Cerebral palsy characteristics in term-born children with and without detectable perinatal risk factors: A cross-sectional study

AimTo compare, in term-born children with cerebral palsy (CP), the characteristics of those who exhibit detectable risk factors for CP at birth with those who do not.MethodThis was a cross-sectional study of term-born children using the Canadian Cerebral Palsy Registry comparing those with and without perinatal risk factors and/or neonatal symptoms for pregnancy, birth and neonatal characteristics, magnetic resonance imaging (MRI) findings, CP subtype, and impairment severity. Risk factors were quantified with a CP risk calculator. Multivariable and multinomial regressions were expressed as odds ratios (OR) and relative risk ratios.ResultsOf 1333 term-born children, 781 (58.6%) had complete variables for the CP risk calculator, of whom 195 (25%) had 'undetectable' newborn infant CP risk, and they did not have greater postneonatal brain injury. Focal injury on MRI was more common (OR 2.0, 95% confidence interval [CI] 1.3-3.1) than in the 'detectable' group. The 'undetectable' group had more unilateral CP (OR 1.8, 95% CI 1.3-2.6), less severe motor impairment (OR 0.76, 95% CI 0.67-0.86), and were more verbal (OR 2.3, 95% CI 1.5-3.6).InterpretationIn the Canadian CP Registry, one-quarter of term-born children lacked neonatal encephalopathy, seizures, or perinatal risk factors. They were more likely to have unilateral CP, focal MRI findings, and communicate with words than children with risk factors or neonatal symptoms. This paper uses a previously published objective newborn infant cerebral palsy (CP) risk calculator and neonatal symptoms (encephalopathy or seizures) to identify participants in the Canadian CP Registry who have 'undetectable' CP risk at birth, and determine their phenotype to aid in earlier detection. Those with 'undetectable' risk are more likely to be female, have focal injury on MRI, unilateral CP, be ambulatory, and communicate with words. Early handedness before the age of 1 year should prompt referral for evaluation of CP, even in the absence of perinatal risk factors.image