Congenital Malformations in Children With Cerebral Palsy: Is Prematurity Protective?,Pediatric Neurology

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Congenital Malformations in Children With Cerebral Palsy: Is Prematurity Protective?
Pediatric Neurology ( IF 3.8 ) Pub Date : 2020-02-12 , DOI: 10.1016/j.pediatrneurol.2020.02.002
Marcel Sévère ₁ , Pamela Ng ₂ , Carmen Messerlian ₃ , John Andersen ₄ , David Buckley ₅ , Darcy Fehlings ₆ , Adam Kirton ₇ , Louise Koclas ₈ , Nicole Pigeon ₉ , Esias Van Rensburg ₁₀ , Ellen Wood ₁₁ , Michael Shevell ₁₂ , Maryam Oskoui ₁₂

Affiliation

Department of Pediatrics, McGill University, Montreal, Quebec City, Canada.
Child Health and Human Development, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, Canada.
Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Department of Pediatrics, Janeway Children's Hospital, St. John's, Newfoundland and Labrador, Canada.
Department of Paediatrics, University of Toronto, Bloorview Research Institute, Toronto, Ontario, Canada.
Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Department of Pediatrics, Centre de réadaptation Marie Enfant du CHU Sainte-Justine.
Department of Pediatrics, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec City, Canada.
Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada.
Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada.
Department of Pediatrics, McGill University, Montreal, Quebec City, Canada; Department of Neurology & Neurosurgery, McGill University, Montreal, Canada.

Background

Congenital malformations are more common in children who are born prematurely, and prematurity is the leading risk factor for cerebral palsy. The primary objective of this study was to describe the profile of congenital malformations in a Canadian cohort of children with cerebral palsy. The secondary objectives were to compare the profiles of children with cerebral palsy with and without a congenital malformation and explore the possible role of prematurity.

Methods

This retrospective cohort study utilized data from the Canadian Cerebral Palsy Registry, a population based registry of children with a confirmed diagnosis of cerebral palsy. Differences between groups were compared using Pearson’s chi-square and Student t test as appropriate. Odds ratios and 95% confidence intervals were calculated

Results

Congenital malformations were present in 23% participants. In term-born children, brain malformations were the most common, whereas heart and gastrointestinal malformations were more common in children born prematurely. Children with a malformation had higher odds of being born at term (odds ratio 1.57, 95% confidence interval 1.20 to 2.04); having hypotonic, ataxic, or dyskinetic cerebral palsy (odds ratio 1.92, 95% confidence interval 1.35 to 2.72; being nonambulatory (odds ratio 1.70, 95% confidence interval 1.29 to 2.25); and having cerebral palsy-associated comorbidities.

Conclusions

One in four children with cerebral palsy have an associated congenital malformation. Their profile of term birth, higher Apgar scores, and lower frequency of perinatal seizures suggests a distinct causal pathway.

中文翻译：

脑瘫患儿的先天性畸形：早产儿有保护作用吗？

背景

先天性畸形在早产儿中更为常见，而早产是脑瘫的主要危险因素。这项研究的主要目的是描述加拿大脑瘫患儿队列中先天性畸形的概况。次要目标是比较有和没有先天性畸形的脑瘫患儿的概况，并探讨早产的可能作用。

方法

这项回顾性队列研究利用了加拿大脑瘫登记处的数据，加拿大脑瘫登记处是一个以人群为基础的确诊为脑瘫儿童的登记处。使用Pearson卡方检验和Student t检验比较组之间的差异。计算赔率和95％置信区间

结果

23％的参与者存在先天性畸形。在足月儿中，脑畸形是最常见的，而心脏和胃肠道畸形在早产儿中更为常见。畸形儿童足月出生的几率更高（优势比1.57，95％置信区间1.20至2.04）；患有低渗，共济失调或运动障碍性脑瘫（赔率1.92，95％置信区间1.35至2.72；不活动（赔率1.70，95％置信区间1.29至2.25）；并患有脑瘫相关合并症。