title: Antecedents of cerebral palsy according to severity of motor impairment.
abstract: The purpose of this study was to determine whether antecedents and neuroimaging patterns vary according to the severity of motor impairment in children with cerebral palsy.
  
  
  
  A population-based study in which all 309 term-born children with spastic and dyskinetic cerebral palsy born between 1983 and 1994 and 618 matched controls were studied. Antecedents were retrieved from obstetric records. Information on neuroimaging was retrieved from the cerebral palsy Register of Western Sweden. Cases were grouped by severity of motor impairment: mild (walks without aids), moderate (walks with aids) or severe (dependent on wheelchair). Binary logistic regression, the Cochran-Armitage test for trends, interaction analyses and interrelationship analyses were performed.
  
  
  
  Antecedents associated with mild motor impairment were antepartum (placental weight, maternal weight and antibiotic therapy) or intrapartum and postpartum adverse events (meconium-stained amniotic fluid, low Apgar score, admission to neonatal intensive care unit and neonatal encephalopathy). Antecedents associated with severe motor impairment were antepartum (congenital infection, small head circumference and brain maldevelopment) or intrapartum and postpartum (emergency cesarean section and maternal antibiotic therapy). Comparisons between mild and severe motor impairment revealed congenital infection, maldevelopment, neonatal encephalopathy and meconium aspiration syndrome significantly more often in the group with severe motor impairment (p < 0.05). White matter injury was the most common neuroimaging pattern in mild motor impairment, whereas maldevelopment and cortical/subcortical lesions were most common in the severe motor impairment group.
  
  
  
  Our results suggest a variation in antecedents associated with cerebral palsy, related to severity of motor impairment. Timing of antecedents corresponded to neuroimaging patterns.
authors.affiliation: Perinatal Center, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Östra, Institute for Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Ahlin
authors.affiliation: Department of Pediatrics, Institute for Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Kate
authors.initials: K
authors.lastname: Himmelmann
authors.affiliation: Department of Mathematical Statistics, Chalmers University of Technology, Gothenburg, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Nilsson
authors.affiliation: Perinatal Center, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Östra, Institute for Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Verena
authors.identifier: 0000-0002-3608-7430
authors.initials: V
authors.lastname: Sengpiel
authors.affiliation: Perinatal Center, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Östra, Institute for Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.|Department of Genes and Environment, Division of Epidemiology, Institute of Public Health, Oslo, Norway.
authors.forename: Bo
authors.initials: B
authors.lastname: Jacobsson
mesh_terms: D001034:Apgar Score; D001927:Brain Diseases; D002547:Cerebral Palsy; D002585:Cesarean Section; D005315:Fetal Diseases; D006801:Humans
keywords: Antecedents; cerebral palsy; motor impairment; severity