Mary Jane Platt

Trends in cerebral palsy among infants of very low birthweight (<1500 g) or born prematurely (<32 weeks) in 16 European centres: a database study

BACKGROUND The risk of cerebral palsy, the commonest physical disability of children in western Europe, is higher in infants of very low birthweight (VLBW)--those born weighing less than 1500 g--and those from multiple pregnancies than in infants of normal birthweight. An increasing proportion of infants from both of these groups survive into childhood. This paper describes changes in the frequency and distribution of cerebral palsy by sex and neurological subtype in infants with a birthweight below 1000 g and 1000-1499 g in the period 1980-96. METHODS A group of 16 European centres, Surveillance of Cerebral Palsy in Europe, agreed a standard definition of cerebral palsy and inclusion and exclusion criteria. Data for children with cerebral palsy born in the years 1980-96 were pooled. The data were analysed to describe the distribution and prevalence of cerebral palsy in VLBW infants. Prevalence trends were expressed as both per 1000 livebirths and per 1000 neonatal survivors. FINDINGS There were 1575 VLBW infants born with cerebral palsy; 414 (26%) were of birthweight less than 1000 g and 317 (20%) were from multiple pregnancies. 1426 (94%) had spastic cerebral palsy, which was unilateral (hemiplegic) in 336 (24%). The birth prevalence fell from 60.6 (99%CI 37.8-91.4) per 1000 liveborn VLBW infants in 1980 to 39.5 (28.6-53.0) per 1000 VLBW infants in 1996. This decline was related to a reduction in the frequency of bilateral spastic cerebral palsy among infants of birthweight 1000-1499 g. The frequency of cerebral palsy was higher in male than female babies in the group of birthweight 1000-1499 g (61.0 [53.8-68..2] vs 49.5 [42.8-56.2] per 1000 livebirths; p=0.0025) but not in the group of birthweight below 1000 g. INTERPRETATION These data from a large population base provide evidence that the prevalence of cerebral palsy in children of birthweight less than 1500 g has fallen, which has important implications for parents, health services, and society.

Prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland.

Objectives: To determine the incidence of severe hyperbilirubinaemia in the newborn, and to identify associated clinical and demographic variables, and short-term outcomes. Design: Prospective, population-based study. Setting: UK and Republic of Ireland, between 1 May 2003 and 31 May 2005. Participants: Infants in the first month of life with severe hyperbilirubinaemia (maximum unconjugated serum bilirubin ⩾510 &mgr;mol/l). Results: 108 infants met the case definition, 106 from the UK and 2 from the Republic of Ireland. The UK incidence of severe hyperbilirubinaemia was 7.1/100 000 live births (95% CI 5.8 to 8.6). Only 20 cases presented in hospital; 88 were admitted with severe jaundice. 64 (60.4%) cases were male, and 56 (51.8%) were of ethnic minority origin. 87 (80.5%) cases were exclusively breast fed. Co-morbidity included haemolysis, dehydration, infection and bruising. 14 infants showed evidence of bilirubin encephalopathy, of whom 3 died. The UK incidence of bilirubin encephalopathy was 0.9/100 000 live births (95% CI 0.46 to 1.5). Conclusions: This is the first large, prospective, population-based study of the incidence of severe hyperbilirubinaemia in the newborn. The clinical and demographic associations, and short-term outcomes identified, are the same as those reported recently in North America and Europe.

The changing epidemiology of cerebral palsy.

AIM: To determine the prevalence of cerebral palsy in a specific population. METHODS: Multiple sources of ascertainment were used to create and maintain a register of all cases of cerebral palsy born to mothers resident in the counties of Merseyside and Cheshire in the years 1966 to 1989. Denominator data of infant births and deaths from 1966 to 1981 were obtained from statutory notifications made to health authorities and, for the period 1982-89, from statutory birth and death registrations. Over 1500 cases formed the database for the study. RESULTS: The prevalence of cerebral palsy has increased among all the low birthweight groups with, most recently, an increase in infants weighing < 1000 g at birth. Low birthweight infants now comprise about 50% of all cases of cerebral palsy; in the early years of the study they comprised about 32% of all cases. The proportion of cerebral palsy by clinical type has changed among low birthweight babies, with relatively fewer cases with diplegia and a concomitant increase in the proportion with hemiplegia. An increase in the severity of functional disability, determined by the proportion of children with severe learning, manual, and ambulatory disabilities, was also found. CONCLUSIONS: The change in the epidemiology of cerebral palsy has implications for the aetiology of the condition, and for health, educational, and social service provision.

Oromotor Dysfunction and Communication Impairments in Children with Cerebral Palsy: A Register Study.

