Prevalence and trends for Aboriginal and Torres Strait Islander children living with cerebral palsy: A birds-eye view.

AIM: To provide a birds-eye view of the trends of cerebral palsy (CP) for Australian Aboriginal and Torres Strait Islander children and young adults. METHOD: Data were obtained for this population-based observational study from the Australian Cerebral Palsy Register (ACPR), birth years 1995 to 2014. The Indigenous status of children was classified by maternal Aboriginal and Torres Strait Islander or non-Indigenous status. Descriptive statistics were calculated for socio-demographic and clinical characteristics. Prenatal/perinatal and post-neonatal birth prevalence was calculated per 1000 live births and per 10 000 live births respectively, and Poisson regression used to assess trends. RESULTS: Data from the ACPR were available for 514 Aboriginal and Torres Strait Islander individuals with CP. Most children could walk independently (56%) and lived in urban or regional areas (72%). One in five children lived in socioeconomically disadvantaged remote/very remote areas. The birth prevalence of prenatal/perinatal CP declined after the mid-2000s from a high of 4.8 (95% confidence interval 3.2-7.0) to 1.9 per 1000 live births (95% confidence interval 1.1-3.2) (2013-2014), with marked declines observed for term births and teenage mothers. INTERPRETATION: The birth prevalence of CP in Aboriginal and Torres Strait Islander children in Australia declined between the mid-2000s and 2013 to 2014. This birds-eye view provides key stakeholders with new knowledge to advocate for sustainable funding for accessible, culturally safe, antenatal and CP services. WHAT THIS PAPER ADDS: Birth prevalence of cerebral palsy (CP) is beginning to decline for Aboriginal and Torres Strait Islanders. Recent CP birth prevalence for Aboriginal and Torres Strait Islanders is 1.9 per 1000 live births. Most children with CP live in more populated areas rather than remote or very remote areas. One in five Aboriginal and Torres Strait Islander children with CP live in socioeconomically disadvantaged remote areas

Implementation of a clinical practice guideline for antenatal magnesium sulphate for neuroprotection in Australia and New Zealand

for The WISH Project TeamHealth professionals at 25 Australian and New Zealand tertiary maternity hospitals were surveyed about local implementation of a clinical practice guideline for antenatal magnesium sulphate for fetal neuroprotection. Seventy-six percent of respondents reported that their hospital is currently following a guideline; 36% confirmed that their hospital is auditing uptake. Estimates of uptake ranged from 53 to 90%. Ongoing education and support are needed to ensure that the guidelines are optimally implemented, and uptake and important health outcomes are monitored.Emily Bain, Tanya Bubner, Pat Ashwood, Caroline A. Crowther and Philippa Middleto

