| Abstract | Cilj ove populacijske studije bio je procijeniti karakteristike cerebralne paralize (CP) i pridruženih odstupanja u odnosu na predominantni uzorak strukturnog oštećenja mozga prema Sustavu klasifikacije magnetskom rezonancijom (MRICS), koji je analogno primijenjen i na dojenački ultrazvuk (UZV). Zatim, ispitati povezanost nekih rizičnih čimbenika majke i djeteta i njihov potencijalni učinak na neurorazvojni ishod kod djece. Konačno, procijeniti relativne rizike za pridružena odstupanja (oštećenje vida i sluha, epilepsiju, poremećaj razvoja govora) te za teški stupanj funkcionalnog deficita (definiran razinom IV i V za GMFCS i BFMF i IQ < 50) u djece s CP i različitim uzorcima ozljede mozga. ISPITANICI I METODE Istraživanje je provedeno na 227 ispitanika s postavljenom dijagnozom CP temeljem podataka SCPE nacionalnog registra C28 RCP-HR - Register of cerebral palsy of Croatia, rođenih od 2004. do 2007. godine. Procijenjen je tip i podtip CP, ispitivane su grube i fine motoričke funkcije, pridružena odstupanja i slikovni prikazi mozga u 227 djece s MRI mozga od kojih je 185 imalo i dojenački UZV. REZULTATI 56 % djece imalo je bilateralnu, 34 % jednostrano spastičnu, 9 % diskinetsku i 1 % ataktičku CP. Prema funkcionalnoj klasifikaciji grubih motoričkih funkcija (GMFCS), 62 % bilo je pokretno (GMFCS I-III), 38 % nepokretno (GMFCS IV-V). UZV je pokazao oštećenje bijele tvari u 60 %, ozljedu sive tvari u 12 %, poremećaj razvoja mozga u 8 %, razne promjene u 13,5 % dok je 6,5 % ispitanika imalo normalan nalaz; MRI je pokazao značajnu podudarnost (κ = 0,675, p < 0,001). Poremećaji razvoja mozga i predominantno oštećenje sive tvari mozga bili su povezani s težim stupnjem CP, no 7 % djece s CP imalo je normalan MRI. U predikciji teškog funkcionalnog nedostatka ventilacija u JIL-u ≥ 24 sata povećavala je rizik za pojavnost teškog funkcionalnog deficita za 6,76 puta. ZAKLJUČAK Postoji snažna veza između stupnja funkcionalnog deficita i pridruženih neurorazvojnih odstupanja u djece s CP, s dominantnim obrascima koji se nalaze na MRI/UZV mozga. Najbolji ishodi nađeni su kod djece s predominantnim oštećenjem bijele tvari mozga. Zbog podudarnosti UZV i MRI nalaza, UZV se preporučuje kod djece s povećanim rizikom od CP. Na temelju slikovnog prikaza može se predvidjeti tip i stupanj neuromotornog odstupanja što je važno za određivanje vrste i opsega terapijskih i habilitacijskih postupaka i predstavlja sekundarnu prevenciju CP. |
| Abstract (english) | OBJECTIVES The aim of this population-based study was to evaluate the characteristics of cerebral palsy (CP) and associated impairments in relation to the predominant pattern of magnetic resonance imaging classification system (MRICS) that was analogously applied to infant cranial ultrasound (CUS). Furthermore, the purpose of this research is to establish the association of some risk factors for mother and child, as well as their potential impact on the neurodevelopmental outcome of children. Finally, the goal was to estimate the relative risks for the accompanying neuroimpairments (visual and hearing impairment, epilepsy, speech development disorder) as well as for the severe degree of functional deficit (as defined by IV and V for GMFCS and BFMF, and IQ <50) in children with different patterns of brain injury. PARTICIPANTS AND METHODS The study included children from Surveillance of Cerebral Palsy in Europe (SCPE) C28 RCP-HR – Register of Cerebral Palsy of Croatia, born between 2004 and 2007. The subtype of CP was estimated, gross and fine motor functions, accompanying impairments, and neuroimaging were evaluated in 227 children with brain MRI, 185 of which also had CUS. RESULTS 56% of evaluated children had a bilateral, 34% an unilateral spastic, 9% a dyskinetic, and 1% an ataxic CP. According to Gross Motor Function Classification System (GMFCS), 62 % were mobile (GMFCS I-III), while 38 % were immobile (GMFCS IV-V). CUS showed a white matter injury in 60 %, a grey matter injury in 12 %, maldevelopments in 8 %, miscellaneous changes in 13,5 %, while 6,5 % were normal; MRI showed significant agreement (κ = 0,675, p<0,001). Neuroimaging findings of maldevelopments and a predominant gray matter injury were associated with more severe CP, yet 7 % of children with CP had a normal MRI. In the prediction of a severe functional deficit, ventilation ≥ 24 hours in a neonatal intensive care unit (NICU) increased the risk of a severe functional deficit by 6.76 times. CONCLUSION The functional outcomes and accompanying neuroimpairments in children with CP are strongly related with predominant patterns on neuroimaging. The best outcomes were found in children with predominant white matter injury. Because of compatibility of CUS and MRI findings, CUS is recommended for children at increased risk of CP. Based on neuroimaging findings, we can predict the type and grade of the neuromotor impairment, that is important for the design and plan interventions and therapeutic procedures, and represents secondary CP prevention. |
