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Background/Aim. Cerebral palsy (CP) etiology is multi-factorial and heterogeneous, manifesting as damage to the developing brain. The associated risk factors can arise in the prenatal, perinatal, or postnatal period. The aim of this study was to determine the risk factors for CP and examine the associations between CP type, gestational age, and perinatal risk factors. Methods. The study sample comprised 206 children with CP. Pertinent data were collected from medical records and included participants’ gestational age at birth, medical history, and CP clinical characteristics. Risk factors were divided according to the timing of brain injury into prenatal, perinatal, and neonatal. Results. Hormonally maintained pregnancy (55.3%), twin pregnancy (28.9%), vaginal bleeding after the 20th week of gestation (21.1%), threatened abortion in the first half of pregnancy (13.2%), and maternal infection (10.5%) were identified as the main prenatal risk factors for CP. Prematurity (54.5%) was the leading perinatal risk factor, followed by low birthweight (50.8%), Apgar score < 7 (41.7%), assisted delivery (41.4%), and breech presentation (13.5%). Respiratory distress syndrome (16%), need for treatment in the Neonatal Intensive Care Unit (22.3%), assisted ventilation (18.4%), hypoxic-ischemic encephalopathy (11.2%), and neonatal convulsions (5.8%) were identified as the leading neonatal risk factors for CP. A statistically significant difference was found in the total number of perinatal risk factors in relation to gestational age (p < 0.001) and CP type (p = 0.006). Perinatal risk factors were most prevalent in preterm infants and children affected by the CP of spastic bilateral type. A statistically significant difference was noted in the distribution of CP types de-pending on the gestational age (p < 0.001). In particular, spastic bilateral CP type was most prevalent in the group of preterm-born children. Conclusion. CP is characterized by heterogeneous risk factors and is a result of interaction among multiple risk factors.

Background/Aim. Children with cerebral palsy (CP) grow at a slower rate relative to their peers. Their body height, body weight and bone mineral density are significantly below those measured for healthy children of corresponding age. The aim of this work was to estimate bone mineral density in relation to the anthropometric parameters and the level of gross motor function in the children with cerebral palsy. Methods. This cross-sectional pilot study included 23 children with CP, aged 6 to 17 years, in whom the gross motor function level was estimated according to the Gross motor function classification system- expanded and revised (GMFCS-E&R), while the anthropometric parameters were established in relation to the developmental charts for healthy children as well as those pertaining to children with CP. Bone mineral density was measured by dual energy X-ray absorptiometry and the findings were interpreted in accordance with the International Society for Clinical Densitometry Official Positions of Adults & Pediatrics. Mean values with interquartile deviations, along with frequencies and percentages were the descriptive statistical measures employed in the analyses. Differences between groups were ascertained through the Kruskal-Wallis test. Results. Our sample of 23 children comprised of 56.5% boys and 43.5% girls, aged 13.00 ± 3.56 years, of whom 3/4 had a severe form of gross motor dysfunction (GMFCS-E&R levels IV and V). All subjects had lower bone density in both regions of interest [spinal Z-score -1.60 ± 1.40 standard devation (SD); hip Z-score -2.00 ± 3.00 SD], as well as lower anthropometric parameters [height Z-score -2.74 ± 4.28; body weight Z-score - 3.22 ± 6.96; body mass index (BMI) Z-score -2.64 ± 6.03]. In the observed sample, bone mineral density in the spine (p < 0.01) and the hip (p < 0.05) was reduced in all subjects, and all children had a lower body weight (p < 0.01) and the BMI (p < 0.01), but not body height, in relation to the existing developmental charts for the CP children adopted from the US. Children with the CP Level IV on the GMFCS-E&R had a significantly lower bone density (spinal Z-score -1.90 SD; hip Z-score -3.40 SD), with the reduction even more pronounced at level V (spinal Z-score -3.80 SD; hip Z-score -2.30 SD). Conclusion. A significantly lower bone mineral density as well as the decreased values of all observed anthropometric parameters, were noted in the children with CP. In the observed sample, bone mineral density in both spine and hip was reduced in all subjects, all of whom also had lower body weight and the BMI, but not body height compared to the existing developmental charts for the children with CP adopted from the US. The children with severe forms of CP (GMFCS-E&R levels IV and V) had significantly lower bone mineral density.

