1 - Unidade de Cuidados Intensivos Neonatais, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, EPE
2 - Serviço de Reabilitação do Hospital Fernando da Fonseca;
3 - Federação das Associações Portuguesas de Paralisia Cerebral (FAPPC);
4 - Serviço de Neurologia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, EPE
- Conference of the American Academy of Cerebral Palsy and Developmental Medicine 2013, Milwaukee 16-19 Out. (Comunicação oral)
Background.Concern about children born moderate or late preterm (32-34 and 35-36 weeks gestational age, respectively) has been growing recently. We aimed to assess the contribution of this subgroup for the pool of children with cerebral palsy (CP) and to explore their clinical and functional characteristics.
Study Design. National, population survey.
Methods.The Portuguese Surveillance of Cerebral Palsy at 5 years of age is affiliated to the Surveillance of Cerebral Palsy in Europe, sharing its definitions, classifications and tools. From the whole registry, survivors at five years age from the birth-cohorts 2001-2005, born and living in Portugal were selected. Prevalence rates (95%CI) were estimated. Clinical types of CP and functional outcomes were compared between children born moderate or late preterm (MLPT) and those born extreme preterm (EPT <28 weeks), very preterm (VPT <32 weeks) and at term (≥37 weeks). Univariate and multivariate analysis were performed.
Results.From 816 children with CP from the index birth-cohorts, 623 were selected (13.5% missing values for gestational age among 720 eligible children). Children born MLPT (99) account for 15.9% of cases (95%CI 13.18-18.92; annual min. 11.1; max. 20.0), while children born EPT account for 11.9% and those born VPT to 17.7%. The proportion of children with spastic CP was 86.9% in those born MLPT, closer to children born EPT or VPT (90%) than to those born at term (75%) (p<0.001), similarly the proportion of children with dyskinetic CP (7.1%) was closer to children born VPT (7.3%) than at term (17.6%) (p=0.001). Children with spastic CP born MLPT were bilaterally affected in 65.1%, closer to those born at term (61.2%) than to those born EPT (73.1%) or VPT (82.8%) (p=0.001). The prevalence of epilepsy in children born MLPT (40%) was similar to those born at term (45.5%) and higher than among EPT (28.8%) or VPT (29.1%) (p=0.006). No clear difference on the pattern of distribution through GMFCS levels was found, though children with CP born at term were more frequently rated at grade 5 (33.4%) than MLPT (16.8%), VPT (18.5%) and EPT (19.1%) children. The pattern of distribution through BFMF levels was significantly better among MLPT children (62.4% at grades 1-2) than in those born at term (49.2%) and similar to VPT (60%) and EPT (63.6%) (p=0.039). Similar significant differences in patterns of distribution were seen for verbal expression, feeding ability and drooling control. No significant differences on the prevalence of cognitive impairment (IQ <70) were registered (59.1% in MLPT) but the prevalence of severe cognitive impairment (IQ <50) was similar between MLPT (41.9%) and children born at term (47.8%) and higher than VPT (27.1%) and EPT (37.9%) (p=0.002). No significant differences on the pattern of preschool inclusion were registered.
Conclusions.Children with CP born moderate or late preterm share clinical features and functional outcomes both with more preterm children and children born at term. Whether differences and similarities depend on the nature of the lesion and insult requires further research.
Keywords: cerebral palsy, preterm, outcome