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American Academy of Pediatrics
Article

Cerebral Palsy and Neonatal Death in Term Singletons Born Small for Gestational Age

Magne Stoknes, Guro L. Andersen, Magnus Odin Dahlseng, Jon Skranes, Kjell Å. Salvesen, Lorentz M. Irgens, Jennifer J. Kurinczuk and Torstein Vik
Pediatrics December 2012, 130 (6) e1629-e1635; DOI: https://doi.org/10.1542/peds.2012-0152
Magne Stoknes
aDepartment of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;
bDepartment of Pediatrics, St. Olavs Hospital/Trondheim University Hospital, Trondheim, Norway;
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Guro L. Andersen
aDepartment of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;
bDepartment of Pediatrics, St. Olavs Hospital/Trondheim University Hospital, Trondheim, Norway;
cThe Cerebral Palsy Registry of Norway, Habilitation Center, Vestfold Hospital, Tønsberg, Norway;
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Magnus Odin Dahlseng
aDepartment of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;
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Jon Skranes
aDepartment of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;
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Kjell Å. Salvesen
aDepartment of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;
dDepartment of Obstetrics and Gynaecology, Clinical Sciences, Lund University, Lund, Sweden;
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Lorentz M. Irgens
eMedical Birth Registry of Norway, Locus of Registry-based Epidemiological Research, Norwegian Institute of Public Health, Oslo, Norway;
fDepartment of Public Health and Primary Health Care, University of Bergen, Bergen, Norway; and
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Jennifer J. Kurinczuk
gNational Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
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Torstein Vik
aDepartment of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;
bDepartment of Pediatrics, St. Olavs Hospital/Trondheim University Hospital, Trondheim, Norway;
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Abstract

BACKGROUND AND OBJECTIVES: To investigate the probable timing of events leading to cerebral palsy (CP) in singletons born small for gestational age (SGA) at term, taking neonatal death into consideration.

METHODS: In this registry-based cohort study, data on 400 488 singletons born during 1996–2003 were abstracted from the Medical Birth and the CP registries of Norway. Among 36 604 SGA children (birth weight <10th percentile), 104 died in the neonatal period and 69 developed CP. Apgar scores at 5 minutes, risk factors, MRI findings, and CP subtypes were used to assess the timing of events leading to CP or neonatal death.

RESULTS: Intrapartum origin of CP was considered in 5 SGA children (7%; 95% confidence interval: 3–16) in comparison with 31 of 263 (12%; 95% confidence interval: 8–16) non-SGA children (P = .28). The proportions of children who died in the neonatal period after a probable intrapartum event did not differ between the groups when children with congenital malformations were excluded. Probable antenatal events leading to CP and neonatal death were more common among SGA than non-SGA children (P < .001).

CONCLUSIONS: In ∼90% of children born SGA the event leading to CP is of probable antenatal origin. The low proportion of SGA children with CP after a probable intrapartum event was not outweighed by a higher neonatal mortality rate when congenital malformations were excluded. The higher risk of CP among SGA than among non-SGA children is probably due to a higher prevalence of antenatal risk factors.

KEY WORDS
  • brain insults
  • antenatal injury
  • fetal growth restriction
  • perinatal hypoxia-ischemia
  • birth asphyxia
  • Abbreviations:
    CI —
    confidence interval
    CP —
    cerebral palsy
    CPRN —
    Cerebral Palsy Register of Norway
    IUGR —
    intrauterine growth restriction
    MBRN —
    Medical Birth Registry of Norway
    OR —
    odds ratio
    SGA —
    small for gestational age
    • Accepted August 14, 2012.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 130, Issue 6
    1 Dec 2012
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    Cerebral Palsy and Neonatal Death in Term Singletons Born Small for Gestational Age
    Magne Stoknes, Guro L. Andersen, Magnus Odin Dahlseng, Jon Skranes, Kjell Å. Salvesen, Lorentz M. Irgens, Jennifer J. Kurinczuk, Torstein Vik
    Pediatrics Dec 2012, 130 (6) e1629-e1635; DOI: 10.1542/peds.2012-0152

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    Cerebral Palsy and Neonatal Death in Term Singletons Born Small for Gestational Age
    Magne Stoknes, Guro L. Andersen, Magnus Odin Dahlseng, Jon Skranes, Kjell Å. Salvesen, Lorentz M. Irgens, Jennifer J. Kurinczuk, Torstein Vik
    Pediatrics Dec 2012, 130 (6) e1629-e1635; DOI: 10.1542/peds.2012-0152
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    • brain insults
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    • fetal growth restriction
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