A systematic review of risk factors for cerebral palsy in children born at term in developed countries

Authors

  • SARAH MCINTYRE,

    1.  Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney;
    2.  Cerebral Palsy Alliance Research Institute, Darlinghurst;
    3.  School of Medicine, University of Notre Dame Australia, Darlinghurst;
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  • DAVID TAITZ,

    1.  School of Medicine, University of Notre Dame Australia, Darlinghurst;
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  • JOHN KEOGH,

    1.  Sydney Adventist Hospital Campus, University of Sydney, Wahroonga;
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  • SHONA GOLDSMITH,

    1.  Cerebral Palsy Alliance Research Institute, Darlinghurst;
    2.  School of Medicine, University of Notre Dame Australia, Darlinghurst;
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  • NADIA BADAWI,

    1.  Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney;
    2.  Cerebral Palsy Alliance Research Institute, Darlinghurst;
    3.  School of Medicine, University of Notre Dame Australia, Darlinghurst;
    4.  Grace Centre for Newborn Care, Sydney Children’s Hospital Network, Westmead;
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  • EVE BLAIR

    1.  Centre for Child Health Research, University of Western Australia at the Telethon Institute for Child Health Research, Perth, Australia.
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Sarah McIntyre, Cerebral Palsy Alliance Research Institute, PO Box 560, Darlinghurst, NSW 1300, Australia. E-mail: smcintyre@cerebralpalsy.org.au

Abstract

Aim  The aim of this study was to conduct a systematic review in order to identify the risk factors for cerebral palsy (CP) in children born at term. The secondary aim was to ascertain if the potential for prevention of these risk factors has been adequately explored.

Method  A MEDLINE search up to 31 July 2011 was completed, following the Meta-Analysis of Observational Studies in Epidemiology guidelines. Publications were reviewed to identify those with both a primary aim of identifying risk factors for all children or term-born children with CP and a cohort or case–control study design. Studies were examined for potential chance or systematic bias. The range of point estimates of relative risk is reported.

Results  From 21 articles meeting inclusion/exclusion criteria and at low risk of bias, data from 6297 children with CP and 3 804 791 children without CP were extracted. Ten risk factors for term-born infants were statistically significant in each study: placental abnormalities, major and minor birth defects, low birthweight, meconium aspiration, instrumental/emergency Caesarean delivery, birth asphyxia, neonatal seizures, respiratory distress syndrome, hypoglycaemia, and neonatal infections. Strategies for possible prevention currently exist for three of these.

Interpretation  Ten consistent risk factors have been identified, some with potential for prevention. Efforts to prevent these risk factors to interrupt the pathway to CP should be extended.

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