Skip to main content
PMC home page
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 2000 Jul;83(1):F7–F12. doi: 10.1136/fn.83.1.F7

Increasing rates of cerebral palsy across the severity spectrum in north-east England 1964-1993

A Colver, M Gibson, E Hey, S Jarvis, P Mackie, S Richmond
PMCID: PMC1721114  PMID: 10873162

Abstract

OBJECTIVES—To report epidemiological trends in cerebral palsy including analyses by severity.
DESIGN—Descriptive longitudinal study in north-east England. Every child with suspected cerebral palsy was examined by a developmental paediatrician to confirm the diagnosis. Severity of impact of disability was derived from a parent completed questionnaire already developed and validated for this purpose.
SUBJECTS—All children with cerebral palsy, not associated with any known postneonatal insult, born 1964-1993 to mothers resident at the time of birth in the study area.
MAIN OUTCOME MEASURES—Cerebral palsy rates by year, birth weight, and severity. Severity of 30% and above defines the more reliably ascertained cases; children who died before assessment at around 6 years of age are included in the most severe group (70% and above).
RESULTS—584 cases of cerebral palsy were ascertained, yielding a rate that rose from 1.68 per 1000 neonatal survivors during 1964-1968 to 2.45 during 1989-1993 (rise = 0.77; 95% confidence interval 0.2-1.3). For the more reliably ascertained cases there was a twofold increase in rate from 0.98 to 1.96 (rise = 0.98; 95% confidence interval 0.5-1.4). By birth weight, increases in rates were from 29.8 to 74.2 per 1000 neonatal survivors < 1500 g and from 3.9to 11.5 for those 1500-2499 g. Newborns < 2500 g now contribute one half of all cases of cerebral palsy and just over half of the most severe cases, whereas in the first decade of this study they contributed one third of all cases and only one sixth of the most severe (χ2 and χ2 for trend p < 0.001).
CONCLUSIONS—The rate of cerebral palsy has risen in spite of falling perinatal and neonatal mortality rates, a rise that is even more pronounced when the mildest and least reliably ascertained are excluded. The effect of modern care seems to be that many babies < 2500 g who would have died in the perinatal period now survive with severe cerebral palsy. A global measure of severity should be included in registers of cerebral palsy to determine a minimum threshold for international comparisons of rates, and to monitor changes in the distribution of severity.



