Cerebral palsy in children of very low birth weight

Abstract

Of 1,081 children weighing not more than 4 lb. (1,800 g.) at birth, 70 (6 · 5%) developed cerebral palsy; of these 57 (81 %) were included in the syndrome of spastic diplegia; five (7%) had choreo-athetoid cerebral palsy, three (4%) had spastic double hemiplegia and only two (30%) had typical spastic hemiplegia. These proportions are very different from those generally found among cases of cerebral palsy as a whole. Diplegia, but not other types, occurred more often in single than in multiple births. In single births the prevalence of diplegia increased from 2 · 80 following pregnancies lasting 35 or more weeks to 12 · 4% in pregnancies lasting less than 31 weeks. It appeared to occur independently of the cause of premature birth, rendering a prenatal origin unlikely. There was no indication that asphyxia in the infant during delivery was an aetiological factor. Cyanotic attacks in the early postnatal period were found to be associated with diplegia, and it is suggested that these may either cause the disorder in immature infants or be closely associated with the cause. Association with jaundice and to a lesser extent with oedema was found, which it is suggested might be explained on the grounds that jaundice and oedema are indicative of immaturity. The relatively low rate of diplegia found in twins whose co-twin survived was perhaps explained by a lower rate of cyanotic attacks. There was some indication that prolonged oxygen therapy prevented diplegia in very immature infants with cyanotic attacks. It is suggested that this treatment may be of value if retrolental fibroplasia can be avoided. Other types of cerebral palsy differed in that they showed a significant association with convulsions or signs of cerebral irritation in the neonatal period, but not with factors associated with diplegia. In three of five children with athetosis, hyperbilirubinaemia was the probable cause, and in the other two and in four hemiplegic children prenatal damage seemed likely.