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Objective: To characterise fetal brain growth in children with specific language impairment (SLI)., Design: A nested case-control study., Setting: Perth, Western Australia., Participants: Thirty children meeting criteria for SLI at age 10 years were individually matched with a typically developing comparison child on sex, non-verbal ability, fetal gestational age, maternal age at conception, smoking and alcohol intake during pregnancy., Main Outcome Measures: Occipitofrontal head circumference (HC) was measured using ultrasonography at approximately 18 weeks gestation. Femur length provided a measure of fetal length. Occipitofrontal HC was measured at birth and at the 1-year postnatal follow-up using a precise paper tape measure, while crown-heel length acted as an index of body length at both time points. Raw data were transformed to z-scores using reference norms., Results: The SLI group had a significantly smaller mean HC than the typically developing comparison children at birth, but there was no group difference at 18 weeks gestation or at the 1-year postnatal follow-up. Individual analyses found that 12 SLI children had an HC z-score less than -1 at birth, with three of these cases meeting criteria for microcephaly. There was no group difference in the indices of overall body size at any time point., Conclusions: Children with SLI are more likely to have a small HC at birth but not at 18 weeks gestation or infancy, suggesting growth asynchrony in brain development during the second half of pregnancy.

Objective: We sought to investigate whether placental infarction determined by macroscopic examination was associated with risk of cerebral palsy (CP)., Study Design: This was a population-based study of macroscopic placental infarcts in singletons>35 weeks' gestational age, in 158 perinatal deaths, 445 infants with CP, and 491 controls matched with CP cases for gestational age., Results: Placental infarcts were recorded in 2.0% of controls, 4.4% of deaths (relative risk [RR], 2.2; 95% confidence interval [CI], 0.8-5.6]), 5.2% of infants with CP (P<.05, RR, 2.5; 95% CI, 1.2-5.3), and 8.4% with spastic quadriplegic CP (P=.0026; RR, 4.4; 95% CI, 1.8-10.6). In children with CP, unlike controls, placental infarction was associated with reduced fetal growth, older maternal age, more prior miscarriages, and poor neonatal condition, but not with maternal preeclampsia., Conclusion: Placental infarction identified by macroscopic examination was associated with increased risk of CP and the CP subtype, spastic quadriplegic CP. Antecedents of placental infarction differed in children with CP compared with control children., (Published by Mosby, Inc.)

Despite the recognition by many researchers that cerebral palsy (CP) is rarely related to obstetric malpractice, there are many instances where obstetricians face litigation when a child is diagnosed with cerebral palsy following a difficult delivery. The aim of this paper is to review relevant research papers to aid practitioners involved in obstetric malpractice litigation. It is also prudent to question the feasibility of costs for long-term care for children with disabilities being met through the legal process., (Copyright © 2011 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Half of the most severe cases of cerebral palsy (CP) survive to adulthood, but because this longevity is relatively recent, there is no empirical experience of their life expectancy past middle age. The last 2 decades have seen significant developments in the management of persons with CP, involving specialist services from an increasing number of disciplines that require coordination to maximize their effectiveness. This article provides an overview of CP. The author discusses definitions of CP, its epidemiology, pathologies, and range of possible clinical descriptions, and briefly touches on management and prevention., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objective: This study investigated the risks for cerebral palsy in survivors of multiple pregnancies with cofetal loss (< 20 weeks' gestation) or cofetal death (>or= 20 weeks' gestation)., Study Design: The total Western Australian population-based case-control study included 741 cases of cerebral palsy., Results: Antenatal cofetal loss or death occurred in 3% of all cases of cerebral palsy, which is a small but significant contribution. The odds ratio for cerebral palsy in survivors of cofetal loss that included iatrogenic pregnancy reduction was 2.65 (95% confidence interval [CI], 0.78-8.98), which gave a population-attributable proportion of 7.28% (95% CI, 0-27.5), compared with 4.25 (95% CI, 1.12-16.10) and 10.6% (95% CI, 1.0-35.6) for survivors of cofetal death., Conclusion: This study quantifies the contribution of cofetal death to cerebral palsy and suggests that cofetal loss makes a similar, although somewhat smaller, contribution to the risk for cerebral palsy in survivors of multiple pregnancies.

This study investigated the relation between birth characteristics and numeracy attainment at age 8 years. Using a multilevel approach, the authors analyzed all non-Aboriginal singletons born in Western Australia who attended government schools and participated in a Western Australia-wide numeracy test in grade 3 between 1999 and 2005. Appropriateness of intrauterine growth was expressed as the proportion of optimal growth parameters for gestational duration, infant sex, and maternal height and parity, which was derived from a total population of births without risk factors for growth restriction. After the authors controlled for sociodemographic factors, term birth and proportion of optimal head circumference at birth were associated with higher numeracy scores. Increasing proportion of optimal birth length and being firstborn were associated with relatively higher numeracy scores among children born to mothers residing in the most educationally deprived area. The relative advantage of being born first was also higher for children born to single mothers. In contrast, higher Apgar scores and greater proportion of optimal birth weight were associated with a lower relative advantage for children born to single mothers. In summary, term birth and increased growth in head circumference and length are key birth characteristics associated with higher numeracy scores, especially among disadvantaged children.

