- Higher rates of severe motor or cognitive impairment were observed in infants born lighter than average for gestational age (up to 40% for extremely low weights).
- Female infants born heavier than average showed increased severe impairment (35%), unlike males.
- Survival to 15 years for those with four severe impairments was lower for heavier-than-average births (<40%) compared to average birth weight births (~60%).
Conclusions:
- Infants with lower-than-average birth weight for gestational age have a higher likelihood of developing more severe cerebral palsy.
- Surprisingly, among severely impaired infants, those born lighter have the longest life expectancy, while those born heavier have the shortest.
Background And Objectives:
Deviations in birth weight from an optimum, thought to be just above average for gestational age, are known to increase both the risk of developing cerebral palsy and the risk of developing cerebral palsy of a more severe form. Influences on survival of such deviations from average birth weight for gestational age are not known.
Methods:
Using a well-established, well-defined and large UK cohort of children and adults with cerebral palsy, followed from birth for nearly 25 years, we investigate the influence of deviations from average birth weight for gestational age, on survival duration, after allowing for severity of impairments.
Results:
A total of 3946 cases, born between 1980 and 1996 were included. For those born much lighter than average for gestational age, more than 30% (n = 313) had a severe motor or cognitive impairment, rising to as much as 40% (n = 239) for extremely low weights. For female infants, the proportions severely impaired increased to as much as 35% (n = 49) among those born much heavier than average; no such increase was observed for heavier than average male infants. For those with four severe impairments and a birth weight close to average for gestational age, around 60% (n = 140) survived to age 15 years, compared with less than 40% (n = 9) of those born much heavier than average for gestational age. A 2-year-old child with four severe impairments and born heavy for gestational age has a predicted median life expectancy of 79% (95% CI 70% to 88%) of the average.
Conclusions:
Infants with a birth weight lighter than average for gestational age have an increased likelihood of developing a more severe form of cerebral palsy. Surprisingly, among the infants who are very severely impaired, those born much lighter than average for gestational age have the longest life expectancy, and those born much heavier than average for gestational age have the shortest life expectancy.
