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Pediatrics. 2013 Oct;132(4):e905-14. doi: 10.1542/peds.2012-3915. Epub 2013 Sep 9.

Cerebral palsy and growth failure at 6 to 7 years.

Collaborators (151)

Ehrenkranz RA, Hintz SR, Pappas A, Tyson JE, Vohr BR, Yolton K, Das A, Higgins RD, Bara R, Jobe AH, Caplan MS, Leach TM, Oh W, Hensman AM, Noel L, Watson VE, Walsh MC, Fanaroff AA, Wilson-Costello DE, Bass N, Friedman HG, Newman NS, Siner BS, Schibler K, Donovan EF, Yolton K, Bridges K, Steichen JJ, Alexander B, Grisby C, Mincey HL, Hessling J, Gratton TL, Goldberg RN, MichaelCotten C, Goldstein RF, Gustafson KE, Auten KJ, Foy KA, Fisher KA, Grimes S, Lohmeyer MB, Carlton DP, Jain L, Blackwelder AM, Hale EC, Fritz S, Wright LL, McClure EM, Archer SW, Poindexter BB, Lemons JA, Appel DD, Bissey J, Herron DE, Miller LC, Richard L, Wilson LD, Poole W, Auman JO, Cunningham M, Hammond J, Hastings BK, Newman JE, Huitema CM, Schaefer SE, Zaterka-Baxter KM, Van Meurs KP, Hintz SR, Stevenson DK, Ball M, DeAnda ME, Carlo WA, Ambalavanan N, Peralta- Carcelen M, Nelson KG, Collins MV, Cosby SS, Phillips VA, Smith LL, Finer NN, Kaegi D, Rasmussen MR, Vaucher YE, Fuller MG, Arnell K, Henderson C, Rich W, Duara S, Bauer CR, Hiriart-Fajardo S, Allison M, Calejo M, Everett-Thomas R, Frade Eguaras SM, Gauthier S, Phelps DL, Myers GJ, Guillet R, Hust D, Reubens LJ, Sánchez PJ, Broyles R, Laptook AR, Rosenfeld CR, Salhab WA, Heyne RJ, Boatman C, Dooley C, Hensley G, Hickman JF, Leps MH, Madison S, Miller NA, Morgan JS, Torres LE, Guzman A, Tyson JE, Kennedy KA, Akpa EG, Franco CI, Lis AE, McDavid GE, Pierce Tate PL, Alaniz NI, Cedillo M, Dieterich S, Evans PW, Green C, Jiminez M, Major-Kincade T, Morris BH, Poundstone M, Reddoch S, Siddiki S, Simmons MC, Whitely LL, Wright SL, Pappas A, Johnson YR, Bara R, Goldston LA, Muran G, Kennedy D, Pruitt PJ, Gettner P, Konstantino M, Poulsen J, Romano E, Williams J, DeLancy S.



To evaluate the association between severity of cerebral palsy (CP) and growth to 6 to 7 years of age among children with moderate to severe (Mod/Sev) hypoxic ischemic encephalopathy (HIE). It was hypothesized that children with Mod/Sev CP would have poorer growth, lower cognitive scores, and increased rehospitalization rates compared with children with no CP (No CP).


Among 115 of 122 surviving children followed in the hypothermia trial for neonatal HIE, growth parameters and neurodevelopmental status at 18 to 22 months and 6 to 7 years were available. Group comparisons (Mod/Sev CP and No CP) with unadjusted and adjusted analyses for growth <10th percentile and z scores by using Fisher's exact tests and regression modeling were conducted.


Children with Mod/Sev CP had high rates of slow growth and cognitive and motor impairment and rehospitalizations at 18 to 22 months and 6 to 7 years. At 6 to 7 years of age, children with Mod/Sev CP had increased rates of growth parameters <10th percentile compared with those with No CP (weight, 57% vs 3%; height, 70% vs 2%; and head circumference, 82% vs 13%; P < .0001). Increasing severity of slow growth was associated with increasing age (P < .04 for weight, P < .001 for length, and P < .0001 for head circumference). Gastrostomy feeds were associated with better growth.


Term children with HIE who develop Mod/Sev CP have high and increasing rates of growth <10th percentile by 6 to 7 years of age. These findings support the need for close medical and nutrition management of children with HIE who develop CP.


cerebral palsy; encephalopathy; growth; hypothermia; hypoxia-ischemia

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