Background/Aim. Assessment of minor neurological dysfunction (MND) provides information about a child's neurological condition which helps to identify the vulnerability of the child to the development of motor impairment, difficulties in learning or behavioral disorders. The aim of this study was to determine differences in the prevalence of MND in children from the general population with respect to age (5 and 6 years old) and sex. Methods. The examination was carried out in a preschool institution in the city of Novi Sad, Serbia. The total sample included 120 children divided into two groups according to age: 60 children aged 5 (group A) and 60 children aged 6 years (group B). The children were recruited at three randomly selected kindergartens and approximately equal sex representation, randomly selected as well. The testing was done by the Touwen's test, modified by Hadders-Algra. The results were classified into three groups: the absence of MND, presence of simple MND (presence of one or two domains of dysfunction) and the presence of complex MND (presence of at least three domains of dysfunction). Results. Sixtyseven children out of 120 (55.8%) had a normal neurological condition, while 53 (44.2%) showed MND [49 (40.8%) simple, and 4 (3.4%) complex]. MND occurred more frequently in the youngest age group than in the older children (57% vs. 32%; p = 0.01). MND was also more frequent in boys than in girls, but this difference was not statistically significant. Conclusion. Our results show the importance of testing children at preschool age in order to detect potential neurological vulnerability and timely begin with the appropriate therapy.

Background/Aim. Cerebral palsy (CP) is one of the leading causes of neurological impairment in childhood. Preterm birth is a significant risk factor in the occurrence of CP. Clinical outcomes may include impairment of gross motor function and intellectual abilities, visual impairment and epilepsy. The aim of this study was to examine the relationships among gestational age, type of CP, functional ability and associated conditions. Methods. The sample size was 206 children with CP. The data were obtained from medical records and included gestational age at birth, clinical characteristics of CP and associated conditions. Clinical CP type was determined according to Surveillance of Cerebral Palsy in Europe (SCPE) and topographically. Gross motor function abilities were evaluated according to the Gross Motor Function Classification System (GMFCS). Results. More than half of the children with CP were born prematurely (54.4%). Statistically significant difference was noted with respect to the distribution of various clinical types of CP in relation to gestational age (p < 0.001). In the group with spastic bilateral CP type, there is a greater proportion of children born preterm. Statistically significant difference was noted in the functional classification based on GMFCS in terms of gestational age (p = 0.049), children born at earlier gestational age are classified at a higher GMFCS level of functional limitation. The greatest percentage of children (70.0%) affected by two or more associated conditions was found in the group that had extremely preterm birth, and that number declined with increasing maturity at birth. Epilepsy was more prevalent in children born at greater gestational age, and this difference in distribution was statistically significant (p = 0.032). Conclusion. The application of antenatal and postnatal protection of preterm children should be a significant component of the CP prevention strategy. [Projekat Ministarstva nauke Republike Srbije, br. 41012 i br. 44008]

Background/Aim. Cerebral palsy (CP) is the most common physical disability in childhood. Children have problems with motor functions as a result of limbs spasticity, which leads to severe contractures and limbs deformity. There is a growing interest in the therapeutic role of botulinum toxin type A (BTA) in CP. The aim of this study was to examine the effects of BTA on spasticity, active range of motion and functional motor outcomes in children with CP. Methods. This study included 42 children of both sexes, aged 2−6 years, with spastic CP, divided into two groups: group I (21 child) treated with BTA and physical therapy, and group II (21 child) treated with physical therapy only. The following parameters were analyzed: spasticity; active range of motion of the hip, knee and ankle, and functional motor outcome. These parameters measurements were carried out four times in both groups: before the treatment, three, eight and 16 weeks after the beginning of the treatment. The obtained results were statistically processed and compared. Results. There was no evidence of any significant difference between the groups before the treatment. After eight weeks there was a remarkable difference concerning spasticity reducing on behalf of the group I (group I - 0.76±0.51 vs. II group - 2.17±0.64; p < 0.0001). There was statistically significant difference concerning active range of motion increasing on behalf of the group I (hip abduction: group I - 44.37±1.130 vs. group II - 32.61±8,070, p < 0,01; knee extension: group I - 0,77±1.820 vs. II group - 14.99±7.610, p < 0.01; dorsiflexion of the foot: group I - 11.50±6.080 vs. group II - 8.98±7.850, p < 0,01). A statistically significant difference was found after 16 weeks in functional motor outcome as well, on behalf of the group I: functional motor abilities level in the group I was 1.86 vs. 2.71 in the group II, p < 0.05. Conclusion. Botulinum toxin type A application leads to an important spasticity decreasing, active range of motion increasing, as well as to functional abilities in children with CP. .