Increasing Prevalence of Cerebral Palsy in Children Born Very Preterm in Denmark

Overview

Journal Dev Med Child Neurol

Date 2024 Jul 12

PMID 38994777

Authors

Martha Veber Fogh

Gorm Greisen

Tine Dalsgaard Clausen

Lone Krebs

Mads Langager Larsen

Christina Engel Hoei-Hansen

Affiliations

Soon will be listed here.

Abstract

Aim: To analyse the rising prevalence of cerebral palsy (CP) in children born preterm in Denmark.

Method: We included all live-born children born preterm in Denmark from 1997 to 2013. The prevalence of CP in children born preterm was categorized by gestational age and correlated with neonatal mortality and changes in clinical factors.

Results: Among 70 876 children, 824 (1.2%) had CP. The overall CP prevalence in children born preterm decreased substantially until 2001, from when it increased annually by 2.8% (95% confidence interval 0.6-5.0). When categorized, the prevalence only increased significantly in children born very preterm (gestational weeks 28-31). Neonatal mortality rates decreased steadily at all gestational ages during the entire study period. Clinical factors that changed during the study period were increasing numbers of high-risk pregnancies, maternal obesity, emergency caesarean sections, neonatal admissions, and usage of assisted ventilation.

Interpretation: The increasing prevalence of CP in children born preterm was driven by the subgroup born very preterm and matched their decrease in neonatal mortality. In similar population studies, decreased mortality was not followed by increased CP prevalence. An increase in clinical risk factors was unlikely to explain our findings, but more active neonatal life support may have played a role.

Citing Articles

A global picture of outcomes after preterm birth: Is there a discrepancy?.

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PMID: 39255389 PMC: 11625464. DOI: 10.1111/dmcn.16092.

Increasing prevalence of cerebral palsy in children born very preterm in Denmark.

Fogh M, Greisen G, Clausen T, Krebs L, Larsen M, Hoei-Hansen C Dev Med Child Neurol. 2024; 67(1):68-76.

PMID: 38994777 PMC: 11625462. DOI: 10.1111/dmcn.16020.

References

Himmelmann K, Pahlman M . The panorama of cerebral palsy in Sweden part XIII shows declining prevalence in birth-years 2011-2014. Acta Paediatr. 2022; 112(1):124-131. PMC: 10092185. DOI: 10.1111/apa.16548. View

Gatman K, May R, Crowther C . Survey on use of antenatal magnesium sulphate for fetal neuroprotection prior to preterm birth in Australia and New Zealand - Ongoing barriers and enablers. Aust N Z J Obstet Gynaecol. 2019; 60(1):44-48. DOI: 10.1111/ajo.12981. View

Nyboe Andersen A . [In vitro fertilisation during 40 years]. Ugeskr Laeger. 2021; 183(48). View

Wolf H, Brok J, Henriksen T, Greisen G, Salvig J, Pryds O . Antenatal magnesium sulphate for the prevention of cerebral palsy in infants born preterm: a double-blind, randomised, placebo-controlled, multi-centre trial. BJOG. 2020; 127(10):1217-1225. DOI: 10.1111/1471-0528.16239. View

Barrington K . The adverse neuro-developmental effects of postnatal steroids in the preterm infant: a systematic review of RCTs. BMC Pediatr. 2001; 1:1. PMC: 29104. DOI: 10.1186/1471-2431-1-1. View

Hoei-Hansen C, Laursen B, Langhoff-Roos J, Rackauskaite G, Uldall P . Decline in severe spastic cerebral palsy at term in Denmark 1999-2007. Eur J Paediatr Neurol. 2018; 23(1):94-101. DOI: 10.1016/j.ejpn.2018.08.010. View

Uldall P, Michelsen S, Topp M, Madsen M . The Danish Cerebral Palsy Registry. A registry on a specific impairment. Dan Med Bull. 2001; 48(3):161-3. View

Larsen M, Hoei-Hansen C, Rackauskaite G . The diagnosis of cerebral palsy in two Danish national registries: a validation study. Scand J Public Health. 2024; 53(1):1-7. DOI: 10.1177/14034948231219825. View

Larsen M, Rackauskaite G, Greisen G, Laursen B, Uldall P, Krebs L . Continuing decline in the prevalence of cerebral palsy in Denmark for birth years 2008-2013. Eur J Paediatr Neurol. 2021; . DOI: 10.1016/j.ejpn.2020.10.003. View

10.

