Children with cerebral palsy and periventricular white matter injury: Does gestational age affect functional outcome?
Introduction
Neuroimaging, particularly magnetic resonance imaging (MRI), plays an important role in the diagnosis of cerebral palsy (CP) in children (Surveillance of Cerebral Palsy in Europe (SCPE), 2000). Advances in neuroimaging over recent years have enabled clinicians to detect specific brain abnormalities in children with CP. Periventricular white matter injury (PWMI) is the most common pattern of brain abnormality in children with CP as shown in three systematic reviews (Ashwal et al., 2004, Korzeniewski et al., 2008, Krageloh-Mann et al., 2007).
Typically, PWMI occurs in preterm infants born between 23 and 34 weeks gestation (Folkerth & Folkerth, 2006). However, it also occurs in children born at or near term, with recent studies reporting that 25–47% of children with CP and PWMI were born at or near term (Bax et al., 2006, Himmelmann and Uvebrant, 2011). Although PWMI is now recognised as being common in term-born infants, what is not known is whether children with CP and PWMI born at different gestational ages have different functional abilities when examined later in childhood? Of particular interest is whether they differ with respect to gross motor function and mobility, manual abilities and communication function.
In a study of 41 children with CP and PWMI, differences in clinical features between those born preterm (<37 weeks) and those born at term (≥37 weeks) were examined when the children were aged 2–7 years (Lasry et al., 2010). The term born group (15 children) had a higher proportion of children with hemiplegia and classified within Gross Motor Function Classification System (GMFCS) levels I and II compared with the preterm group (26 children), whereas the preterm group had more children with diplegia. This small study did not examine movement disorder type or use other functional classification systems such as the Manual Ability Classification System (MACS) (Eliasson et al., 2006) and the Communication Function Classification System (CFCS) (Hidecker et al., 2011). More information is required about potential differences in outcomes of children with CP and PWMI based on their gestational age to inform parents and clinicians and to plan therapy programs.
The aim of the current study was to determine whether children with CP and PWMI born >34 weeks differ in functional abilities compared with those born ≤34 weeks when assessed at 4–12 years of age. In addition we wanted investigate whether children differ in their type of movement disorder and topographical pattern. Children were grouped by gestational age into ≤34 weeks and >34 weeks based on evidence that children with CP born ≤34 weeks were considered most likely to have PWMI (Folkerth & Folkerth, 2006).
Section snippets
Methods
This cross-sectional observational study was undertaken in a tertiary care hospital setting.
Results
Letters were sent to the families of 211 of the 279 eligible children with PWMI. The remaining 68 children could not be contacted because they had not consented to be on the VCPR and had no means of being contacted through hospital clinics. Of the 211 contacted, 101 declined to participate, did not respond or failed to attend their assessment. A further child was excluded because data on gestational age were not available as the child was adopted. This gave a final sample of 109 children (40
Discussion
This study examined differences in functional profiles and movement disorder type and topography of children aged 4–12 years of age with CP and PWMI born ≤34 weeks’ gestation compared with those born >34 weeks gestation. Children born >34 weeks had milder limitations in gross motor function, mobility, manual ability and communication than those born earlier. There was little evidence of difference between the groups in the type of movement disorder, although there were more children born ≤34
Acknowledgements
The project was supported through funding received from the Barr Family Foundation and the Lorenzo and Pamela Galli Charitable Trust. Assessment of the MRI scans was funded by the William Henry and Vera Ellen Houston Memorial Trust Fund and the CP Alliance. The Victorian Cerebral Palsy Register is funded by the Victorian Department of Health and the Victorian Medical Insurance Agency Ltd. In addition, this research was supported by the Victorian Government's Operational Infrastructure Support
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