Aim
To monitor the trends in prevalence of cerebral palsy (CP) by birthweight in Europe, 1980 to 2003.
Method
Data were collated from 20 population‐based registers contributing to the Surveillance of ...Cerebral Palsy in Europe database. Trend analyses were conducted in four birthweight groups: <1000g (extremely low birthweight ELBW); 1000 to 1499g (very low birthweight VLBW); 1500 to 2499g (moderately low birthweight MLBW); and >2499g (normal birthweight NBW).
Results
The overall prevalence of CP decreased from 1.90 to 1.77 per 1000 live births, p<0.001, with a mean annual fall of 0.7% (95% confidence interval CI −0.3% to −1.0%). Prevalence in NBW children showed a non‐significant trend from 1.17 to 0.89 per 1000 live births (p=0.22). Prevalence in MLBW children decreased from 8.5 to 6.2 per 1000 live births (p<0.001), but not linearly. Prevalence in VLBW children also declined from 70.9 to 35.9 per 1000 live births (p<0.001) with a mean annual fall of 3.4% (95% CI −2.4% to −4.3%). Prevalence in ELBW children remained stable, at a mean rate of 42.4 per 1000 live births.
Interpretation
The decline in prevalence of CP in children of VLBW continues, and confirms that previously reported. For the first time, there is also a significant decline among those of MLBW, resulting in a significant overall decrease in the prevalence of CP.
What this paper adds
Cerebral palsy (CP) prevalence in children born very low birthweight in 1980 to 2003 further decreased compared to 1980 to 1996.
CP prevalence in children born moderately low birthweight has significantly decreased.
The result is a significant decrease in the overall CP prevalence.
This article is commented on by Smithers‐Sheedy on page 14 of this issue.
Aim
Determining inclusion/exclusion criteria for cerebral palsy (CP) surveillance is challenging. The aims of this paper were to (1) define inclusion/exclusion criteria that have been adopted ...uniformly by surveillance programmes and identify where consensus is still elusive, and (2) provide an updated list of the consensus concerning CP inclusion/exclusion when a syndrome/disorder is diagnosed.
Method
Data were drawn from an international survey of CP registers, the New South Wales CP Register (1993–2003), the Western Australian CP Register (1975–2008), and the Surveillance of CP in Europe (SCPE; 1976–1998). An expert panel used a consensus building technique, which utilized the SCPE ‘decision tree’ and the original ‘What constitutes cerebral palsy?’ paper as frameworks.
Results
CP surveillance programmes agree on key clinical criteria pertaining to the type, severity, and origin of motor disorder in CP. Further work is warranted to reach agreement for (1) minimum age of survival and maximum age of postneonatal brain injury, and (2) metabolic disorders with highly variable clinical courses/responses to treatment. One hundred and ninety‐seven syndromes/disorders were reviewed and advice on their inclusion/exclusion is provided.
Interpretation
What constitutes CP will continue to evolve as diagnostics improve. Surveillance programmes throughout the world are committed to addressing their differences regarding inclusion/exclusion criteria for the umbrella term CP.
What this paper adds
There is now considerable international agreement that CP is defined by clinically descriptive criteria rather than cerebral pathology or aetiological diagnoses.
Disagreement remains concerning criteria pertaining to minimum age of survival and maximum age for postneonatal brain injury.
Provided age of acquisition and death is recorded, these otherwise uniform criteria provide opportunities to pool and analyse data across registers, over time.
This study examines the interplay between maternal depression/anxiety and infant temperament's developmental trajectory in 1687 Swedish‐speaking mother–infant dyads from Uppsala County (2009–2019), ...Sweden. The sample includes a high proportion of university‐educated individuals and a low share of foreign‐born participants. Maternal depressive and anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale during gestational weeks 17 and 32 and postpartum at week 6. Multinomial regression explored associations between maternal variables and infant temperament trajectories at 6 weeks, 12 months, and 18 months. Prenatal anxiety is associated with the high‐rising infant difficult temperament trajectory, while prenatal depression/anhedonia is associated with the stable‐medium trajectory, attenuated postpartum. Associations between infant temperament and maternal mood depended on timing (pre/postpartum) and symptom type (depression/anhedonia vs. anxiety).
