Congenital anomalies in children with postneonatally acquired cerebral palsy: an international data linkage study
Shona Goldsmith1, Sarah McIntyre1, Heather Scott2
1Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.
Insights
One-quarter of children with postneonatally acquired cerebral palsy (CP) have major congenital anomalies, most commonly cardiac defects. Causes of CP differ between those with and without anomalies, highlighting potential prevention strategies.
Area of Science:
- Pediatrics
- Neurology
- Medical Genetics
Background:
- Postneonatally acquired cerebral palsy (CP) affects children after the neonatal period.
- Understanding associated congenital anomalies is crucial for comprehensive care and etiology.
- Previous studies have not extensively detailed the prevalence and impact of congenital anomalies in this population.
Purpose of the Study:
- To identify and describe major congenital anomalies in children with postneonatally acquired CP.
- To compare clinical outcomes between children with and without congenital anomalies.
- To investigate differences in the causes of postneonatally acquired CP based on the presence of anomalies.
Main Methods:
- Linked data from CP and congenital anomaly registers across European and Australian regions (1991-2009).
- Analyzed data for 468 children with postneonatally acquired CP, classifying them by anomaly type.
- Compared clinical outcomes and etiological factors between children with and without congenital anomalies.
Main Results:
- Major congenital anomalies were present in 25.6% of children with postneonatally acquired CP.
- Cardiac anomalies were the most frequent, occurring in 14.5% of cases and often severe.
- Clinical outcomes did not differ significantly, but causes of CP varied, with cerebrovascular accidents more common in the anomaly group.
Conclusions:
- Congenital anomalies, particularly cardiac, are common in postneonatally acquired CP.
- The presence of anomalies influences the underlying cause of CP.
- Further research into causal pathways is needed for targeted prevention strategies.
Aim:
To describe the major congenital anomalies present in children with postneonatally acquired cerebral palsy (CP), and to compare clinical outcomes and cause of postneonatally acquired CP between children with and without anomalies.
Method:
Data were linked between total population CP and congenital anomaly registers in five European and three Australian regions for children born 1991 to 2009 (n=468 children with postneonatally acquired CP; 255 males, 213 females). Data were pooled and children classified into mutually exclusive categories based on type of congenital anomaly. The proportion of children with congenital anomalies was calculated. Clinical outcomes and cause of postneonatally acquired CP were compared between children with and without anomalies.
Results:
Major congenital anomalies were reported in 25.6% (95% confidence interval [CI] 21.7-29.9) of children with postneonatally acquired CP. Cardiac anomalies, often severe, were common and present in 14.5% of children with postneonatally acquired CP. Clinical outcomes were not more severe in children with congenital anomalies than those without anomalies. Cause of postneonatally acquired CP differed with the presence of congenital anomalies, with cerebrovascular accidents predominating in the anomaly group. Congenital anomalies were likely associated with cause of postneonatally acquired CP in 77% of children with anomalies.
Interpretation:
In this large, international study of children with postneonatally acquired CP, congenital anomalies (particularly cardiac anomalies) were common. Future research should determine specific causal pathways to postneonatally acquired CP that include congenital anomalies to identify opportunities for prevention.
What This Paper Adds:
One-quarter of children with postneonatally acquired cerebral palsy (CP) have a major congenital anomaly. Cardiac anomalies, often severe, are the most common anomalies. Causes of postneonatally acquired CP differ between children with and without congenital anomalies.
