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Cerebral palsy after neonatal encephalopathy: do neonates with suspected asphyxia have worse outcomes?
Author(s) -
Garfinkle Jarred,
Wintermark Pia,
Shevell Michael I,
Oskoui Maryam
Publication year - 2016
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.12953
Subject(s) - medicine , neonatal encephalopathy , gross motor function classification system , cerebral palsy , asphyxia , pediatrics , odds ratio , interquartile range , encephalopathy , spastic , confidence interval , spastic quadriplegia , physical therapy
Aim We sought to investigate how brain injury and severity, and neurological subtype of cerebral palsy (CP) differed in term‐born children with CP after neonatal encephalopathy, between those with suspected birth asphyxia and those without. Method Using the Canadian CP Registry, which included 1001 children, those with CP born at ≥36wks after moderate or severe neonatal encephalopathy, were dichotomized according to the presence or absence of suspected birth asphyxia. Gross Motor Function Classification System ( GMFCS ) scores, neurological subtypes, comorbidities, and magnetic resonance imaging findings were compared. Results Of the 147 term‐born children with CP (82 males, 65 females; median age 37 months, interquartile range [ IQR ] 26–52.5) who after moderate or severe neonatal encephalopathy had the required outcome data, 61 (41%) met criteria for suspected birth asphyxia. They had a higher frequency of non‐ambulatory GMFCS status (odds ratio [ OR ] 3.4, 95% confidence interval [ CI ] 1.72–6.8), spastic quadriplegia ( OR 2.8, 95% CI 1.4–5.6), non‐verbal communication skills impairment ( OR 4.2, 95% CI 2.0–8.6), isolated deep grey matter injury ( OR 4.1, 95% CI 1.8–9.5), a lower frequency of spastic hemiplegia ( OR 0.17, 95% CI 0.07–0.42), focal injury ( OR 0.20; 95% CI 0.04–0.93), and more comorbidities ( p =0.017) than those who did not meet criteria. Interpretation Term‐born children who develop CP after neonatal encephalopathy with suspected birth asphyxia have a greater burden of disability than those without suspected birth asphyxia.