Population case-control study of cerebral palsy: neonatal predictors for low-risk term singletons.

Abstract

For singletons with cerebral palsy (CP) who were born at term, the goals were (1) to determine the proportion not admitted to a Special Care Unit/NICU (NICU), (2) to compare clinical descriptions of those admitted to NICUs and those not admitted, and (3) to identify neonatal predictors of CP among those not admitted to a NICU. A total-population case- (N = 442) control (N = 468) study of, singleton, term-born infants with CP, as ascertained from the Western Australian Cerebral Palsy Register, was performed. All types of CP were represented among the 67% of term infants with CP (N = 295) who were not admitted to a NICU, which also included 54% of the subjects with the most severe impairments. Independent neonatal predictors were abnormalities of tone (odds ratio [OR]: 7.3 [95% confidence interval [CI]: 2-26.8]), temperature regulation (OR: 4.1 [95% CI: 1.2-14]), consciousness (OR: 3.7 [95% CI: 2-7]), and fontanelles (OR: 4.4 [95% CI: 0.8-23]), requirement for resuscitation (OR: 2.9 [95% CI: 2.2-12.9]), and birth defects (OR: 5.1 [95% CI: 2.4-10]). The risk of CP increased with the number of factors, but 58% of subjects who were not admitted to a NICU exhibited none of these factors. Neonatal predictors of CP among term infants not admitted to a NICU were identified. However, 39% of all term singletons with CP were not admitted to a NICU and exhibited none of these predictors.