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Diplegic cerebral palsy in Swedish term and preterm children. Differences in reduced optimality, relations to
Insights
Swedish diplegic children born at term (TDC) showed more severe handicaps and neurological issues than preterm diplegic children (PDC). Pre- and perinatal factors differed significantly between TDC and PDC, impacting their developmental outcomes.
Area of Science:
- Neurology
- Pediatrics
- Developmental Biology
Background:
- Cerebral palsy, specifically diplegia, affects children differently based on gestational age at birth.
- Understanding pre- and perinatal risk factors is crucial for identifying causes of diplegia.
Purpose of the Study:
- To analyze differences in pre- and perinatal conditions between term-born diplegic children (TDC) and preterm diplegic children (PDC).
- To relate these conditions to the severity of handicap, associated neurological abnormalities, and pathogenetic grouping.
- To compare diplegic children with dyskinetic and control groups.
Main Methods:
- Analysis of 93 Swedish diplegic children (49 TDC, 44 PDC) born between 1969-1976.
- Assessment of reduced optimality in pre- and perinatal conditions.
- Comparison of optimality profiles with dyskinetic and control series.
Main Results:
- TDC exhibited more severe handicaps and additional neurological abnormalities compared to PDC.
- TDC's reduced optimality profile indicated fetal maladjustment/deprivation and birth asphyxia.
- PDC's profile was linked to preterm birth complications and postpartal issues.
- Diplegic children had reduced optimality compared to controls, and more so than dyskinetic children, particularly TDC.
- Pre-existing conditions were the sole cause of diplegia in 41% of TDC and a contributing factor in 24%.
Conclusions:
- Distinct pre- and perinatal mechanisms contribute to diplegia in term-born versus preterm-born children.
- Postpartal complications were more prevalent in preterm diplegic children.
- Birth asphyxia was a significant factor in term diplegia but rarely the sole cause.
Abstract:
An unselected series of 93 Swedish diplegic children born in 1969-1976 and subgrouped into 49 term (TDC) and 44 preterm (PDC) cases were analyzed for differences in reduced optimality in pre- and perinatal conditions, these also being related to degree of handicap, associated neurology and conventional pathogenetic grouping. Comparisons of the reduced optimality with those of a dyskinetic and a control series were also made. TDC were shown to have more severe handicaps and more additional neurologic abnormalities than PDC. The profile of reduced optimality was weighted in TDC to items pointing to fetal maladjustment/deprivation and birth asphyxia and in PDC to items accompanying preterm birth and to postpartal items. The optimality of diplegics was in general more reduced than in controls and less than in dyskinetics. This was especially true for TDC. Differences in the background mechanisms of the diplegia between TDC and PDC were indicated from dissimilarities in the combined patterns of reduced optimality and conventional pathogenetic grouping. Postpartal complications predominated among PDC. A prepartal factor as the only cause of the diplegia was likely in 41% of TDC, and as a contributory cause in another 24%. Birth asphyxia, present in 31% of the TDC, was never the only risk factor among infants born at term.