Birth Asphyxia Is Associated With Increased Risk of Cerebral Palsy: A Meta-Analysis

Abstract

Objective: To assess the association between birth asphyxia-as defined by the pH of umbilical cord blood-and cerebral palsy in asphyxiated neonates ≥35 weeks' gestation. Methods: Two reviewers independently selected English-language studies that included data on the incidence of cerebral palsy in asphyxiated neonates ≥35 weeks' gestation. Studies were searched from the Embase, Google Scholar, PubMed, and Cochrane Library databases up to 31 December 2019, and the references in the retrieved articles were screened. Results: We identified 10 studies that met the inclusion criteria for our meta-analysis, including 8 randomized controlled trials and 2 observational studies. According to a random effects model, the pooled rate of cerebral palsy in the randomized controlled trials was 20.3% (95% CI: 16.0-24.5) and the incidence of cerebral palsy in the observational studies was 22.2% (95% CI: 8.5-35.8). Subgroup analysis by treatment for hypoxic ischemic encephalopathy in asphyxiated neonates showed that the pooled rates of cerebral palsy were 17.3% (95% CI: 13.3-21.2) and 23.9% (95% CI: 18.1-29.7) for the intervention group and non-intervention group, respectively. Conclusion: Our findings suggest that the incidence of cerebral palsy in neonates (≥35 weeks' gestation) with perinatal asphyxia is significantly higher compared to that in the healthy neonate population. With the growing emphasis on improving neonatal neurodevelopment and reducing neurological sequelae, we conclude that the prevention and treatment of perinatal asphyxia is essential for preventing the development of cerebral palsy.

Keywords: birth asphyxia; cerebral palsy; erythropoietin; hypothermia; meta-analysis.

Figure 1

Flow chart for study selection.

Figure 2

Forest plot of the pooled rate of cerebral palsy. The solid diamonds and horizontal solid lines represent the proportions and 95% CIs of each included study. The size of the gray area indicates the study-specific statistical weight. The hollow diamonds show the pooled proportions and 95% CIs of each group and the overall population. The vertical red dotted line shows the combined effect estimate.

Figure 3

Forest plot of the pooled rate of cerebral palsy in the intervention and non-intervention groups in randomized controlled trials. The solid diamonds and horizontal solid lines represent the proportions and 95% CIs of each included study. The size of the gray area indicates the study-specific statistical weight. The hollow diamonds show the pooled proportions and 95% CIs of each subgroup and the overall population. The vertical red dotted line shows the combined effect estimate.