The aim of this study was to show the role of magnetic resonance imaging (MRI) in elucidating the aetiology, or at least pathogenesis, of cerebral palsy (CP). A systematic review of studies using MRI ...in children with CP was performed according to pathogenetic patterns characterizing different timing periods of occurence of the lesions, and with respect to gestational age (term vs preterm) and CP subtypes. Out of the studies published since 1990 in English, six met all the inclusion criteria; they involved children with spastic and dyskinetic CP. Abnormal MRI was reported in 334 out of 388 (86%) patients and gave clues to pathogenesis in 83%. Fourteen studies met only part of the inclusion criteria and abnormal MRIs were reported even more frequently in these (91%; 930/1022). Periventricular white matter lesions were most frequent (56%) followed by cortical and deep grey matter lesions (18%); brain maldevelopments were rather rare, described in 9%. Brain maldevelopments and grey matter lesions were more often seen in term than in preterm‐born children with CP (brain maldevelopments: 16% vs 2.5%; grey matter lesions: 33% vs 3.5%); periventricular white matter lesions occurred significantly more often in preterm than in term‐born children (90% vs 20%). CP is mainly characterized by brain lesions which can be identified by MRI in around 75% of preterm infants; brain maldevelopments occur in around 10%.
•Maternal depressive trajectories are differently associated with child behavior.•Antenatal depression has a direct effect on child behavior.•Postpartum depression is not linked to child behavior ...when adjusted for bonding.•Persistent depression in mothers was linked to higher mean child problem scores.
Maternal perinatal depression is a public health problem affecting mothers and children worldwide. This study aimed to increase the knowledge regarding the impact of timing of maternal depression on child behavioral difficulties at 18 months, taking into consideration child gender and maternal bonding.
Data from a Swedish population-based longitudinal mother-infant study (n = 1,093) were used for linear regression modeling. Associations between antenatal depression, postpartum depression, persistent depression and child behavioral problems were assessed.
Maternal antenatal and persistent depression were associated with higher Child Behavior Checklist scores. Girls were affected to a greater degree. Postpartum bonding mediated most of the negative effects of postpartum and persistent depression on child behavior; not the effects of antenatal depression, however.
Child behavioral problems were reported by the mother. Information regarding paternal depressive symptoms was lacking.
Different onset and timing of maternal depression showed distinct associations with child behavioral problems. The effects of antenatal depression were not mediated by maternal bonding, indicating underlying mechanisms possibly related to fetal programming. Screening of depressive symptoms even during pregnancy would be important in routine care in order to early identify and treat depression.
Objective To evaluate whether an early postnatal infection poses a long-term risk for neuropsychological impairment to neonates born very prematurely. Study design Adolescents born very preterm ...(n = 42, 11.6-16.2 years, mean = 13.9; 15 girls; 19 with and 23 without an early postnatal human cytomegalovirus CMV infection) and typically developing, term born controls (n = 24, 11.3-16.6 years, mean = 13.6; 12 girls) were neuropsychologically assessed with the German version of the Wechsler Intelligence Scale and the Developmental Test for Visual Perception. Results As expected, the full cohort of adolescents born preterm had significantly lower scores than term born controls on IQ (preterm: mean SD = 98.43 14.83, control: 110.00 8.10, P = .015) and on visuoperceptive abilities (95.64 12.87 vs 106.24 9.95, P = .016). Furthermore, adolescents born preterm with early postnatal CMV infection scored significantly lower than those without this infection regarding overall cognitive abilities (92.67 14.71 vs 102.75 13.67, P = .030), but not visuoperceptive abilities (91.22 10.88 vs 98.96 13.45, P > .05). Conclusions In our small but well-characterized group, our results provide evidence for adverse effects of early postnatal CMV infection on overall cognitive functions in adolescents born preterm. If confirmed, these results support the implementation of preventive measures.
Abstract A common language on CP has been developed for the European registers by the SCPE (Surveillance of Cerebral Palsy in Europe) working group and the common database allows prevalence analyses ...on a larger basis. CP prevalence increases with lower birthweight and higher immaturity. Increase of survival after preterm birth has first also increased CP rates. But already in the 80s this trend was reversed for LBW infants, and in the 90s also for VLBW or very immature infants. The outcome with respect to CP in the group of extremely LBW or immature infants remains a matter of specific concern, as prevalence seems to be rather stable on a high level. CP is caused in more than 80% by brain lesions or maldevelopments which can be attributed to different timing periods of the developing brain. Extent and topography determine the clinical subtype of CP and are related also to the presence and severity of associated disabilities. CP, thus, offers a model to study plasticity of the developing brain. Reorganisation following unilateral lesions is mainly interhemispheric and homotopic. In the motor system, it involves the recruitment of ipsilateral tracts; functionality seems to be limited and decreases already towards the end of gestation. There is no clear evidence for substantial reorganisation in the sensory system. The best compensatory potential is described concerning language function following left hemispheric lesions. Language function reorganized to the right hemisphere eventually seems not to be impaired, this occurs, however, on the expense of primary right hemispheric functions.
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