BMJ 1994;309:431-5 (13 August)

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Life expectancy in children with cerebral palsy

J L Hutton, T Cooke, P O D Pharoah 

Departments of Statistics, Computational Mathematics, and Public Health, University of Liverpool, Liverpool L69 3BX Department of Public Health, University of Liverpool, Liverpool L69 3BX Correspondence to: Professor Pharoah.

Abstract

Objective : To determine life expectancy of children with cerebral palsy.
Design : Cohort analysis, by means of register compiled from multiple sources of ascertainment, of all children with cerebral palsy born during 1966-84 to mothers resident in Mersey region. Status of children was determined by flagging through NHS central register.
Subjects : 1258 subjects with idiopathic cerebral palsy, of whom 1251 were traced and included in analysis.
Main outcome measures : Effect of functional ability (ambulation, manual dexterity, and mental ability), sex, birth weight, and gestational age on survival.
Results : 20 year survival for whole cohort was 89.3% for females and 86.9% for males. For subjects with no severe functional disabilities 20 year survival was 99% (95% confidence interval 98% to 100%), while subjects severely disabled in all three functional groups had 20 year survival of 50% (42% to 58%). Subjects with birth weight <=2500 g had 20 year survival of 92% (89% to 95%), while those with birth weight >2500 g had survival of 87% (84% to 89%). Subjects with gestational age of >37 weeks had 20 year survival of 93% (91% to 96%), while those with gestational age >=37 weeks had survival of 85% (83% to 88%). Birth weight and gestational age were less predictive of survival than functional disability. Best statistical model used gestational age and number of severe functional disabilities as predictors.
Conclusions : Life expectancy of this cohort of children with cerebral palsy was greater than has been suggested in some previous studies. This has important implications for social, educational, and health services.

Public health implications

  • Public health implications

  • Cerebral palsy is the commonest cause of severe physical disability in children, and its prevalence is increasing because of improved survival of low birthweight babies

  • Little information is available on life expectancy, which is needed to plan for adequate provision of services for disabled people

  • We studied life expectancy of all children with cerebral palsy born in Mersey region during 1966-84

  • Survival rates (to 20 years of age) of mild and moderately disabled children were not much lower than those of unaffected children, and about half of severely disabled children survived to age of 20

  • These results have important implications for provision of social, educational, and health services


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