Risk factors and clinical patterns of cerebral palsy in children welfare teaching hospital in Baghdad

ABSTRACT

Cerebral palsy [CP] is a disorder of posture, movement and tone due to a static encephalopathy acquired during brain growth in fetal life, infancy or early childhood. To identify the risk factors of CP and its clinical patterns. This case control study was done from the 1st of January 2009 to the end of September 2009, on 100 patients with CP who attended the neurology clinic or have been admitted to the neurology ward in Children Welfare Teaching Hospital in Medical City complex, Baghdad. For comparative purposes,100 control individuals matched for sex and age were selected. Some of those patients were referred to pediatric clinic and registered with a diagnosis of CP and some of them were brought by the parents or caregivers without referral for various complaints, then we reviewed their full history and examination [mainly neurological] to confirm the diagnosis of CP. A specially designed questionnaire form was used. Out of 100 patients with cerebral palsy, malefemale ratio was [1.31], 89% of the patients were born at term whereas 11% were preterm. Those patients were found to have history of normal vaginal delivery in 70%, with one patient only delivered by assisted delivery, while 29% of them delivered by caesarean section mode of delivery. History of intrauterine growth retardation found in 21% patients, 4% were twin. The mothers of those patients had history of pre-eclampsia in 8% of the cases, regular antenatal care in 65%, history of antipartum haemorrhage in 4%, premature rupture of membrane in 13%. Abnormal presentation was found in 8%, cord prolapse in 4%, neonatal jaundice in 62%, neonatal seizure in 8%, history of head trauma in 4% and history of central nervous system infection in 20%. Spastic CP was the commonest type [67%], while mixed and atonic CP were the least type [1% for each]. Quadriplegic CP was the commonest topographical subtype [56%]. Delayed social milestone was found in 46%, speech difficulty in 94%, deafness in 2%, ocular problem in 29%, seizure in 58% and all of them had delayed milestone and weakness. Neonatal convulsion, neonatal jaundice, neonatal infection, antepartum hemorrhage and head trauma are significant risk factors for cerebral palsy while precipitate labour, caesarean section, twins, toxemia, breech delivery, low birth weight and cord prolapse were not found to be significantly associated with cerebral palsy. The most common clinical pattern of CP was spastic quadriplegic CP