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Advanced Neurology

REVIEW ARTICLE
Worsening of cerebral palsy following neonatal

encephalopathy: A meta-analysis

1
Meng Yang , Sarah Eide , Emily W.Y. Tam , Vann Chau , S.R. Wayne Chen ,
1
3
2
2
4
Steven P. Miller , Hong-Shuo Sun , and Zhong-Ping Feng *
1
1,5
1 Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario,
Canada
2 Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
3 Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary,
Calgary, Alberta, Canada
4 Department of Pediatrics, Faculty of Medicine, University of British Columbia and BC Children’s
Hospital, Vancouver, British Columbia, Canada
5 Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Abstract

Cerebral palsy (CP), the most common motor disorder in early childhood, arises from
neonatal brain injury. The potential role of neonatal encephalopathy (NE) as a risk
factor for cerebral palsy has been postulated, yet a systematic examination of its
clinical impact on cerebral palsy patients remains absent. This meta-analysis aims
to delineate the incidence of commonly reported complications associated with
cerebral palsy following NE compared to those without a history of NE. A systematic
*Corresponding author: search of PubMed and Google Scholar yielded 424 studies, with 7 meeting the
Zhong-Ping Feng inclusion criteria. These studies reported at least one comparison of cerebral palsy
(zp.feng@utoronto.ca) symptoms between patients with or without NE and provided the corresponding
Citation: Yang M, Eide S, case numbers for each group. Utilizing RevMan 5.4, we analyzed the data and
Tam EWY, et al., 2023, Worsening assessed potential publication bias. Among the 7 studies included, we compared
of cerebral palsy following neonatal
encephalopathy: A meta-analysis. the characteristics of 117 patients with cerebral palsy with preceding NE to 287
Adv Neuro, 2(4): 1719. without such antecedents. Significantly, the incidence of the spastic quadriplegic
https://doi.org/10.36922/an.1719 subtype of cerebral palsy was higher in patients with NE (odds ratio [OR]: 4.34, 95%
Received: August 30, 2023 confidence interval [CI]: 2.69 – 7.00, P < 0.00001). CP patients following NE exhibited a
significantly increased incidence of severe communication difficulties (OR: 2.33, 95%
Accepted: November 28, 2023
CI: 1.32 – 4.10, P = 0.003), difficulty swallowing (OR: 2.50, 95% CI: 1.31 – 4.77, P = 0.005),
Published Online: December 15, and cognitive impairment (OR: 2.73, 95% CI: 1.45 – 5.13, P = 0.002). Children with
2023 cerebral palsy born following NE were more predisposed to the most severe spastic
Copyright: © 2023 Author(s). quadriplegic subtype and encountered significant comorbidities. It is essential to
This is an Open-Access article acknowledge the limitations of this study, primarily the small number of studies
distributed under the terms of the
Creative Commons Attribution that separately reported cerebral palsy cases with or without NE. Nevertheless,
License, permitting distribution, these findings contribute valuable insights for a more accurate clinical prognosis
and reproduction in any medium, and the prospective development of targeted treatments for specific complications
provided the original work is
properly cited. associated with cerebral palsy in patients with NE.
Publisher’s Note: AccScience
Publishing remains neutral with Keywords: Neonatal encephalopathy; Cerebral palsy; Hypoxic-ischemic brain
regard to jurisdictional claims in
published maps and institutional injury; Patients
affiliations.

Volume 2 Issue 4 (2023) 1 https://doi.org/10.36922/an.1719