title: Cerebral palsy after neonatal encephalopathy: do neonates with suspected asphyxia have worse outcomes?
abstract: OBJECTIVE
  We sought to investigate how brain injury and severity, and neurological subtype of cerebral palsy (CP) differed in term-born children with CP after neonatal encephalopathy, between those with suspected birth asphyxia and those without.
  
  
  METHODS
  Using the Canadian CP Registry, which included 1001 children, those with CP born at ≥ 36 wks after moderate or severe neonatal encephalopathy, were dichotomized according to the presence or absence of suspected birth asphyxia. Gross Motor Function Classification System (GMFCS) scores, neurological subtypes, comorbidities, and magnetic resonance imaging findings were compared.
  
  
  RESULTS
  Of the 147 term-born children with CP (82 males, 65 females; median age 37 months, interquartile range [IQR] 26-52.5) who after moderate or severe neonatal encephalopathy had the required outcome data, 61 (41%) met criteria for suspected birth asphyxia. They had a higher frequency of non-ambulatory GMFCS status (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.72-6.8), spastic quadriplegia (OR 2.8, 95% CI 1.4-5.6), non-verbal communication skills impairment (OR 4.2, 95% CI 2.0-8.6), isolated deep grey matter injury (OR 4.1, 95% CI 1.8-9.5), a lower frequency of spastic hemiplegia (OR 0.17, 95% CI 0.07-0.42), focal injury (OR 0.20; 95% CI 0.04-0.93), and more comorbidities (p=0.017) than those who did not meet criteria.
  
  
  CONCLUSIONS
  Term-born children who develop CP after neonatal encephalopathy with suspected birth asphyxia have a greater burden of disability than those without suspected birth asphyxia.
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.
authors.forename: Jarred
authors.initials: J
authors.lastname: Garfinkle
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.|Division of Neonatology, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.
authors.forename: Pia
authors.initials: P
authors.lastname: Wintermark
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.|Department of Neurology/Neurosurgery, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.|Division of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.
authors.forename: Michael I
authors.initials: MI
authors.lastname: Shevell
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.|Department of Neurology/Neurosurgery, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.|Division of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.
authors.forename: Maryam
authors.initials: M
authors.lastname: Oskoui
mesh_terms: D001238:Asphyxia Neonatorum / Q000150:complications* / Q000453:epidemiology; D001927:Brain Diseases / Q000150:complications* / Q000453:epidemiology; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002547:Cerebral Palsy / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012042:Registries; D012720:Severity of Illness Index