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Which growth parameters can affect mortality in cerebral palsy?
Hyun Jung Kim1, Tae Uk Kang2, Kyu Yong Park3
1Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
Insights
Underweight status significantly increases mortality risk in children with cerebral palsy (CP) and the general population. Special care is crucial for underweight children with CP to mitigate this heightened risk.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Cerebral palsy (CP) is a significant concern with varying mortality rates.
- Identifying factors influencing mortality in CP is crucial for improving patient outcomes.
- Growth parameters are potential indicators of mortality risk in children.
Purpose of the Study:
- To identify specific growth parameters that impact the mortality of children diagnosed with cerebral palsy (CP).
- To compare mortality risks associated with growth parameters between children with CP and the general population.
- To inform clinical practice regarding the management of growth in children with CP.
Main Methods:
- A large-scale birth cohort study utilizing linked national health databases (Infants and Children, National Health Insurance Service).
- Inclusion of over 2 million live births (2007-2011) with up to 10 years of follow-up.
- Analysis of growth parameters including birth weight and underweight (weight-for-age below the 3rd percentile), and all-cause mortality post-1 year of age.
Main Results:
- The prevalence of CP was 2.0 per 1000 live births.
- Children with CP exhibited a significantly higher all-cause mortality rate (32.15 times higher) compared to the general population.
- Underweight status was a significant predictor of increased mortality in both children with CP and the general population, with hazard ratios increasing with age.
Conclusions:
- Underweight is a critical growth parameter associated with increased all-cause mortality in both children with cerebral palsy (CP) and the general population.
- Children with CP face substantially higher mortality risks, and underweight status exacerbates this risk.
- This study underscores the necessity for heightened clinical vigilance and targeted interventions for underweight children with CP.
Background:
The objective of this study was to identify growth parameters that can affect mortality of cerebral palsy (CP).
Method:
This was a birth cohort study based on the National Health Screening Program for Infants and Children database along with the National Health Insurance Service, which were linked using a personal identifier number. The birth cohort consisted of 2 191 956 subjects, representing 93.5% of live births from 2007-2011, with maximal 10-year follow-up (range, 5-10 years) until October 2016. Subjects with CP were identified. Growth parameters in terms of birth weight, underweight (weight-for-age below the 3rd percentile), rate of body weight gain were collected, along with all-cause mortality after the age of 1 year.
Result:
Prevalence of CP was 2.0 per 1000 live births (95% CI, 1.94-2.06). All-cause mortality after the age of 1 year was 0.09 deaths/1000 person-years (95% CI, 0.08-0.09) in the general population (GP) and 2.85 deaths/1000 person-years (95% CI, 2.32-3.50) in subjects with CP during the follow-up. Therefore, the incidence rate ratio for all-cause mortality was 32.15 (95% CI, 25.72-39.76) in subjects with CP compared to GP. Presence of underweight was significantly associated with higher mortality in both subjects with CP and GP, where the adjusted hazard ratio of death was 2.60 (95% CI, 1.93-3.50) at the age of 18-24 months, 3.12 at 30-36 months, 4.37 at 42-48 months, 5.12 at 54-60 months, and 4.17 at 66-71 months. Birth weight did not affect mortality in both subjects with CP and GP after the age of 1 year (p > 0.05).
Conclusion:
While subjects with CP shows higher mortality, underweight is an important growth parameter that affects all-cause mortality of both subjects with CP and GP. This study urges increased awareness that subjects with CP who are underweight require special care.
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