1 - Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central;
2 - Programa de Vigilância Nacional de Paralisia Cerebral aos 5 Anos de Idade em Portugal (PVNPC5A);
3 - Centro de Reabilitação de Paralisia Cerebral Calouste Gulbenkian (Lisboa), Santa Casa da Misericórdia de Lisboa;
4 - Federação das Associações Portuguesas de Paralisia Cerebral;
5 - Serviço de Medicina Física e de Reabilitação do Hospital Fernando Fonseca (Amadora);
6 - Sociedade Portuguesa de Pediatria do Neurodesenvolvimento da Sociedade Portuguesa de Pediatria;
7 - Centro de Paralisia Cerebral de Beja; 8 Escola Superior de Saúde da Universidade de Aveiro.
XII Congresso da Sociedade Portuguesa de Neuropediatria. Lisboa, 1 e 2 de fevereiro de 2018
Resumo:
Objective. Cerebral palsy (CP) is the most common childhood motor deficiency. There is a wide range of functional impairment between these patients. This study aims to investigate the risk factors and major morbidities associated with severe impairment in children with CP in Portugal. Methods. A cross-sectional with nested retrospective cohort study was conducted using active surveillance data from 5-year-old children born in Portugal between 2001 and 2007 (n=2170). Based on this data, extreme clusters according to SCPE definitions and functional classifications were extracted (highly functional (n=130) versus severely affected (n=210)) and analyzed using bivariate and multivariate logistic regression models. Results. Multivariate logistic regression revealed that prematurity (OR= 0.65, 95% CI 0.49-0.91) and low birth weight (OR= 0.48, 95% CI 0.31-0.75) were associated with a better functional profile. In the other hand, being light-for-gestational age (OR= 2.57, 95% CI 1.21-5.30), anoxia (OR= 7.85, 95% CI 2.93-21.07), brain malformation (OR= 13.90, 95% CI 3.59-53.85), discynetic (OR= 124.71, 95% CI 10.20-1524.98) and ataxic (OR= 9.35, 95% CI 0.29-300.30) CP subtypes were significantly associated with severe functional impairment. All the tested outcomes were significantly more prevalent among the severely affected group. Epilepsy was the most prevalent comorbidity among highly functional patients. Conclusions. Prematurity and low birth weight are apparently associated with a better functional profile. Differences on physiopathology and the potential of the remaining grey matter may probably cause a different pattern of clinical subtypes and functionality degree of CP.
Palavras Chave: clusters; severity; cerebral palsy; PVNPC5A; Portugal.