BACKGROUND AND OBJECTIVES:
Cerebral palsy (CP) is a lifelong neurodevelopmental condition caused by injury to the developing fetal or infant brain. In developed countries 75% to 80% of cases are as a result of prenatal brain injury. Data from developing countries are limited; however, a higher proportion of affected children may have perinatal or postnatal injury. The objectives were to classify children with CP attending a neurodevelopmental clinic in Accra into clinical subtypes, determine the prevalence of associated impairments, and identify risk factors for CP among the study population.
Prenatal, perinatal, and postnatal events were compared between 142 children with CP and 142 age- and gender-matched controls. We assessed clinical subtypes by using the Surveillance of Cerebral Palsy in Europe classification system and evaluated associated impairments. Risk factors were expressed as odds ratios (ORs) with 95% confidence intervals, and a multivariate logistic regression model was used.
Bilateral spastic (60.6%) and dyskinetic CP (20.4%) were the most common clinical subtypes, followed by unilateral spastic CP (10.6%). The prevalence rates of epilepsy and visual and hearing impairments were 40.1%, 23.2%, and 9.9%, respectively. Factors associated with an elevated risk for CP were severe neonatal hyperbilirubinemia (OR = 43.94, P < .0001), neonatal seizures (OR = 32.81, P = .001), birth asphyxia (OR = 6.69, P = .027), irregular menstrual cycle (OR = 4.58, P = .021), prematurity (OR = 3.45, P = .008), and neonatal sepsis (OR = 2.83, P = .020).
The clinical spectrum of CP in this study cohort differs from that of developed countries with a high prevalence of dyskinetic CP. Severe neonatal hyperbilirubinemia resulting in dyskinetic CP was the most significant and preventable risk factor for CP in this study population.
- Copyright © 2015 by the American Academy of Pediatrics