Page 9 - AN-2-4

Advanced Neurology Neonatal encephalopathy and cerebral palsy

affect their activities of daily living, challenges that are not across CP subtypes, and (iv) the incidence of CP-related
fully addressed by current treatment. At present, the optimal complications, including difficulties or impairments in
training intensity and delivery for CP patients remain communication, hearing, vision, swallowing, and cognitive
unknown. Therefore, clinicians encounter challenges in function in each patient group, as well as the occurrence
clinical judgment, both prognostically and during therapy. of seizures. Subsequent to data extraction, analyses were
These challenges may be further complicated in patients carried out for each parameter accordingly.
with a history of NE.
2.3. Data analysis
The present analysis aims to compare and characterize
features of CP with and without preceding NE conditions RevMan 5.4 software was used to conduct a random-effects
in patients. Characterizing features of CP following NE model meta-analysis, aiming to identify differences in the
may provide a more accurate clinical prognosis and, in incidence of CP and each clinical characteristic of CP between
turn, contribute to the development of more effective, individuals with or without preceding NE conditions. The
personalized treatment plans for CP patients with NE parameters considered in the present analysis were reported
conditions. as dichotomous variables. The number of cases for each
parameter and the total number of cases in each group were
2. Methods utilized to calculate odd ratios (OR).
2.1. Publication search For each comparison of the incidence of CP or the
CP-related complication in those with or without preceding
Two electronic databases, PubMed (https://pubmed. NE, case numbers in each category across all included studies
ncbi.nlm.nih.gov/) and Google Scholar (https://scholar. were pooled together to calculate an overall estimate of effect
google.com/), were used for publication searches. The size, reported as an OR, using the random-effects model
search terms employed in both databases were as follows: with inverse variance methods. Statistical significance was
(i) Cerebral Palsy AND Hypoxia, (ii) Cerebral Palsy AND determined by a two-tailed P < 0.05 between CP patients
HIE, (iii) Cerebral Palsy AND NE, (iv) Cerebral Palsy AND with or without preceding NE conditions. For each OR,
Neonatal Brain Injury, (v) Cerebral Palsy Risk Factors, the 95% confidence interval (CI) was calculated using
(vi) Cerebral Palsy Clinical Cases, and (vii) Cerebral Palsy RevMan5.4. Particularly, to determine the sex-specific
Cohort. These searches encompassed publications up to difference in the incidence of CP patients with or without
September 2021 and were limited to publications in the preceding NE conditions, the number of cases in each sex
English language.
was tallied within each condition and analyzed using OR
2.2. Publication selection and a two-tailed significance test.
Studies relevant to the present analysis and meeting the The statistical algorithms utilized by RevMan 5 have
[37]
inclusion criteria were initially identified through title and been previously described . To assess publication bias for
abstract screening, followed by a comprehensive review of each parameter, funnel plots were generated in RevMan
full texts. The inclusion criteria comprised: (i) the study 5.4, plotting OR against the standard error of log(OR) for
must report cases of CP in human neonates or children, the included studies.
(ii) The study must separately report CP cases with and 3. Results
without preceding NE, (iii) The study must measure
and characterize at least one parameter or characteristic 3.1. Selected studies
of CP in both groups, such as subtype of CP, sex of the A total of 424 studies were collected after conducting
patient, and subsequent complications, with and without publication searches using the two electronic databases,
NE conditions, (iv) The study must report original data of which 355 were identified as duplicates either within
regarding CP; reviews and meta-analyses were excluded. or across databases, leaving 69 studies for full-text review
Through the screening of included studies, clinical (Figure 2). Among these, 57 studies were excluded as they
characteristics of CP in patients with preceding NE and did not report the number of cases of CP with preceding
those without preceding NE conditions were gathered. HIE or NE, and 1 study was excluded due to inaccessibility.
Two reviewers (MY and SE) worked independently to A full-text review was then conducted on the remaining
ensure the extracted data met the criteria for inclusion in 11 studies. Following the full-text reviews, 4 additional
the present analysis. The data extracted from the studies articles were excluded as they did not provide a comparison
fell into 4 parameter categories: (i) the number of CP cases between CP patients with or without NE [32,38-40] . Therefore,
with and without NE, (ii) the incidence of CP cases across 7 studies met the inclusion criteria and were included in
sex, (iii) the number of patients with and without NE the present meta-analysis [4,33,41-45] . Of the 7 included studies,

Volume 2 Issue 4 (2023) 3 https://doi.org/10.36922/an.1719