Research Article: Which growth parameters can affect mortality in cerebral palsy?

Date Published: June 14, 2019

Publisher: Public Library of Science

Author(s): Hyun Jung Kim, Tae Uk Kang, Kyu Yong Park, Jihyun Kim, Hyeong Sik Ahn, Shin-Young Yim, Sebastian Grunt.

http://doi.org/10.1371/journal.pone.0218320

Abstract

The objective of this study was to identify growth parameters that can affect mortality of cerebral palsy (CP).

This was a birth cohort study based on the National Health Screening Program for Infants and Children database along with the National Health Insurance Service, which were linked using a personal identifier number. The birth cohort consisted of 2 191 956 subjects, representing 93.5% of live births from 2007–2011, with maximal 10-year follow-up (range, 5–10 years) until October 2016. Subjects with CP were identified. Growth parameters in terms of birth weight, underweight (weight-for-age below the 3rd percentile), rate of body weight gain were collected, along with all-cause mortality after the age of 1 year.

Prevalence of CP was 2.0 per 1000 live births (95% CI, 1.94–2.06). All-cause mortality after the age of 1 year was 0.09 deaths/1000 person-years (95% CI, 0.08–0.09) in the general population (GP) and 2.85 deaths/1000 person-years (95% CI, 2.32–3.50) in subjects with CP during the follow-up. Therefore, the incidence rate ratio for all-cause mortality was 32.15 (95% CI, 25.72–39.76) in subjects with CP compared to GP. Presence of underweight was significantly associated with higher mortality in both subjects with CP and GP, where the adjusted hazard ratio of death was 2.60 (95% CI, 1.93–3.50) at the age of 18–24 months, 3.12 at 30–36 months, 4.37 at 42–48 months, 5.12 at 54–60 months, and 4.17 at 66–71 months. Birth weight did not affect mortality in both subjects with CP and GP after the age of 1 year (p > 0.05).

While subjects with CP shows higher mortality, underweight is an important growth parameter that affects all-cause mortality of both subjects with CP and GP. This study urges increased awareness that subjects with CP who are underweight require special care.

Partial Text

Cerebral palsy (CP) describes a group of permanent disorders affecting the development of movement and posture, causing activity limitations that are attributed to non-progressive disturbances which occur in the developing fetal or infant brain [1,2]. CP is the most common cause of motor disability in childhood [3]. CP has an adverse influence on many aspects of growth, survival, and the daily functioning of subjects. It also imposes demands on health, social, and educational services [4].

We conducted a population-based study of Korean children born from January 1st, 2007–December 31st, 2011. We observed the Record Statement (http://record-statement.org, S1 Checklist). This study was approved as an exempted study for Ajou University Hospital Institutional Review Board (MED-EXP-17-174).

In this nationwide birth cohort, we found a CP prevalence rate of 2.0 per 1000 live births. The incidence rate ratio for all-cause mortality was 32.15 in SCP compared to the subjects in the GP. Underweight was the growth parameter that significantly affects all-cause mortality in both SCP and the subjects in the GP. Birth weight did not affect mortality in both SCP and the subjects in the GP after the age of 1 year (p > 0.05).

In a nationwide birth cohort, we found a CP prevalence rate of 2.0 per 1000 live births. While subjects with CP shows higher mortality, underweight is an important growth parameter that affects all-cause mortality of both subjects with CP and GP. This study urges increased awareness that subjects with CP who are underweight require special care.

 

Source:

http://doi.org/10.1371/journal.pone.0218320

 

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