Etiology, outcomes and co-morbidities among cerebral palsy children attending tertiary care hospital, India: a prospective study

N. Dushyanth Subramaniam, Antony Jenifer, Uma Devi L., Suresh P.


Background: Cerebral palsy is the most common aetiology for motor dysfunction among children worldwide. It is associated with range of co-morbid conditions that affects the quality of life. Cerebral palsy has been studied extensively in western countries and there are only few articles available on epidemiological information in developing countries and low resource settings. This study focuses on the aetiology, risk factors, types and co-morbidities in cerebral palsy.

Methods: Cerebral palsy children attending tertiary care hospital were prospectively recruited into the study. The study was conducted during January 2017 to July 2018. The cross-sectional study included complete prenatal, natal and postnatal history of the participants, BERA and Ophthalmological examinations were done.

Results: One hundred and fifty children with cerebral palsy were enrolled. The mean age of participants were 36±30 months.  Male to female ratio was 2.19:1. The most common maternal risk factor among study participants was consanguinity in marriage (23.33%). 16% had prolonged labour and 10% had toxaemia during pregnancy. 47% of the children were born by institutional normal vaginal delivery. The most common neonatal risk factor was Birth Asphyxia (23%), low birth weight (20%) and neonatal sepsis (21%). 122 had spastic type of cerebral palsy. The most common morbidity associated with cerebral palsy was Gastro intestinal disturbances in 61% of the participants.

Conclusions: History of prolonged labour and birth asphyxia were risk factors for cerebral palsy. Spastic CP is the most common type. Malnutrition, Gross Motor delay, Seizures, Mental retardation were the most common morbidities associated with CP.



Cerebral palsy, Co-morbidities, India, Risk factors

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Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Executive Committee for the Definition of Cerebral Palsy. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol. 2005;47(8):571-6.

Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil. 2006;28(4):183-91.

Pakula AT, Van Naarden Braun K, Yeargin-Allsopp M. Cerebral palsy: classification and epidemiology. Phys Med Rehabil Clin N Am. 2009;20(3):425-52.

Chen KL, Tseng MH, Shieh JY, Lu L, Huang CY. Determinants of quality of life in children with cerebral palsy: a comprehensive biopsychosocial approach. Res Dev Disabil. 2014;35(2):520-8.

Raina P, O’Donnell M, Rosenbaum P, Brehaut J, Walter SD, Russell D, et al. The health and well-being of caregivers of children with cerebral palsy. Pediatr. 2005;115(6):e626-36.

Torfs CP, van den Berg B, Oechsli FW, Cummins S. Prenatal and perinatal factors in the etiology of cerebral palsy. J Pediatr. 1990;116(4):615-9.

Colver A, Fairhurst C, Pharoah PO. Cerebral palsy. Lancet. 2014;383(9924):1240-9.

Smithers-Sheedy H, McIntyre S, Gibson C, Meehan E, Scott H, Goldsmith S, et al. Australian Cerebral Palsy Register Group. A special supplement: findings from the Australian Cerebral Palsy Register, birth years 1993 to 2006. Dev Med Child Neurol. 2016;58(2):5-10.

Sellier E, Platt MJ, Andersen GL, Krägeloh-Mann I, De La Cruz J, Cans C. Surveillance of Cerebral Palsy Network. Decreasing prevalence in cerebral palsy: a multi-site European population-based study, 1980 to 2003. Dev Med Child Neurol. 2016;58(1):85-92.

Van Naarden Braun K, Doernberg N, Schieve L, Christensen D, Goodman A, Yeargin-Allsopp M. Birth prevalence of cerebral palsy: a population-based study. Pediat. 2016;137(1):e20152872.

Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2013;55(6):509-19.

Were FN, Bwibo NO. Two year neurological outcomes of Very Low Birth Weight infants. East African medical journal. 2006;83(5):243.

Vyas AG, Kori VK, Rajagopala S, Patel KS. Etiopathological study on cerebral palsy and its management by Shashtika Shali Pinda Sweda and Samvardhana Ghrita. Ayu. 2013;34(1):56-62.

Sankar C, Mundkur N. Cerebral palsy-definition, classification, etiology and early diagnosis. Indian J Pediatr. 2005;72(10):865-8.

Singhi PD, Ray M, Suri G. Clinical spectrum of cerebral palsy in North India-an analysis of 1000 cases. J Trop Pediatr. 2002;48(3):162-6.

Strijbis EM, Oudman I, van Essen P, MacLennan AH. Cerebral palsy and the application of the international criteria for acute intrapartum hypoxia. Obstet Gynecol. 2006;107(6):1357-65.

McIntyre S, Taitz D, Keogh J, Goldsmith S, Badawi N, Blair E. A systematic review of risk factors for cerebral palsy in children born at term in developed countries. Dev Med Child Neurol. 2013;55(6):499-508.

El Tallawy HN, Farghaly WM, Rageh TA, Shehata GA, Metwaly NA, Abo Elftoh N, et al. Epidemiology of major neurological disorders project in Al Kharga district, New Valley, Egypt. Neuroepidemiol. 2010;35(4):291-7.

Ogunlesi T, Ogundeyi M, Ogunfowora O, Olowu A. Socio-clinical issues in cerebral palsy in Sagamu, Nigeria. South African Journal of Child Health. 2008;2(3).

Gladstone M. A review of the incidence and prevalence, types and aetiology of childhood cerebral palsy in resource-poor settings. Ann Trop Paediatr. 2010;30(3):181-96.

Belonwu RO, Gwarzo GD, Adeleke SI. Cerebral palsy in Kano, Nigeria-a review. Niger J Med. 2009;18(2):186-9.

Reid SM, Lanigan A, Reddihough DS. Post-neonatally acquired cerebral palsy in Victoria, Australia, 1970-1999. J Paediatr Child Health. 2006;42(10):606-11.