Jöud Anna, Sehlstedt Andréa, Källén Karin, Westbom Lena, Rylander Lars
Institution for Laboratory medicine, Division of Environmental and occupational medicine, Lund University, Lund, Sweden
Institution for Laboratory medicine, Division of Environmental and occupational medicine, Lund University, Lund, Sweden.
BMJ Open. 2020 Aug 7;10(8):e038453. doi: 10.1136/bmjopen-2020-038453.
To investigate known and suggested risk factors associated with cerebral palsy in a Swedish birth cohort, stratified by gestational age.
Information on all births between 1995 and 2014 in Skåne, the southernmost region in Sweden, was extracted from the national birth register.
The cohort comprised a total of 215 217 children. Information on confirmed cerebral palsy and subtype was collected from the national quality register for cerebral palsy (Cerebral Palsy Follow-up Surveillance Programme).
We calculated the prevalence of risk factors suggested to be associated with cerebral palsy and used logistic regression models to investigate the associations between potential risk factors and cerebral palsy. All analyses were stratified by gestational age; term (≥37 weeks), moderately or late preterm (32-36 weeks) and very preterm (<32 weeks).
In all, 381 (0.2 %) children were assigned a cerebral palsy diagnosis. Among term children, maternal preobesity/obesity, small for gestational age, malformations, induction, elective and emergency caesarian section, Apgar <7 at 5 min and admission to neonatal care were significantly associated with cerebral palsy (all p values<0.05). Among children born moderately or late preterm, small for gestational age, malformations, elective and emergency caesarian section and admission to neonatal care were all associated with cerebral palsy (all p values <0.05), whereas among children born very preterm no factors were significantly associated with the outcome (all p values>0.05).
Our results support and strengthen previous findings on factors associated with cerebral palsy. The complete lack of significant associations among children born very preterm probably depends on to the small number of children with cerebral palsy in this group.
在瑞典一个出生队列中，按胎龄分层，调查与脑瘫相关的已知和推测的风险因素。
从瑞典最南部地区斯科讷的国家出生登记处提取了1995年至2014年期间所有出生的信息。
该队列共有215217名儿童。从国家脑瘫质量登记处（脑瘫随访监测项目）收集了确诊脑瘫及其亚型的信息。
我们计算了推测与脑瘫相关的风险因素的患病率，并使用逻辑回归模型研究潜在风险因素与脑瘫之间的关联。所有分析均按胎龄分层；足月儿（≥37周）、中度或晚期早产儿（32 - 36周）和极早产儿（<32周）。
共有381名（0.2%）儿童被诊断为脑瘫。在足月儿中，母亲孕前肥胖/肥胖、小于胎龄儿、畸形、引产、择期和急诊剖宫产、5分钟时阿氏评分<7以及入住新生儿重症监护病房均与脑瘫显著相关（所有p值<0.05）。在中度或晚期早产儿中，小于胎龄儿、畸形、择期和急诊剖宫产以及入住新生儿重症监护病房均与脑瘫相关（所有p值<0.05），而在极早产儿中，没有因素与结局显著相关（所有p值>0.05）。
我们的结果支持并强化了先前关于与脑瘫相关因素的研究发现。极早产儿中完全缺乏显著关联可能取决于该组中脑瘫儿童数量较少。
