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Cerebral Palsy in Children Presenting to Paediatric Services iKampala, Uganda: What Percentage is Attributed to Acute Intrapartum Related Encephalopathy?

Presented at the Neonatal Society 2013 Summer Meeting.

Hassell J1, Tann C1,2, Nakibirango M3, Masoke M3, Idro R3,4, Robertson NJ1

1 Institute for Women’s Health, University College London, UK
2 London School of Hygiene and Tropical Medicine, UK
3 Makarere University College of Health Sciences, Uganda
4 Nuffield Centre for Tropical Medicine, Oxford University, UK

Background: Worldwide an estimated 200 million children are disabled, including those with cerebral palsy (CP); 80% live in low-income countries. Large cohort studies in high-income countries attribute 80% of CP to antenatal causes (1). These data are difficult to obtain in resource-poor settings where the proportion of intrapartum events is higher, with an estimated 1 million survivors of neonatal encephalopathy developing cerebral palsy and other neurological sequelae every year (2). We hypothesised that intrapartum events and neonatal encephalopathy would be a major contributor the aetiology of CP in a sub-Saharan Africa setting and investigated the aetiological distribution of CP in affected children presenting to Mulago Hospital, Kampala, Uganda.

Methods: Ethical approval was granted by Mulago Hospital, Uganda National Council of Science and Technology and UCL. Seventy-four children with CP presenting over a 6-week study period were recruited from all in- and out-patient Paediatric services at Mulago, a tertiary referral hospital. Consent was sought. Assessment involved (i) Detailed retrospective history obtained from the mother or primary caregiver, including any self-identified antecedents to the onset of motor impairment; and (ii) Neurological examination to describe the pattern of cerebral palsy and assign a Gross Motor Function Classification System score. Neuroimaging was not available. 

Results: Mean age was 25.4 months; 58% were aged <2 years (mean 9.7m). Fifty-one percent were new to Paediatric services (mean 24.1m); 49% were attending follow-up (mean 26.7m). According to maternal report 93% of infants were born at term. Overall, 49% had spastic quadraplegia; 3% spastic diplegia; 8% hemiplegia; 9% choreoathetoid; 8% hypotonic, 22% mixed pattern impairment. 70% of mothers gave a peripartum history consistent with neonatal encephalopathy (NE) and 83% attributed CP to illness in the newborn period. 

Conclusion: Mean age was 25.4 months; 58% were aged <2 years (mean 9.7m). Fifty-one percent were new to Paediatric services (mean 24.1m); 49% were attending follow-up (mean 26.7m). According to maternal report 93% of infants were born at term. Overall, 49% had spastic quadraplegia; 3% spastic diplegia; 8% hemiplegia; 9% choreoathetoid; 8% hypotonic, 22% mixed pattern impairment. 70% of mothers gave a peripartum history consistent with neonatal encephalopathy (NE) and 83% attributed CP to illness in the newborn period. 

Corresponding author: janehassell@doctors.org.uk

References
1. Blair E, Watson L. Seminars in Fetal and Neonatal Medicine. 2006; 11: 116-125.
2. Lawn JE et al., Bull WHO 2005; 83: 409-417

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