Aim  To report the prevalence, clinical associations, and trends over time of oromotor dysfunction and communication impairments in children with cerebral palsy (CP).

Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy

P H D ~ , ON BEHALF OF SCPE COLLABORATIVE GROUP aRHEOP-TTMC-T%EM4S, Pavillon Taillefeq BP217X, 38043 Grenoble, Cedex9, France; bFaculty ofLife and Health Sciences, University of Ulster atJordanstown, Newtownabbey; ‘Division ofPublic Health, The University of Livetpool, Liverpool; dUniversity of Newcastle upon Tyne, SirJames Spence Institute, Royal Victoria Infirmary, Newcastle upon Dne, UK; eKaunas Child Development Clinci ‘Lopselis’, Kaunas, Lithuania; funiversity Children’s Hospital, Department of Child Neurologv, Tubingen, Gemzany

St Vincent’s Declaration 10 years on: outcomes of diabetic pregnancies

Aims To monitor pregnancies in women with pregestational Type 1 diabetes for pregnancy loss, congenital malformations and fetal growth parameters, in a geographically defined area in the north west of England.

Decreasing prevalence in cerebral palsy: A multi-site European population-based study, 1980 to 2003

To monitor the trends in prevalence of cerebral palsy (CP) by birthweight in Europe, 1980 to 2003.

Outcomes in preterm infants

Preterm birth is defined as birth before 37 completed weeks gestation, and it is estimated that each day, across the world over 41,000 infants are born before this gestational age. The risk of adverse consequences declines with increasing gestational age. While this paper focuses on the consequences of preterm birth, the adverse consequences for infants born at 38 and 39 weeks gestation are also of a higher risk than those for infants born at 40 weeks gestation, with the neonatal mortality risk increasing again in infants born beyond the 42nd week of gestation.

Children with cerebral palsy: severity and trends over time

Increasingly, more very-low-birthweight infants in the developed world are now expected to survive the neonatal period than was previously the case. There are concerns that there may be a related increase in the number of infants developing severe sensorimotor impairments. Pooled data from five registers contributing to the UK Network of Cerebral Palsy Registers, Surveys and Databases were used to identify patterns of motor impairment in relation to additional impairments and to birthweight, and to assess whether prevalence of cerebral palsy (CP) by birthweight and by severity of motor impairment had changed over time. Low-birthweight infants are at greater risk of developing CP than larger-birthweight babies. The CP rate amongst children with birthweights <2500 g was significantly higher at 16 per 1000 livebirths [95% confidence interval (CI) 14.9, 16.2] than 1.2 per 1000 livebirths [95% CI 11, 1.2] for normal-birthweight children. Despite being at greater risk of developing CP, smaller-birthweight babies are proportionately less likely to develop the most severe forms of motor impairment. Of those born weighing > or = 2500 g, 23% compared with 15% weighing <1000 g (P < 0.001) were in the most severely motor impaired group. Severe motor impairment is associated with higher levels of additional impairments. CP rates for each motor impairment group in the 1990s were similar to those in the late 1970s. Rates of CP among infants born below normal birthweight are high but have decreased over time. The CP rate for infants weighing 1000-1499 g at birth decreased from around 180 per 1000 livebirths in 1979 to around 50 per 1000 livebirths from the early 1990s onwards.

Regional variation in survival of people with cerebral palsy in the United Kingdom

Objectives. Regional variation in survival of people who have cerebral palsy (CP) has been observed but not previously investigated in detail. In addition to true differences, variations in the methods and definitions used, completeness of ascertainment, and the role of potential confounding factors all have been proposed as possible explanations for these observed variations. Our aim was to assess the regional differences in survival of young people with CP and the effect on survival of socioeconomic differences after adjustment for variations in level of impairment and birth characteristics. Methods. Survival patterns for young people with CP were calculated using information from a collaborative database. This database consisted of registrations of children who were born with CP in 5 geographically defined areas in the United Kingdom between 1980 and 1996. Notification of subsequent deaths was provided by the relevant births and death register. We consider the effects of birth characteristics, socioeconomic status, and severity of CP on survival. Results. There were 325 deaths among the 4007 cases of CP identified. The proportion of affected children who survived to 20 years of age ranged from 85% (Mersey-side and Cheshire, male individuals) to 94% (North of England, male individuals). Multivariate modeling showed that the severity of impairment had the biggest impact on survival and that additional contributions were made by birth weight and socioeconomic status but that after such adjustments regional differences were no longer significant. Conclusions. The number and the severity of impairments are the best predictors of survival in young people with CP. After adjustment for the number of impairments, children who were born in affluent areas and had a low birth weight have an increased risk for death over those who were born with a normal birth weight. The same does not hold, however, for those who were born in deprived areas.