0703 Risk of cerebral palsy (CP) in children born below 1500g

Significant advances in neonatology over the past 25-30 years have resulted in progressive reductions in mortality of VLBW (<1500g) and ELBW (<1000g) infants. However the question for clinicians, parents, policy-makers, ethicists and others is always how the improved survival relates to morbidity in these high-risk groups. Of particular interest to many is whether the higher survival rates have been at the expense of higher cerebral palsy rates, and in this regard a multi-centre study was undertaken in Europe (16 centres in the UK, France, Denmark, Italy and Germany). This was a follow up by the group which in 1998 established a collaborative network of CP registers and surveys known as the SCPE (Surveillance of Cerebral Palsy in Europe), and in 2002 reported on findings covering the period 1980 -1990. The overall CP rate for that period was 2.08/1000 live births, with infants weighing <1500g and surviving the neonatal period having a CP rate of 72.6/1000 vs a rate of 1.2/1000 for post-neonatal survivors of >2500g. The group also found that while the CP rate had risen during the 1970’s (probably reflecting less than perfect knowledge and understanding of neonatal care during the 1960’s), it had stabilised during the 1980’s. Of particular note is that for the SCPE surveys, CP is assessed at or beyond 4 years of age, when neurological patterns are established and there is little doubt about diagnosis. In the follow-up study, which covered children born between 1980 and 1996, the focus was on VLBW and ELBW infants. The group identified 7884 CPs amongst the cohort (all births), of which 2103 (26.6%) were born at <1500g or <32 wks gestation. Recognising that only ~1% of livebirths are below 1500g, the higher risk of CP among VLBW infants is obvious (~1% of births contribute ~27% of CPs). Within the VLBW group, for the full study period the CP rate was 50.6/1000 livebirths, however there was a significant fall over the study period from 60.6/1000 livebirths in 1980 to 39.5/1000 in 1996. This reduction was restricted to the group weighing between 1000 and 1499g (i.e. the rate remained constant for ELBW infants), and was also accompanied by a reduction in the rate of bilateral spastic CP (a change explained by the authors on the basis of fewer episodes of periventricular leucomalacia in infants weighing between 1000 and 1499g.

Read more:
Lancet 2007; 369: 43-50
Dev Med Child Neurol 2002; 44: 633-40
Pediatrics 2002; 110: 1220-25