Increasing prevalence of cerebral palsy in children born very preterm in Denmark

Abstract

Cerebral palsy (CP) is a neurodevelopmental disorder that affects movement, posture, and muscle tone. It results from brain damage that occurs before, during, or shortly after birth. The highest risk factor is preterm birth, with around half of all children with CP being born preterm.

In Denmark, the overall number of children with CP has been declining over the past couple of decades. However, the number of children born preterm with CP has slowly been increasing since the early 2000s. This study aimed to explore the reasons for this rise.

Our results reveal that the increase in CP among children born preterm was primarily driven by a significant rise among those born very preterm (between 28–33 weeks), with a similar trend among those born extremely preterm (before 28 weeks). During the study period, neonatal survival rates improved across all preterm gestational ages, suggesting that more infants at high risk for CP are surviving. Interestingly, similar trends in comparable countries, such as Sweden, Australia, and Canada, did not show an increase in CP despite similar improvements in survival rates, highlighting the complexity of the factors involved.

Key clinical factors that changed during the study period included a rise in high-risk pregnancies, maternal obesity, neonatal admissions, the use of emergency cesarean sections, and assisted ventilation treatment for newborn infants. These changes suggest a shift in the Danish approach to obstetric and neonatal care, towards more active neonatal life support, which may contribute to the rising CP prevalence. Moving forward, it is crucial to continue monitoring these trends and to develop strategies to support infants born preterm and their families.