Changing diagnosis of cerebral palsy in very low birthweight children
G W Ford1, W H Kitchen, L W Doyle
1Department of Obstetrics & Gynaecology, University of Melbourne, Carlton, Australia.
Insights
Cerebral palsy diagnosis in children under 1500 gm birthweight is not always stable. Many diagnosed at age 2 still had cerebral palsy at age 5, but some diagnoses resolved, indicating it can overestimate prevalence.
Area of Science:
- Neurology
- Developmental Pediatrics
- Neonatology
Background:
- Cerebral palsy (CP) is a common motor disability in children.
- Accurate diagnosis and prognosis are crucial for early intervention.
- The stability of early CP diagnosis, particularly in preterm infants, requires further investigation.
Purpose of the Study:
- To assess the diagnostic stability of cerebral palsy (CP) from 2 to 5 years of age.
- To evaluate the persistence and resolution of CP diagnoses in very low birthweight infants.
- To determine the impact of early CP diagnosis on later developmental outcomes.
Main Methods:
- Longitudinal study of children with birthweights under 1500 gm.
- Diagnosis of cerebral palsy assessed at 2 years and re-evaluated at 5 years of age.
- Comparison of diagnostic outcomes between children with and without initial CP diagnosis.
Main Results:
- Of 20 children diagnosed with cerebral palsy at 2 years, 11 (55%) maintained the diagnosis at 5 years.
- Severe or moderate CP at 2 years persisted in all 8 children (100%) at 5 years.
- In 9 of 12 children whose CP diagnosis resolved by age 5, minor neurological abnormalities and left-hand preference were common, but psychological test scores were similar to children without CP.
Conclusions:
- Cerebral palsy diagnosis at 2 years of age is not static and can overestimate later prevalence in preterm infants.
- Resolution of CP diagnosis is possible, though associated with subtle neurological signs.
- Early diagnosis of cerebral palsy in high-risk infants requires careful monitoring and reassessment for accurate prognosis.
Abstract:
The stability of the diagnosis of cerebral palsy from 2 to 5 years of age was examined in 83 children of birthweight under 1000 gm, and 112 of birthweight 1000 to 1500 gm. In 20 2-year-old children with cerebral palsy, the diagnosis persisted in 11 (55%, 95% confidence intervals 35.1 to 76.9%); 2 of 175 children (1.1%) free of cerebral palsy at 2 years of age subsequently developed the condition. Severe or moderate cerebral palsy at 2 years persisted in all eight children (100%). In 9 of 12 children in whom cerebral palsy at 2 years had disappeared by 5 years, minor neurologic abnormalities and left-hand preference occurred frequently but mean psychologic tests scores were similar to children always free of cerebral palsy. In this cohort, cerebral palsy at 2 years was not a static condition, but overestimated later prevalence.
