Abstract
Background
Motor impairment is common after extremely preterm (EPT, <28 weeks’ gestational age (GA)) birth, with cerebral palsy (CP) affecting about 10% of children and non-CP movement difficulties (MD) up to 50%. This study investigated the sociodemographic, perinatal and neonatal risk factors for CP and non-CP MD.
Methods
Data come from a European population-based cohort of children born EPT in 2011–2012 in 11 countries. We used multinomial logistic regression to assess risk factors for CP and non-CP MD (Movement Assessment Battery for Children – 2nd edition ≤5th percentile) compared to no MD (>15th percentile) among 5-year-old children.
Results
Compared to children without MD (n = 366), young maternal age, male sex and bronchopulmonary dysplasia were similarly associated with CP (n = 100) and non-CP MD (n = 224) with relative risk ratios (RRR) ranging from 2.3 to 3.6. CP was strongly related to severe brain lesions (RRR >10), other neonatal morbidities, congenital anomalies and low Apgar score (RRR: 2.4–3.3), while non-CP MD was associated with primiparity, maternal education, small for GA (RRR: 1.6–2.6) and severe brain lesions, but at a much lower order of magnitude.
Conclusion
CP and non-CP MD have different risk factor profiles, with fewer clinical but more sociodemographic risk factors for non-CP MD.
Impact
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Young maternal age, male sex and bronchopulmonary dysplasia similarly increased risks of both cerebral palsy and non-cerebral palsy movement difficulties.
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Cerebral palsy was strongly related to clinical risk factors including severe brain lesions and other neonatal morbidities, while non-cerebral palsy movement difficulties were more associated with sociodemographic risk factors.
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These results on the similarities and differences in risk profiles of children with cerebral palsy and non-cerebral palsy movement difficulties raise questions for etiological research and provide a basis for improving the identification of children who may benefit from follow-up and early intervention.
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Data availability
The datasets analyzed during the current study are not publicly available due to health data protection but are available from the corresponding author on reasonable request.
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Acknowledgements
Additional funding is acknowledged from the following regions: France (French Institute of Public Health Research/Institute of Public Health and its partners the French Health Ministry, the National Institute of Health and Medical Research, the National Institute of Cancer and the National Solidarity Fund for Autonomy; grant ANR-11-EQPX-0038 from the National Research Agency through the French Equipex Program of Investments in the Future and the PremUp Foundation) and United Kingdom (funding for The Neonatal Survey from Neonatal Networks for East Midlands and Yorkshire and the Humber regions).
Funding
The EPICE and SHIPS projects have both received funding from the European Union: Seventh Framework Programme (FP7/2007–2013) under grant agreement No 259882; and Union Horizon 2020 Research and Innovation Program, under grant agreement No 633724 and No 733280. R.C. was supported by the FSE and FCT under the Post-Doctoral Grant SFRH/BPD/117597/2016. EPIUnit (UIDB/04750/2020) and ITR (LA/P/0064/2020) are financed by the FCT (Fundação para a Ciência e a Tecnologia, I.P.). The funders/sponsors did not participate in the work.
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R.C., S.J., U.A., M.C., C.K.-E., J.L., H.V., M.Z., V.P., J.Z., and the SHIPS Research group made substantial contributions to the conception and design and acquisition of data. A.M.A. and J.Z. analyzed the data. A.M.A., R.C., S.J., U.A., M.C., C.K.-E., J.L., H.V., M.Z., V.P., and J.Z. contributed to the interpretation of data, drafting the article, revising it critically for important intellectual content, and approved the final version to be published. Members of the SHIPS research group approved the final version to be published.
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All study regions obtained ethical approval according to national legislation. The study was also approved by the French Advisory Committee on Use of Health Data in Medical Research (CCTIRS) and the French National Commission for Data Protection and Liberties (CNIL). Parents gave their written informed consent to participate in the study prior to any data collection.
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Aubert, A.M., Costa, R., Johnson, S. et al. Risk factors for cerebral palsy and movement difficulties in 5-year-old children born extremely preterm. Pediatr Res 94, 771–780 (2023). https://doi.org/10.1038/s41390-022-02437-6
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DOI: https://doi.org/10.1038/s41390-022-02437-6