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Determinants of ambulation in children with spastic quadriplegic cerebral palsy: a population-based study
Elisabeth Simard-Tremblay1, Michael Shevell, Lynn Dagenais
1Department of Neurology/Neurosurgery, McGill University, Montreal, Quebec, Canada.
Insights
Predicting ambulation in spastic quadriplegic cerebral palsy is possible. Factors like gestational age and birth weight significantly influence a child
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Spastic quadriplegic cerebral palsy (CP) is a severe form of CP affecting all four limbs.
- Predicting functional outcomes, such as ambulation, is crucial for early intervention and care planning.
- Identifying prognostic factors can guide therapeutic strategies and resource allocation.
Purpose of the Study:
- To identify clinical factors that predict the ability to ambulate in children diagnosed with spastic quadriplegic cerebral palsy.
- To compare clinical features between ambulant and non-ambulant groups within this population.
- To establish predictors for achieving independent ambulation in spastic quadriplegic cerebral palsy.
Main Methods:
- A registry-based birth cohort of children diagnosed with spastic quadriplegic cerebral palsy was analyzed.
- Patients were classified into ambulant (Gross Motor Function Classification System level ≤ III) and non-ambulant (Gross Motor Function Classification System level ≥ IV) groups.
- Clinical features were retrospectively compared between the two groups.
Main Results:
- Out of 85 children with spastic quadriplegic CP, 20 were classified as ambulant and 65 as non-ambulant.
- Seizures within the first 72 hours of life and antibiotic use during pregnancy/delivery were associated with an inability to ambulate.
- Gestational age ≤ 27 weeks, birth weight <1000g, Caucasian ethnicity, and hyperbilirubinemia were significantly linked to achieving independent ambulation.
Conclusions:
- Early-life seizures and antibiotic exposure are negative predictors for ambulation in spastic quadriplegic CP.
- Prematurity (gestational age ≤ 27 weeks), very low birth weight (<1000g), and hyperbilirubinemia are positive predictors for ambulation.
- These findings aid in predicting ambulation potential and tailoring interventions for children with spastic quadriplegic cerebral palsy.
Abstract:
The objective of this study was to identify factors that predict ambulation in spastic quadriplegic cerebral palsy. A 4-year registry-based birth cohort was searched for patients with a diagnosis of spastic quadriplegic cerebral palsy. All patients were then divided in 2 groups: (a) Gross Motor Function Classification System level < or = III (ambulant group) and (b) Gross Motor Function Classification System level > or = IV (nonambulant group). Clinical features were then compared between the 2 groups. A total of 85 children with a diagnosis of spastic quadriplegic cerebral palsy were identified. Of these, 65 and 20 were classified in the ''nonambulant'' and ''ambulant'' groups, respectively. The presence of seizures in the first 24 or 72 hours of life and the administration of antibiotics during pregnancy/delivery were all associated with an eventual inability to achieve ambulation. A gestational age < or = 27 weeks, birth weight <1000 g, Caucasian mother, and the presence of hyperbilirubinemia were significantly linked with independent ambulation.
