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Prevalence, type, distribution, and severity of cerebral palsy in relation to gestational age: a meta-analytic review
E Himpens1, C Van den Broeck, A Oostra
1Rehabilitation Sciences and Physiotherapy Ghent, Artevelde University College - Ghent University, Ghent, Belgium. eveline.himpens@ugent.be
Insights
The prevalence of cerebral palsy (CP) significantly decreases with increased gestational age (GA), particularly after 27 weeks. Spastic CP is common in preterm infants, while non-spastic CP increases in term infants.
Area of Science:
- Perinatology
- Neurology
- Epidemiology
Background:
- Cerebral palsy (CP) is a significant concern in neonatal care.
- Gestational age (GA) is a known risk factor for CP.
- Understanding the GA-CP relationship is crucial for prevention and management.
Purpose of the Study:
- To determine the relationship between gestational age (GA) and the prevalence, type, distribution, and severity of cerebral palsy (CP).
Main Methods:
- Systematic review and meta-analysis of epidemiological studies.
- Meta-regression analysis across four fetal age categories.
- Inclusion of studies with CP as the target population.
Main Results:
- CP prevalence decreases significantly with increasing GA: 14.6% (22-27 wks), 6.2% (28-31 wks), 0.7% (32-36 wks), 0.1% (term).
- A significant decrease in CP prevalence begins after 27 weeks GA.
- Spastic CP predominates in preterm infants; non-spastic CP is more prevalent in term infants. Bilateral spastic CP is most common overall.
- No correlation found between CP severity and GA.
Conclusions:
- Gestational age is a critical determinant of cerebral palsy prevalence.
- CP subtypes vary between preterm and term infants.
- A standardized international classification system for CP subtypes and severity is needed.
Abstract:
The aim of this review is to determine the relationship between gestational age (GA) and prevalence, type, distribution, and severity of cerebral palsy (CP). Epidemiological studies with cohorts expressed by GA were assessed. A comprehensive meta-analysis and meta-regression was performed on four fetal age categories. Studies of children with CP as a target population were added. Twenty-six articles met the inclusion criteria. The prevalence of CP decreases significantly with increasing GA category: 14.6% at 22 to 27 weeks' gestation, 6.2% at 28 to 31 weeks, 0.7% at 32 to 36 weeks, and 0.1% in term infants. Interestingly, a significant decrease in prevalence of CP starts only from a GA of 27 weeks onwards. In preterm infants, spastic CP is predominant. In term infants, the non-spastic form of CP is more prevalent than in preterm infants. Bilateral spastic CP is most prevalent in both preterm and term infants. However, the proportion of unilateral spastic CP in term infants is substantial. No relationship could be detected between severity of CP and GA. There is a strong need for an international, well-described, and generally accepted classification system for subtypes and severity of CP.
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