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Published on: November 20, 2015
Cerebral Palsy in Extremely Preterm Infants
Maria Hafström1,2,3, Karin Källén4, Fredrik Serenius5,6
1Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; maria.hafstrom@ntnu.no.
Insights
Cerebral palsy (CP) affects over 10% of extremely preterm infants, often with severe disabilities and comorbidities. Comprehensive, long-term follow-up is crucial for accurate outcome assessment in these children.
Area of Science:
- Pediatrics
- Neurology
- Developmental Pediatrics
Background:
- Extremely preterm infants face a high risk of cerebral palsy (CP).
- CP in this population is frequently associated with neurodevelopmental comorbidities.
- Understanding the lifetime prevalence and spectrum of CP and its associated conditions is critical.
Purpose of the Study:
- To determine the lifetime prevalence of CP in extremely preterm infants.
- To characterize the type, severity, and comorbidities associated with CP.
- To evaluate factors influencing outcome assessment, including age and data sources.
Main Methods:
- Prospective, population-based cohort study of Swedish children born before 27 weeks' gestation (2004-2007).
- Data collection included neonatal records, clinical/neuropsychological assessments at 2.5 and 6.5 years, and medical chart reviews.
- Outcome data was obtained for 94.5% of eligible children alive at 1 year.
Main Results:
- 10.5% of eligible children received a lifetime CP diagnosis.
- Of those with CP, 76% were ambulatory, 29% were diagnosed after 2.5 years, and 55% had severe disability.
- Children with CP had a higher probability of incomplete evaluation compared to those without CP.
Conclusions:
- Extremely preterm infants with CP frequently present with diverse comorbidities and severe disability.
- Emphasizes the necessity of long-term, comprehensive follow-up using multiple information sources for accurate disability assessment.
- Highlights the challenges in outcome evaluation for this vulnerable population.
Background And Objectives:
The risk of cerebral palsy (CP) is high in preterm infants and is often accompanied by additional neurodevelopmental comorbidities. The present study describes lifetime prevalence of CP in a population-based prospective cohort of children born extremely preterm, including the type and severity of CP and other comorbidities (ie, developmental delay and/or cognitive impairment, neurobehavioral morbidity, epilepsy, vision and hearing impairments), and overall severity of disability. In this study, we also evaluate whether age at assessment, overall severity of disability, and available sources of information influence outcome results.
Methods:
All Swedish children born before 27 weeks' gestation from 2004 to 2007 were included (the Extremely Preterm Infants in Sweden Study). The combination of neonatal information, information from clinical examinations and neuropsychological assessments at 2.5 and 6.5 years of age, original medical chart reviews, and extended chart reviews was used.
Results:
The outcome was identified in 467 (94.5%) of eligible children alive at 1 year of age. Forty-nine (10.5%) children had a lifetime diagnosis of CP, and 37 (76%) were ambulatory. Fourteen (29%) had CP diagnosed after 2.5 years of age, 37 (76%) had at least 1 additional comorbidity, and 27 (55%) had severe disability. The probability for an incomplete evaluation was higher in children with CP compared with children without CP.
Conclusions:
Children born extremely preterm with CP have various comorbidities and often overall severe disability. The importance of long-term follow-up and of obtaining comprehensive outcome information from several sources in children with disabilities is shown.