Ahmed A, Rosella L, Oskoui M, Watson T, Yang S . Prevalence and temporal trends of cerebral palsy in children born from 2002 to 2017 in Ontario, Canada: Population-based cohort study. Dev Med Child Neurol. 2022; 65(2):243-253. DOI: 10.1111/dmcn.15324. View

11.

Smithers-Sheedy H, Waight E, Goldsmith S, Reid S, Gibson C, Watson L . Declining trends in birth prevalence and severity of singletons with cerebral palsy of prenatal or perinatal origin in Australia: A population-based observational study. Dev Med Child Neurol. 2022; 64(9):1114-1122. PMC: 9544021. DOI: 10.1111/dmcn.15195. View

12.

Larsen M, Wiingreen R, Jensen A, Rackauskaite G, Laursen B, Hansen B . The effect of gestational age on major neurodevelopmental disorders in preterm infants. Pediatr Res. 2021; 91(7):1906-1912. DOI: 10.1038/s41390-021-01710-4. View

13.

Richter L, Ting J, Muraca G, Boutin A, Wen Q, Lyons J . Temporal Trends in Preterm Birth, Neonatal Mortality, and Neonatal Morbidity Following Spontaneous and Clinician-Initiated Delivery in Canada, 2009-2016. J Obstet Gynaecol Can. 2019; 41(12):1742-1751.e6. DOI: 10.1016/j.jogc.2019.02.151. View

14.

Arnaud C, Ehlinger V, Delobel-Ayoub M, Klapouszczak D, Perra O, Hensey O . Trends in Prevalence and Severity of Pre/Perinatal Cerebral Palsy Among Children Born Preterm From 2004 to 2010: A SCPE Collaboration Study. Front Neurol. 2021; 12:624884. PMC: 8173253. DOI: 10.3389/fneur.2021.624884. View

15.

Greisen G . Managing births at the limit of viability: the Danish experience. Semin Fetal Neonatal Med. 2005; 9(6):453-7. DOI: 10.1016/j.siny.2004.08.003. View

16.

Larsen M, Rackauskaite G, Greisen G, Laursen B, Uldall P, Krebs L . Declining prevalence of cerebral palsy in children born at term in Denmark. Dev Med Child Neurol. 2021; 64(6):715-722. DOI: 10.1111/dmcn.15136. View

17.

Bliddal M, Broe A, Pottegard A, Olsen J, Langhoff-Roos J . The Danish Medical Birth Register. Eur J Epidemiol. 2018; 33(1):27-36. DOI: 10.1007/s10654-018-0356-1. View

18.

Fogh M, Greisen G, Clausen T, Krebs L, Larsen M, Hoei-Hansen C . Increasing prevalence of cerebral palsy in children born very preterm in Denmark. Dev Med Child Neurol. 2024; 67(1):68-76. PMC: 11625462. DOI: 10.1111/dmcn.16020. View

19.

Jolving L, Nielsen J, Kesmodel U, Nielsen R, Beck-Nielsen S, Norgard B . Prevalence of maternal chronic diseases during pregnancy - a nationwide population based study from 1989 to 2013. Acta Obstet Gynecol Scand. 2016; 95(11):1295-1304. DOI: 10.1111/aogs.13007. View

20.

Smithers-Sheedy H, Badawi N, Blair E, Cans C, Himmelmann K, Krageloh-Mann I . What constitutes cerebral palsy in the twenty-first century?. Dev Med Child Neurol. 2013; 56(4):323-8. DOI: 10.1111/dmcn.12262. View