Diplegic cerebral palsy in Swedish term and preterm children. Differences in reduced optimality, relations to neurology and pathogenetic factors.

An unselected series of 93 Swedish diplegic children born in 1969-1976 and subgrouped into 49 term (TDC) and 44 preterm (PDC) cases were analyzed for differences in reduced optimality in pre- and perinatal conditions, these also being related to degree of handicap, associated neurology and conventional pathogenetic grouping. Comparisons of the reduced optimality with those of a dyskinetic and a control series were also made. TDC were shown to have more severe handicaps and more additional neurologic abnormalities than PDC. The profile of reduced optimality was weighted in TDC to items pointing to fetal maladjustment/deprivation and birth asphyxia and in PDC to items accompanying preterm birth and to postpartal items. The optimality of diplegics was in general more reduced than in controls and less than in dyskinetics. This was especially true for TDC. Differences in the background mechanisms of the diplegia between TDC and PDC were indicated from dissimilarities in the combined patterns of reduced optimality and conventional pathogenetic grouping. Postpartal complications predominated among PDC. A prepartal factor as the only cause of the diplegia was likely in 41% of TDC, and as a contributory cause in another 24%. Birth asphyxia, present in 31% of the TDC, was never the only risk factor among infants born at term.