Long-Term Growth and Neurodevelopmental Outcomes in Children with Cerebral Palsy: A Nationwide Population-Based Study

Background/Objectives: Although cerebral palsy (CP) is a leading cause of childhood disability, population-based data on long-term growth trajectories and domain-specific developmental outcomes remain limited. This study aimed to investigate the prevalence of growth failure and neurodevelopmental delay, along with the associated perinatal risk factors, in Korean children with CP. Methods: We conducted a nationwide, retrospective cohort study using data from the National Health Insurance Service. A birth cohort of 1,256,934 infants born between 2013 and 2015 was linked to claims and infant health screening data, followed through 2020. Longitudinal outcomes were assessed at 30-36 months and 54-60 months. Multivariable logistic regression identified risk factors for growth failure (height/weight/head circumference < 3rd percentile) and developmental delay (K-DST score < -2 SD). Results: The overall prevalence of CP was 0.18%. Outcomes for affected children progressively worsened over time. Specifically, the relative disparity in developmental delay between children with and without CP widened over time, with the adjusted odds ratio increasing from 30-36 to 54-60 months. In the multivariable analysis, CP diagnosis showed the strongest independent association with adverse outcomes. Regarding neonatal morbidities, hypoxic-ischemic encephalopathy (HIE) and necrotizing enterocolitis (NEC) were associated with the most pronounced and persistent deficits across the overall cohort, independently of CP. The association between bronchopulmonary dysplasia and developmental delay was attenuated and no longer significant at 54-60 months, whereas its association with growth failure persisted. Conclusions: Children with CP face profound and widening deficits in somatic growth and neurodevelopment throughout early childhood. Persistent growth failure, particularly in patients with HIE or NEC, underscores the critical need for early multidisciplinary nutritional intervention to mitigate long-term adverse outcomes.