Investigating the aetiology, classification and trends of post-neonatally acquired cerebral palsy

Abstract

Background: Children with post-neonatally acquired (PNN) cerebral palsy (CP) are a subgroup of children with CP who sustained a brain injury after the prenatal/perinatal period. PNN-CP accounts for 6% of all CP in Australia and remains an important, preventable and understudied group. The aims of this thesis were to improve New South Wales (NSW)/Australian Capital Territory (ACT) CP register ascertainment of children with PNN-CP, characterise PNN-CP in Australia, identify the global causes of PNN-CP and review how injury timing is defined, and evaluate a PNN-CP causal event classification system.

Methods: A combination of CP register quality assurance work, CP register population-based research, a systematic review, and survey were conducted to address the aims of this thesis.

Results: Application of a new strategy improved ascertainment of PNN-CP to the NSW/ACT CP Register. The prevalence of PNN-CP in Australia has declined over time, with an identified reduction in infectious causes. However, there was no statistically significant decline in head injury or cerebrovascular accidents. Children born to teenage mothers, born in remote areas and those born to Aboriginal and Torres Strait Islander mothers were over-represented in the cohort. Globally, infections were the most common cause of PNN-CP and definitions of brain injury timing varied. The survey study of the causal event classification system found substantial agreement across raters and the participants found it to be acceptable, appropriate and feasible.

Conclusion: Further prevention strategies (such as childhood vaccinations) targeted at reducing post-neonatal brain injury are required across all global contexts. Consistent definitions of the timing of PNN-CP will assist in improving global collaboration and surveillance of this understudied group.