Antecedents of Cerebral Palsy in children born at term - according to subtype, motor severity and accompanying impairments

Abstract

Aims: To explore antecedents of cerebral palsy (CP) according to subtype, severity of motor impairment and accompanying impairments (epilepsy and/or cognitive impairments) in relation to neuroimaging patterns. Material and methods: Case control studies were performed in a population-based serie of children with CP born at term (n=309), matched with a control group (n=618). The cases and the matched controls were divided into CP subtype; spastic hemiplegia, spastic diplegia or tetraplegia and dyskinetic CP and into severity of motor impairment; mild, moderate or severe. Obstetric records and the CP register of western Sweden were reviewed and 88 antecedents to CP were analyzed for their associations to different subtypes, severity of motor impairment, associated impairments in CP as well as to neuroimaging pattern. Binary logistic regression, the Cochran-Armitage Chi-squared test for trends, interaction analyses and interrelationship analyses were used. Both univariable and adjusted analyzes were performed. Results: Paper I: The antecedent pattern differed by CP subtype. All subtypes shared a mix of prepartal, intrapartal and postpartal antecedents, except for dyskinetic CP, for which intra- and postpartal events played a major role. Paper II: Maternal infections were associated only with the subgroup spastic hemiplegia whereas neonatal infection was associated with the subgroups of spastic diplegia or tetraplegia. Paper III: The antecedent pattern differed by severity of motor impairment in CP. Timing of antecedents corresponded to identified neuroimaging patterns. Paper IV: The accompanying impairments epilepsy and cognitive impairment in CP were associated with poor intrauterine growth, maldevelopment, and neonatal infections. Accompanying impairments in CP are more often associated with abnormal neuroimaging than motor impairment alone.

Conclusions: The antecedent pattern differed by CP subtype, severity of motor impairment and by presence of accompanying impairments in CP. Our results might illustrate some of the causal pathways to CP, namely hypoxia, malformations and infection.