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Trends in Prevalence and Severity of Pre/Perinatal Cerebral Palsy Among Children Born Preterm From 2004 to 2010: A
Catherine Arnaud1,2,3, Virginie Ehlinger1,2, Malika Delobel-Ayoub1,2
1UMR 1027 SPHERE Team, Inserm, Toulouse 3 Paul Sabatier University, Toulouse, France.
Insights
The prevalence of cerebral palsy (CP) in preterm infants is decreasing in Europe, except for extremely premature babies. Severe CP trends mirror overall prevalence, with white matter injuries more common in very preterm infants.
Area of Science:
- Neurology
- Pediatrics
- Public Health
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder affecting children born preterm.
- Understanding the prevalence, severity, and lesion types in preterm infants is crucial for targeted interventions.
Purpose of the Study:
- To determine the prevalence and severity of cerebral palsy (CP) in preterm infants.
- To analyze the types of brain lesions in relation to gestational age groups.
- To investigate time trends in CP prevalence among preterm births from 2004 to 2010.
Main Methods:
- Utilized data from 12 European population-based cerebral palsy registries.
- Included preterm infants (<37 weeks gestational age) born between 2004-2010, assessed at ≥4 years old.
- Assessed CP severity using the impairment index and classified brain lesions from postnatal imaging.
Main Results:
- Overall CP prevalence decreased significantly in infants born 32-36 weeks gestational age.
- Prevalence remained steady for infants born ≤27 weeks and showed a fluctuating trend for those born 28-31 weeks.
- White matter injuries were more prevalent in infants born <32 weeks (81.5% to 86.4%) compared to those born 32-36 weeks (63.6%).
Conclusions:
- Cerebral palsy prevalence in preterm infants continues to decline in Europe, with exceptions for extremely preterm infants.
- Trends in severe CP prevalence mirrored overall trends across gestational age groups.
- Higher rates of white matter injuries in extremely preterm infants highlight specific vulnerabilities.
Abstract:
Aim: To report on prevalence of cerebral palsy (CP), severity rates, and types of brain lesions in children born preterm 2004 to 2010 by gestational age groups. Methods: Data from 12 population-based registries of the Surveillance of Cerebral Palsy in Europe network were used. Children with CP were eligible if they were born preterm (<37 weeks of gestational age) between 2004 and 2010, and were at least 4 years at time of registration. Severity was assessed using the impairment index. The findings of postnatal brain imaging were classified according to the predominant pathogenic pattern. Prevalences were estimated per 1,000 live births with exact 95% confidence intervals within each stratum of gestational age: ≤27, 28-31, 32-36 weeks. Time trends of both overall prevalence and prevalence of severe CP were investigated using multilevel negative binomial regression models. Results: The sample comprised 2,273 children. 25.8% were born from multiple pregnancies. About 2-thirds had a bilateral spastic CP. 43.5% of children born ≤27 weeks had a high impairment index compared to 37.0 and 38.5% in the two other groups. Overall prevalence significantly decreased (incidence rate ratio per year: 0.96 [0.92-1.00[) in children born 32-36 weeks. We showed a decrease until 2009 for children born 28-31 weeks but an increase in 2010 again, and a steady prevalence (incidence rate ratio per year = 0.97 [0.92-1.02] for those born ≤27 weeks. The prevalence of the most severely affected children with CP revealed a similar but not significant trend to the overall prevalence in the corresponding GA groups. Predominant white matter injuries were more frequent in children born <32 weeks: 81.5% (≤27 weeks) and 86.4% (28-31 weeks), compared to 63.6% for children born 32-36 weeks. Conclusion: Prevalence of CP in preterm born children continues to decrease in Europe excepting the extremely immature children, with the most severely affected children showing a similar trend.
