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Worsening of cerebral palsy following neonatal encephalopathy: A meta-analysis

Meng Yang1 ,  Sarah Eide1 ,  Emily W.Y. Tam2 ,  Vann Chau2 ,  S.R. Wayne Chen3 ,  Steven P. Miller4 ,  Hong-Shuo Sun1,5 ,  Zhong-Ping Feng1*
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1 Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
2 Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
3 Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
4 Department of Pediatrics, Faculty of Medicine, University of British Columbia and BC Children’s Hospital, Vancouver, British Columbia, Canada
5 Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Advanced Neurology 2023, 2(4), 1719 https://doi.org/10.36922/an.1719
Submitted: 30 August 2023 | Accepted: 28 November 2023 | Published: 15 December 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Cerebral palsy (CP), the most common motor disorder in early childhood, arises from neonatal brain injury. The potential role of neonatal encephalopathy (NE) as a risk factor for cerebral palsy has been postulated, yet a systematic examination of its clinical impact on cerebral palsy patients remains absent. This meta-analysis aims to delineate the incidence of commonly reported complications associated with cerebral palsy following NE compared to those without a history of NE. A systematic search of PubMed and Google Scholar yielded 424 studies, with 7 meeting the inclusion criteria. These studies reported at least one comparison of cerebral palsy symptoms between patients with or without NE and provided the corresponding case numbers for each group. Utilizing RevMan 5.4, we analyzed the data and assessed potential publication bias. Among the 7 studies included, we compared the characteristics of 117 patients with cerebral palsy with preceding NE to 287 without such antecedents. Significantly, the incidence of the spastic quadriplegic subtype of cerebral palsy was higher in patients with NE (odds ratio [OR]: 4.34, 95% confidence interval [CI]: 2.69 – 7.00, P < 0.00001). CP patients following NE exhibited a significantly increased incidence of severe communication difficulties (OR: 2.33, 95% CI: 1.32 – 4.10, P = 0.003), difficulty swallowing (OR: 2.50, 95% CI: 1.31 – 4.77, P = 0.005), and cognitive impairment (OR: 2.73, 95% CI: 1.45 – 5.13, P = 0.002). Children with cerebral palsy born following NE were more predisposed to the most severe spastic quadriplegic subtype and encountered significant comorbidities. It is essential to acknowledge the limitations of this study, primarily the small number of studies that separately reported cerebral palsy cases with or without NE. Nevertheless, these findings contribute valuable insights for a more accurate clinical prognosis and the prospective development of targeted treatments for specific complications associated with cerebral palsy in patients with NE.

Keywords
Neonatal encephalopathy
Cerebral palsy
Hypoxic-ischemic brain injury
Patients
Funding
Natural Sciences and Engineering Research Council of Canada
Canadian Institutes of Health Research
Ontario Graduate Scholarship
Conflict of interest
The authors declare that they have no competing interests.
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