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Preterm Birth as a Risk Factor for Cerebral Palsy in Children: A Systematic Review and Meta-Analysis
Kaleab Tesfaye Tegegne1, Tadele Kassahun Wudu2, Moges Tadesse Abebe3
1Department of Public Health, College of Health Science, Debark University, Debark, Ethiopia, dku.edu.et.
Insights
Preterm birth increases cerebral palsy (CP) risk, especially with greater prematurity. This updated meta-analysis confirms the association and highlights the need for targeted interventions for preterm infants.
Area of Science:
- Neurology
- Pediatrics
- Public Health
Background:
- Cerebral palsy (CP) is the leading physical disability in childhood, frequently stemming from early brain injury.
- Preterm birth (<37 weeks gestation) is a major risk factor for CP due to the immature brain's vulnerability.
- Despite neonatal care advancements, CP risk remains high in preterm infants, particularly those born very preterm.
Purpose of the Study:
- To synthesize current evidence on the association between preterm birth and cerebral palsy (CP) risk.
- To analyze recent, high-quality observational studies globally.
- To provide an updated understanding of CP risk factors in preterm populations.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
- Searched major databases (PubMed, Web of Science, Scopus, Google Scholar) up to May 2024 for relevant observational studies.
- Included 16 studies (≥6 NOS score) with over 30,000 participants, performing fixed-effects meta-analysis and Egger's test for publication bias.
Main Results:
- The pooled odds ratio (OR) for CP in preterm versus term children was 1.02 (95% CI: 0.72-1.31), indicating a significant association.
- Subgroup analyses revealed that CP risk escalates with increasing degrees of prematurity.
- No significant publication bias was detected (Egger's p = 0.4783).
Conclusions:
- The study confirms a global association between preterm birth and increased CP risk, particularly for very preterm infants.
- Findings underscore the necessity for enhanced neurodevelopmental monitoring and early interventions for preterm infants.
- Public health strategies to reduce preterm birth rates and further research into prematurity stratification are recommended.
Background:
Cerebral palsy (CP) is the most common physical disability in childhood, often resulting from early brain injury. Preterm birth (< 37 weeks gestation) is a critical risk factor for CP due to the vulnerability of the immature brain. Despite advances in neonatal care, the risk of CP remains elevated among preterm infants, especially those born very preterm. Existing meta-analyses are limited by outdated data or methodological gaps.
Objective:
To provide an updated, comprehensive synthesis of the association between preterm birth and CP risk in children, utilizing recent high-quality observational studies worldwide.
Methods:
A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. We searched PubMed, Web of Science, Scopus, and Google Scholar from inception to May 1, 2024, for observational studies reporting odds ratios (ORs) relating preterm birth and CP in children (< 18 years). Studies were screened independently by two reviewers. Methodological quality was assessed via the Newcastle-Ottawa Scale (NOS), including only studies with scores ≥ 6. A fixed-effects meta-analysis was performed given low heterogeneity (I 2 = 28.04%). Publication bias was evaluated using Egger's test.
Results:
Sixteen studies encompassing diverse geographic regions and 30,000+ participants were included. The pooled OR for CP in preterm versus term children was 1.02 (95% CI: 0.72-1.31, p < 0.0001), indicating a significantly increased risk associated with preterm birth. No evidence of publication bias was detected (Egger's p = 0.4783). The methodological rigor and consistency of findings across varied populations strengthen the evidence for a global association.
Conclusions:
While the pooled estimate for the broad preterm birth category was not statistically significant, subgroup analyses confirm that the risk of CP increases significantly with the degree of prematurity. These findings reinforce the need for targeted neurodevelopmental monitoring and early interventions in preterm populations, particularly for those born at lower gestational ages, alongside public health strategies to reduce preterm birth incidence. Future research should stratify risks by degree of prematurity and explore biological modifiers to optimize preventive care.
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