Changing panorama of cerebral palsy in children of low birth weight

Of 2,840 out-patients who visited the Tokyo Metropolitan Kita Rehabilitation Center in 1965, 1968, 1970, 1973, 1975 and 1978, 278 children with cerebral palsy (CP) of low birth weight were studied to analyse changes in type of CP in relation to gestational week, birth weight, perinatal factors and subsequent complications. 1. The incidence of handicap associated with low birth weight in new out-patients had not changed. 2. The number of doubly handicapped CP patients was gradually increasing while number of uncomplicated CP patients was gradually decreasing. 3. The number of children with tension athetosis was remarkably decreasing; the number of children with spastic quadriplegia was gradually increasing. Increase in number of the spastic type was found especially in the group whose birth weight was over 1,500 gm. and gestational week over 37 weeks. The numbers of spastic diplegia and hemiplegia patients had not significantly changed. 4. In the athetoid group, the complication of severe jaundice was apparently decreasing since 1970 while the number of asphyxia cases was gradually increasing. In the spastic group, there were no remarkable changes in the perinatal complications. 5. Of spastic quadriplegia patients 78.3% were of IQ of less than 67 while 33.3% of spastic hemiplegia and 23.5% of spastic diplegia patients had IQs of less than 67.31.4% of the athetoid type had IQs of less than 67. 6. In the asphyxia group, 34 of 82 children with low birth weight CP (41.5%) had epilepsy. Our results suggest that the causes of brain damage in low birth weight infants are not merely preventable perinatal factors, but are due to a more complex interaction of prenatal and perinatal factors.