Perinatal Regionalization and Implications for Long-Term Health Outcomes in Cerebral Palsy

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
Corneliu BolboceanM Oskoui

Abstract

Perinatal regionalization is linked to improved neonatal outcomes; however, the effects on long-term outcomes in cerebral palsy (CP) are not known. We estimate the effect of highest levels of neonatal care available at delivery on the risk of developing a nonambulatory CP status. Children with CP born in Quebec from the Canadian CP Registry excluding postneonatal causes were included (N=360). We estimate the effect of level of care available at delivery on risk of nonambulatory status among children with CP using propensity score matching and instrumental variables methods to adjust for differences in case mix among the three groups of hospitals. The outcome variable is an indicator for CP nonambulation assigned according to Gross Motor Function Classification System (levels IV and V). This study used data that predated therapeutic hypothermia in Quebec. Propensity score estimates of change in the adjusted risk of having a nonambulatory CP status because of birth at level II versus level I is -0.081, 95% confidence interval (CI; -0.2182 to 0.0562); level III versus level I is -0.072 95% CI (-0.225 to 0.08), and level III versus level II is 0.157 95% CI (0.027 to 0.286). Differences in levels of neonatal care available at hospit...Continue Reading

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Citations

Jul 10, 2020·Health Economics Review·Corneliu Bolbocean, Michael Shevell
Apr 21, 2020·Neurology. Clinical Practice·Jake P LevyMichael Shevell

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