Magnesium sulphate for women at term for neuroprotection of the fetus

BACKGROUND Magnesium sulphate is extensively used in obstetrics for the treatment and prevention of eclampsia. A recent meta-analysis has shown that magnesium sulphate is an effective fetal neuroprotective agent when given antenatally to women at risk of very preterm birth. Term infants account for more than half of all cases of cerebral palsy, and the incidence has remained fairly constant. It is important to assess if antenatal administration of magnesium sulphate to women at term protects the fetus from brain injury, and associated neurosensory disabilities including cerebral palsy. OBJECTIVES To assess the effectiveness of magnesium sulphate given to women at term as a neuroprotective agent for the fetus. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trial Register (31 July 2012) and the reference lists of other Cochrane reviews assessing magnesium sulphate in pregnancy. SELECTION CRITERIA Randomised controlled trials comparing antenatally administered magnesium sulphate to women at term with placebo, no treatment or a different fetal neuroprotective agent. We also planned to include cluster-randomised trials, and exclude cross-over trials and quasi-randomised trials. We planned to exclude studies reported as abstracts only. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for eligibility and for risk of bias. Two authors independently extracted data. Data were checked for accuracy. MAIN RESULTS We included one trial (involving 135 women with mild pre-eclampsia at term). An additional six studies are awaiting further assessment. The included trial compared magnesium sulphate with a placebo and was at a low risk of bias. The trial did not report any of this review's prespecified primary outcomes. There was no significant difference between magnesium sulphate and placebo in Apgar score less than seven at five minutes (risk ratio (RR) 0.51; 95% confidence interval (CI) 0.05 to 5.46; 135 infants), nor gestational age at birth (mean difference (MD) -0.20 weeks; 95% CI -0.62 to 0.22; 135 infants). There were significantly more maternal side effects (feeling warm and flushed) in the magnesium sulphate group than in the placebo group (RR 3.81; 95% CI 2.22 to 6.53; 135 women). However, no significant difference in adverse effects severe enough to cease treatment was observed (RR 3.04; 95% CI 0.13 to 73.42; 135 women). There were no significant differences seen between groups in the rates of postpartum haemorrhage (RR 4.06; 95% CI 0.47 to 35.38; 135 women) and caesarean section (RR 0.80; 95% CI 0.39 to 1.63; 135 women). AUTHORS' CONCLUSIONS There is currently insufficient evidence to assess the efficacy and safety of magnesium sulphate when administered to women for neuroprotection of the term fetus. As there has been recent evidence for the use of magnesium sulphate for neuroprotection of the preterm fetus, high-quality randomised controlled trials are needed to determine the safety profile and neurological outcomes for the term fetus. Strategies to reduce maternal side effects during treatment also require evaluation.Thuy-My N Nguyen, Caroline A Crowther, Dominic Wilkinson, Emily Bai

Clinical acceptability of the sense_assess© kids: Children and youth perspectives

© 2017 Occupational Therapy Australia. Background: The sense_assess© kids is a standardised, norm-referenced assessment designed to measure the functional somatosensation capacity of the upper limb of children with cerebral palsy. The objective of the current study was to determine if the sense_assess© kids was clinically acceptable to children and youth. Methods: A questionnaire was completed by participants following administration of the sense_assess© kids by a trained occupational therapist. Twenty-six children with spastic hemiplegic cerebral palsy (aged 6-15 years six months; mean 10 years eight months; 16 boys) were recruited. Participants responded to questions regarding the administration and level of difficulty of the sense_assess© kids using a Q-Sort of 'like' and 'dislike', Likert scales and short answers. Content analysis was applied. Results: Twenty-one of twenty-six children, indicated that they were 'very happy' or 'happy' with the administration process of the sense_assess© kids. Most participants indicated that they liked the sensation they felt in the hand when tested. Conclusion: This study has demonstrated the acceptability of sense_assess© kids for the population for whom it is intended

What Constitutes Self-Concept for Children with CP? A Delphi Consensus Survey

This study aimed to identify constructs (factors) and content (items) that constitutes self-concept for children with cerebral palsy (CP). Three participant groups were recruited for a three-round Delphi survey: 12 children with CP aged 8–12 years, 18 caregivers, and 21 professionals working with this population. Delphi Round I involved item generation and literature review. In Round II, participants used a five-point scale to rate the importance of factors/items collated from (a) existing self-concept measures identified from literature review and (b) additional factors/items raised in Round I. To increase understanding for children, the rating process was incorporated into a game-based format called “myTREEHOUSE” where ramps leading up to the tree house represented progressively higher ratings. Each item was presented by the researcher verbally (short standard phrase) and visually (Pictorial Communication Symbols card). Factors and items reaching 75 % consensus within each group were removed and those not reaching consensus were repeated in Round III. Consensus on factors and items reaching consensus after Rounds II and III was examined within and between groups. A total of 117 items were identified by the review and 24 from Delphi Round I, totalling 141 items. After Delphi Rounds II and III, 52 items achieved consensus from two or more participant groups. While many areas of self-concept recognised as important for children with CP were similar to typically developing children, several additional CP-specific elements were identified through the Delphi survey