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Published on: January 11, 2016
Characteristics of children with cerebral palsy in the ORACLE children study
Neil Marlow1, Katie Pike, Eva Bower
1Institute for Women's Health, University College London, London, UK. n.marlow@ucl.ac.uk
Insights
Antibiotic treatment for spontaneous preterm labor (SPL) in mothers increased cerebral palsy (CP) risk in children. While CP patterns were similar, functional outcomes were milder, suggesting inflammation plays a role.
Area of Science:
- Obstetrics and Gynecology
- Pediatric Neurology
- Clinical Epidemiology
Background:
- An excess of children with cerebral palsy (CP) was observed in mothers treated with antibiotics for spontaneous preterm labor (SPL).
- The ORACLE Children Study (OCS) investigated the characteristics of CP in children born following preterm labor, comparing outcomes with a population-based CP registry (4Child).
Purpose of the Study:
- To investigate the profile of impairment among children with CP in the OCS.
- To contrast CP outcomes in the OCS with those in the 4Child registry.
- To determine if antibiotic treatment for SPL influences CP risk and severity.
Main Methods:
- A nested study within the OCS included 167 children aged 7-10 years with CP, divided into preterm rupture of membranes (PROM) and SPL groups.
- Follow-up data on health and behavior were collected via parent-report questionnaires and physiotherapy assessments.
- Outcomes were compared between OCS subgroups and the 4Child population registry.
Main Results:
- Prevalence of CP was significantly higher in the OCS SPL group (3.12) and PROM group (1.56) compared to general population rates.
- Children with CP in the SPL group were more likely to be born after 32 weeks gestation (73%) than in the PROM group (30%).
- Neuroimpairment distributions were similar to the 4Child registry, but motor, vision, and hearing impairments were less severe in OCS children.
Conclusions:
- The pattern of CP was similar between PROM and SPL groups, but functional outcomes were milder than in the general population.
- Increased CP risk was observed independently of gestational age in both PROM and SPL groups.
- Findings support the hypothesis that ongoing inflammatory damage contributes to CP development.
Aims:
We have identified an excess of children with cerebral palsy (CP) born to women who received antibiotic treatment for spontaneous preterm labour (SPL). This nested study investigated the profile of impairment among children with CP in the ORACLE Children Study (OCS), and contrasted outcomes with those in 4Child, a population CP registry.
Method:
The study group comprised 167 children aged from 7 to 10 years (100 males, 67 females) with CP from the OCS, who were subdivided into a preterm rupture of membranes (PROM) group (87 children) and an SPL group (80 children). The OCS sought follow-up information regarding the health and behaviour of surviving children at 7 years of age in the UK using a parent-report postal questionnaire. Families provided further information to define wider aspects of function and were offered a physiotherapy assessment.
Results:
The prevalence of CP was higher among children in the OCS than among those in 4Child (standardized morbidity ratios: SPL group, 3.12 [95% confidence interval {CI} 2.47-3.87); PROM group: 1.56 (CI 1.24-1.92)]. The proportion of children with CP born after 32 weeks of gestation was higher in in the SPL group (73%) than in the PROM group (30%); the prevalence of CP was higher in the SPL group than in the PROM group or 4Child. Children with CP in the OCS tended to have similar distributions of neuroimpairment as children in 4Child, but motor impairment and associated vision and hearing problems were found to be less severe.
Interpretation:
The pattern of CP in both the PROM and the SPL groups was similar, but functional outcomes were milder, compared with children with CP in the general population. However, in these groups the risk of CP was increased independently of gestational age. This is consistent with findings that ongoing inflammatory damage can cause CP.
