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ABSTRACT: Objective
To investigate the association between hypoxic-ischaemic insult timing and brain injury type in infants with severe cerebral palsy (CP).Design
Longitudinal study.Setting
Database of the Recurrence Prevention Committee, Japan Obstetric Compensation System for Cerebral Palsy.Sample
Infants with severe CP born at ≥34 weeks of gestation.Methods
The intrapartum fetal heart rate (FHR) strips were categorised as continuous bradycardia; persistently non-reassuring (NR-NR); reassuring-prolonged deceleration (R-PD); Hon's pattern (R-Hon); persistently reassuring (R-R); and unclassified. The brain magnetic resonance imaging (MRI) scans were categorised based on the predominant site involved: basal ganglia-thalamus (BGT); white matter (WM); watershed (WS); stroke; normal; and unclassified.Main outcome measures
Manifestations of the brain MRI types and the association between FHR evolution pattern and MRI type were analysed.Results
Among 672 eligible infants, 76% had BGT-dominant injury, 5.4% WM, 1.2% WS, 1.6% stroke, 1.9% normal, and 14% unclassified. Placental abruption and small-for-gestational age were associated with an increased (adjusted odds ratio [aOR] 8.02) and decreased (aOR 0.38) risk of BGT injury, respectively. The majority of infants had BGT injury in most FHR groups (bradycardia, 97%; NR-NR, 75%; R-PD, 90%; R-Hon, 76%; and R-R, 45%). The risk profiles in case of BGT in the NR-NR group were similar to those in the R-PD and R-Hon groups.Conclusion
BGT-dominant brain damage accounted for three-fourths of the cases of CP in term or near-term infants, even in prenatal onset cases. Hypoxic-ischaemic insult has a major impact on CP development during the antenatal period.Tweetable abstract
Basal ganglia-thalamus injury constitutes 76% of severe cerebral palsy cases, predominant even in antenatal-onset cases.
SUBMITTER: Nakao M
PROVIDER: S-EPMC9545186 | biostudies-literature | 2022 Aug
REPOSITORIES: biostudies-literature
Nakao Masahiro M Nanba Yukiko Y Okumura Asumi A Hasegawa Junichi J Toyokawa Satoshi S Ichizuka Kiyotake K Kanayama Naohiro N Satoh Shoji S Tamiya Nanako N Nakai Akihito A Fujimori Keiya K Maeda Tsugio T Suzuki Hideaki H Iwashita Mitsutoshi M Oka Akira A Ikeda Tomoaki T
BJOG : an international journal of obstetrics and gynaecology 20220213 9
<h4>Objective</h4>To investigate the association between hypoxic-ischaemic insult timing and brain injury type in infants with severe cerebral palsy (CP).<h4>Design</h4>Longitudinal study.<h4>Setting</h4>Database of the Recurrence Prevention Committee, Japan Obstetric Compensation System for Cerebral Palsy.<h4>Sample</h4>Infants with severe CP born at ≥34 weeks of gestation.<h4>Methods</h4>The intrapartum fetal heart rate (FHR) strips were categorised as continuous bradycardia; persistently non- ...[more]