Cerebral palsy patients discovered dead during sleep: experience from a comprehensive tertiary pediatric center.
OBJECTIVE
It is not uncommon for children with cerebral palsy (CP) to be discovered dead during sleep (DDDS); however, the factors associated with this pattern of mortality remain unknown. The current study aims to describe the mortality associated with children with CP from a single, tertiary care center who were DDDS.


METHODS
A retrospective (case-only) design to examine proportionate mortality and patient characteristics and co-morbidities that may be related to children DDDS between 1993 and 2011.


RESULTS
There were 177 patients with CP whose deaths were reported to our institution during the study period, of which 19 were DDDS at home. The period proportionate mortality (PPM) was 114.5 per 1000. The average age at time of death was 17 years and 6 months (minimum, 6 years; maximum, 25 years). All but one of the DDDS patients had gastrointestinal feeding tubes, seizure disorders, respiratory disorders, and were non-ambulatory. Very importantly, our DDDS patients manifested clusters of respiratory disorders, namely recurrent aspiration pneumonia (10/19), asthma pneumonitis (4/19), food/vomitius inhalation (6/19), reactive airway disease (16/19), respiratory failure (14/19), chronic bronchitis (7/19), chronic obstructive lung disease (9/19), and nocturnal respiratory insufficiency (16/19).


CONCLUSIONS
Respiratory disorders, severe motor disability, seizures, and intellectual status are possible co-morbidities that may be associated with DDDS. There is a need for further study in order to understand what type of monitoring and care (if any) may help prevent DDDS related to these co-morbidities and sleep disorders/abnormalities.
Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Ali F
AF
Karatas
Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Elissa G
EG
Miller
Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Freeman
F
Miller
Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Kirk W
KW
Dabney
Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Steven
S
Bachrach
Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Justin
J
Connor
Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Kenneth
K
Rogers
Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Laurens
L
Holmes
D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000401:mortality*; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology*; D008297:Male; D012120:Respiration Disorders / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012890:Sleep; D055815:Young Adult
Cerebral palsy; co-morbidities; mortality; proportionate mortality; respiratory disorders