Behavioural and emotional symptoms of preschool children with cerebral palsy: a population‐based study

Aim To describe behavioural and emotional symptoms among Icelandic preschool children with cerebral palsy (CP). Method Children with congenital CP, assessed with the Child Behavior Checklist/1½–5 (CBCL/1½–5) and Caregiver‐Teacher Report Form (C‐TRF), were enrolled in the study. A comparison group was recruited from the general population. Thirty‐six children (53% males) with CP were assessed at a mean age of 4 years 11 months (SD 5mo, range 4–6y); 26 (72%) had bilateral distribution of symptoms and 32 (89%) had spastic CP. Thirty (83%) were at Gross Motor Function Classification System levels I or II and six at levels III or IV. For comparison, 110 (43% males) and 120 (48% males) children were assessed with the CBCL/1½–5 and the C‐TRF respectively, at a mean age of 4 years 6 months (SD 6mo, range 4–6y). Results Sixteen children (48%) with CP had high scores on total problems scale of the CBCL/1½–5 and 20 (65%) on the C‐TRF compared with 18% of the comparison group, both on the CBCL/1½–5 and the C‐TRF (p<0.001). Children with CP had higher scores on all subscales of the CBCL/1½–5 and the C‐TRF, except somatic complaints. Attention difficulties, withdrawn, aggressive behaviour, and anxious/depressed symptoms were most pronounced among children with CP. Interpretation A large proportion of preschool children with CP have substantial behavioural and emotional difficulties, which need to be addressed in their treatment.     

Predictors of cerebral palsy in very preterm infants: the EPIPAGE prospective population‐based cohort study

Aim The aim of this study was to assess the independent role of cerebral lesions on ultrasound scan, and several other neonatal and obstetric factors, as potential predictors of cerebral palsy (CP) in a large population‐based cohort of very preterm infants. Method As part of EPIPAGE, a population‐based prospective cohort study, perinatal data and outcome at 5 years of age were recorded for 1812 infants born before 33 weeks of gestation in nine regions of France in 1997. Results The study group comprised 942 males (52%) and 870 females with a mean gestational age of 30 weeks (SD 2wks; range 24–32wks) and a mean birthweight of 1367g (SD 393g; range 450–2645g). CP was diagnosed at 5 years of age in 159 infants (prevalence 9%; 95% confidence interval [CI] 7–10%), 97 males and 62 females, with a mean gestational age of 29 weeks (SD 2wks; range 24–32wks) and a mean birthweight of 1305g (SD 386g; range 500–2480g). Among this group, 67% walked without aid, 14% walked with aid, and 19% were unable to walk. Spastic, ataxic, and dyskinetic CP accounted for 89%, 7%, and 4% of cases respectively. The prevalence of CP was 61% among infants with cystic periventricular leukomalacia, 50% in infants with intraparenchymal haemorrhage, 8% in infants with grade I intraventricular haemorrhage, and 4% in infants without a detectable cerebral lesion. After controlling for cerebral lesions and obstetric and neonatal factors, only male sex (odds ratio [OR] 1.52; 95% CI 1.03–2.25) and preterm premature rupture of membranes or preterm labour (OR 1.72; 95% CI 0.95–3.14) were predictors of the development of CP in very preterm infants. Interpretation Cerebral lesions were the most important predictor of CP in very preterm infants. In addition, infant sex and preterm premature rupture of membranes or preterm labour were also independent predictors of CP.