Full Text

The Full Text of this article is available as a PDF (290.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BAX M. C. TERMINOLOGY AND CLASSIFICATION OF CEREBRAL PALSY. Dev Med Child Neurol. 1964 Jun;6:295–297. doi: 10.1111/j.1469-8749.1964.tb10791.x. [DOI] [PubMed] [Google Scholar]
  2. Badawi N., Watson L., Petterson B., Blair E., Slee J., Haan E., Stanley F. What constitutes cerebral palsy? Dev Med Child Neurol. 1998 Aug;40(8):520–527. doi: 10.1111/j.1469-8749.1998.tb15410.x. [DOI] [PubMed] [Google Scholar]
  3. Blair E., Stanley F. When can cerebral palsy be prevented? The generation of causal hypotheses by multivariate analysis of a case-control study. Paediatr Perinat Epidemiol. 1993 Jul;7(3):272–301. doi: 10.1111/j.1365-3016.1993.tb00405.x. [DOI] [PubMed] [Google Scholar]
  4. Bottos M., Granato T., Allibrio G., Gioachin C., Puato M. L. Prevalence of cerebral palsy in north-east Italy from 1965 to 1989. Dev Med Child Neurol. 1999 Jan;41(1):26–39. doi: 10.1017/s0012162299000067. [DOI] [PubMed] [Google Scholar]
  5. Grether J. K., Cummins S. K., Nelson K. B. The California Cerebral Palsy Project. Paediatr Perinat Epidemiol. 1992 Jul;6(3):339–351. doi: 10.1111/j.1365-3016.1992.tb00774.x. [DOI] [PubMed] [Google Scholar]
  6. Hagberg B., Hagberg G., Olow I. The changing panorama of cerebral palsy in Sweden. VI. Prevalence and origin during the birth year period 1983-1986. Acta Paediatr. 1993 Apr;82(4):387–393. doi: 10.1111/j.1651-2227.1993.tb12704.x. [DOI] [PubMed] [Google Scholar]
  7. Hagberg B., Hagberg G., Olow I., von Wendt L. The changing panorama of cerebral palsy in Sweden. V. The birth year period 1979-82. Acta Paediatr Scand. 1989 Mar;78(2):283–290. doi: 10.1111/j.1651-2227.1989.tb11071.x. [DOI] [PubMed] [Google Scholar]
  8. Hagberg B., Hagberg G., Olow I., von Wendt L. The changing panorama of cerebral palsy in Sweden. VII. Prevalence and origin in the birth year period 1987-90. Acta Paediatr. 1996 Aug;85(8):954–960. doi: 10.1111/j.1651-2227.1996.tb14193.x. [DOI] [PubMed] [Google Scholar]
  9. Jarvis S. N., Holloway J. S., Hey E. N. Increase in cerebral palsy in normal birthweight babies. Arch Dis Child. 1985 Dec;60(12):1113–1121. doi: 10.1136/adc.60.12.1113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Mackie P. C., Jessen E. C., Jarvis S. N. The lifestyle assessment questionnaire: an instrument to measure the impact of disability on the lives of children with cerebral palsy and their families. Child Care Health Dev. 1998 Nov;24(6):473–486. doi: 10.1046/j.1365-2214.1998.00083.x. [DOI] [PubMed] [Google Scholar]
  11. Meberg A., Broch H. A changing pattern of cerebral palsy. Declining trend for incidence of cerebral palsy in the 20-year period 1970-89. J Perinat Med. 1995;23(5):395–402. doi: 10.1515/jpme.1995.23.5.395. [DOI] [PubMed] [Google Scholar]
  12. Murphy C. C., Yeargin-Allsopp M., Decouflé P., Drews C. D. Prevalence of cerebral palsy among ten-year-old children in metropolitan Atlanta, 1985 through 1987. J Pediatr. 1993 Nov;123(5):S13–S20. doi: 10.1016/s0022-3476(05)80892-3. [DOI] [PubMed] [Google Scholar]
  13. Pharoah P. O., Cooke T., Johnson M. A., King R., Mutch L. Epidemiology of cerebral palsy in England and Scotland, 1984-9. Arch Dis Child Fetal Neonatal Ed. 1998 Jul;79(1):F21–F25. doi: 10.1136/fn.79.1.f21. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Pharoah P. O., Platt M. J., Cooke T. The changing epidemiology of cerebral palsy. Arch Dis Child Fetal Neonatal Ed. 1996 Nov;75(3):F169–F173. doi: 10.1136/fn.75.3.f169. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Rosenbaum P., Saigal S., Szatmari P., Hoult L. Vineland Adaptive Behavior Scales as a summary of functional outcome of extremely low-birthweight children. Dev Med Child Neurol. 1995 Jul;37(7):577–586. doi: 10.1111/j.1469-8749.1995.tb12046.x. [DOI] [PubMed] [Google Scholar]
  16. Stanley F. J., Watson L. Trends in perinatal mortality and cerebral palsy in Western Australia, 1967 to 1985. BMJ. 1992 Jun 27;304(6843):1658–1663. doi: 10.1136/bmj.304.6843.1658. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Topp M., Uldall P., Langhoff-Roos J. Trend in cerebral palsy birth prevalence in eastern Denmark: birth-year period 1979-86. Paediatr Perinat Epidemiol. 1997 Oct;11(4):451–460. doi: 10.1046/j.1365-3016.1997.d01-24.x. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood. Fetal and Neonatal Edition are provided here courtesy of BMJ Publishing Group

RESOURCES