Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. 690-697 (doi:10.1542/peds.2006-0278)
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ARTICLE

Cerebral Palsy in a Term Population: Risk Factors and Neuroimaging Findings

Yvonne W. Wu, MD, MPHa,b, Lisa A. Croen, PhDc, Sameer J. Shah, BSa, Thomas B. Newman, MD, MPHb,d and Daniel V. Najjar, MSc

a Departments of Neurology
b Pediatrics
d Epidemiology and Biostatistics, University of California, San Francisco, California
c Kaiser Permanente Division of Research, Oakland, California

OBJECTIVE. The purpose of this work was to study risk factors and neuroimaging characteristics of cerebral palsy in term and near-term infants.

PATIENTS AND METHODS. Among a cohort of 334339 infants ≥36 weeks’ gestation born at Kaiser Permanente Medical Care Program in northern California in 1991–2003, we identified infants with cerebral palsy and obtained clinical data from electronic and medical charts. Risk factors for cerebral palsy among infants with different brain abnormalities were compared using polytomous logistic regression.

RESULTS. Of 377 infants with cerebral palsy (prevalence: 1.1 per 1000), 273 (72%) received a head computed tomography or MRI. Abnormalities included focal arterial infarction (22%), brain malformation (14%), and periventricular white matter abnormalities (12%). Independent risk factors for cerebral palsy were maternal age >35, black race, and intrauterine growth restriction. Intrauterine growth restriction was more strongly associated with periventricular white matter injury than with other neuroimaging findings. Nighttime delivery was associated with cerebral palsy accompanied by generalized brain atrophy but not with cerebral palsy accompanied by other brain lesions.

CONCLUSIONS. Cerebral palsy is a heterogeneous syndrome with focal arterial infarction and brain malformation representing the most common neuroimaging abnormalities in term and near-term infants. Risk factors for cerebral palsy differ depending on the type of underlying brain abnormality.

Key Words: cerebral palsy • epidemiology

Abbreviations: CP—cerebral palsy • CT—computed tomography • KPMCP—Kaiser Permanente Medical Care Program • ICD-9-CM—International Classification of Diseases, Ninth Revision, Clinical Modification • IUGR—intrauterine growth restriction • RR—relative risk • CI—confidence interval • OR—odds ratio

Accepted Mar 2, 2006.




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