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Increasing prevalence of cerebral palsy in children born very preterm in Denmark
Martha Veber Fogh1, Gorm Greisen2,3, Tine Dalsgaard Clausen2,4
1Center for Cerebral Palsy, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Insights
Cerebral palsy (CP) prevalence increased in preterm infants, particularly those born very preterm, despite falling neonatal mortality. This trend may be linked to intensive neonatal care rather than other clinical risk factors.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Public Health
Background:
- Cerebral palsy (CP) is a significant concern in preterm infants.
- Understanding trends in CP prevalence is crucial for improving neonatal care and outcomes.
Purpose of the Study:
- To analyze the rising prevalence of cerebral palsy (CP) in children born preterm in Denmark.
- To investigate the correlation between CP prevalence, gestational age, neonatal mortality, and clinical factors.
Main Methods:
- A population-based cohort study of live-born preterm infants in Denmark (1997-2013).
- Analysis of CP prevalence categorized by gestational age.
- Correlation with neonatal mortality rates and changes in clinical factors.
Main Results:
- Among 70,876 preterm infants, 1.2% had CP.
- CP prevalence decreased until 2001, then increased by 2.8% annually.
- The increase was significant only in very preterm infants (28-31 weeks gestation).
- Neonatal mortality decreased across all gestational ages.
- Increasing high-risk pregnancies, maternal obesity, emergency C-sections, neonatal admissions, and assisted ventilation were noted.
Conclusions:
- The rise in CP among preterm infants was driven by the very preterm subgroup, coinciding with decreased neonatal mortality.
- Unlike other studies, decreased mortality was associated with increased CP prevalence in this cohort.
- While clinical risk factors increased, intensive neonatal life support may be a contributing factor to the observed CP trends.
Aim:
To analyse the rising prevalence of cerebral palsy (CP) in children born preterm in Denmark.
Method:
We included all live-born children born preterm in Denmark from 1997 to 2013. The prevalence of CP in children born preterm was categorized by gestational age and correlated with neonatal mortality and changes in clinical factors.
Results:
Among 70 876 children, 824 (1.2%) had CP. The overall CP prevalence in children born preterm decreased substantially until 2001, from when it increased annually by 2.8% (95% confidence interval 0.6-5.0). When categorized, the prevalence only increased significantly in children born very preterm (gestational weeks 28-31). Neonatal mortality rates decreased steadily at all gestational ages during the entire study period. Clinical factors that changed during the study period were increasing numbers of high-risk pregnancies, maternal obesity, emergency caesarean sections, neonatal admissions, and usage of assisted ventilation.
Interpretation:
The increasing prevalence of CP in children born preterm was driven by the subgroup born very preterm and matched their decrease in neonatal mortality. In similar population studies, decreased mortality was not followed by increased CP prevalence. An increase in clinical risk factors was unlikely to explain our findings, but more active neonatal life support may have played a role.