The authors investigated the association between intrauterine growth and intellectual disability (ID). The appropriateness of intrauterine growth was assessed using percentage of optimal birth weight, a measure that accounts for gestational age, maternal height, parity, and infant sex. Using population-based record linkage, singleton Caucasian and Aboriginal children born in Western Australia in 1983-1992 and alive in 2002 with ID of unknown cause (n = 2,625) were compared with children without ID (n = 217,252). The odds of ID increased with less-than-optimal intrauterine growth. In Caucasian children, after adjustment for sociodemographic factors, severe growth restriction was associated with development of mild-moderate ID among preterm births (<37 weeks) (odds ratio (OR) = 1.71, 95% confidence interval (CI): 1.06, 2.77) and term births (> or =37 weeks) (OR = 2.42, 95% CI: 1.88, 3.12) and with severe ID (OR = 4.79, 95% CI: 2.59, 8.83) among term births. Effects were similar among Aboriginal children. Severe growth restriction (OR = 3.2, 95% CI: 1.3, 7.9) and poor head growth (OR = 3.6, 95% CI: 1.4, 9.0) were independently associated with severe ID. Infants with excess intrauterine growth were more likely to be diagnosed with ID associated with autism spectrum disorder (OR = 2.36, 95% CI: 0.93, 6.03). These findings suggest that inappropriate intrauterine growth, less than or greater than optimal birth weight, is associated with development of ID.

The authors examined the relation between birth weight, intrauterine growth, and risk of childhood leukemia using population-based linked health data from Western Australia. A cohort of 576,593 infants born in 1980-2004 were followed from birth to diagnosis of acute lymphoblastic leukemia (ALL) (n = 243) or acute myeloid leukemia (AML) (n = 36) before their 15th birthday, death, or the end of follow-up (December 31, 2005). Data were analyzed using Cox regression. Risk of ALL was positively associated with the proportion of optimal birth weight--a measure of the appropriateness of fetal growth--particularly among children younger than 5 years; the hazard ratio for a 1-standard-deviation increase in proportion of optimal birth weight was 1.25 (95% confidence interval: 1.07, 1.47). Among children younger than 5 years not classified as having high birth weight (defined as >3,500 g, >3,800 g, and >4,000 g), a 1-unit increase in proportion of optimal birth weight was associated with an approximately 40% increase in ALL risk. This suggests that accelerated growth, rather than high birth weight per se, is involved in the etiology of ALL. These findings are consistent with a role for insulin-like growth factor I in the causal pathway. Findings for AML were inconclusive, probably because of small numbers.

The objective of the study was to identify the origin (s) of the association between cerebral palsy (CP) and birth defects in the absence of cerebral birth defects. Data from the 1980 to 1994 Western Australian birth cohorts (355 659 neonatal survivors) were linked to the Cerebral Palsy Register (941 links) and the Birth Defects Registry (17070 links). Associations between CP (congenital or acquired) and birth defects (cerebral or exclusively non-cerebral) were estimated. The origin of the association between non-cerebral defects and acquired CP was investigated with an observational study, and the origin of the association between non-cerebral defects and congenital CP was investigated with a blinded case-control study of births with non-cerebral defects with or without CP. With non-cerebral defects, the odds ratio for CP was 4.8 (95% CI 3.1-7.4) if acquired and 4.7 (3.9-5.7) if congenital. For acquired CP, the association arose primarily as a result of cardiac defects. For congenital CP, the association arose partly from ascertainment bias and partly from defects known to be associated with cerebral defects (but not identified in these data). However, a significant portion remained unexplained. The presence of non-cerebral defects should heighten clinical alertness to the possibility of CP and of cerebral birth defects.

Context: Overweight/obesity in children is increasing. Incidence data for medical complications use arbitrary cutoff values for categories of overweight and obesity. Continuous relationships are seldom reported., Objectives: The objective of this study is to report relationships of child body mass index (BMI) z-score as a continuous variable with the medical complications of overweight., Design: This study is a part of the larger, prospective cohort Growth and Development Study., Setting: Children were recruited from the community through randomly selected primary schools. Overweight children seeking treatment were recruited through tertiary centers., Participants: Children aged 6-13 yr were community-recruited normal weight (n = 73), community-recruited overweight (n = 53), and overweight treatment-seeking (n = 51). Medical history, family history, and symptoms of complications of overweight were collected by interview, and physical examination was performed. Investigations included oral glucose tolerance tests, fasting lipids, and liver function tests., Main Outcome Measure: Adjusted regression was used to model each complication of obesity with age- and sex-specific child BMI z-scores entered as a continuous dependent variable., Results: Adjusted logistic regression showed the proportion of children with musculoskeletal pain, obstructive sleep apnea symptoms, headaches, depression, anxiety, bullying, and acanthosis nigricans increased with child BMI z-score. Adjusted linear regression showed BMI z-score was significantly related to systolic and diastolic blood pressure, insulin during oral glucose tolerance test, total cholesterol, high-density lipoprotein, triglycerides, and alanine aminotransferase., Conclusion: Child's BMI z-score is independently related to complications of overweight and obesity in a linear or curvilinear fashion. Children's risks of most complications increase across the entire range of BMI values and are not defined by thresholds.

When birth weight for gestation is used as a surrogate for intrauterine growth, the prevalence of cerebral palsy varies continuously in a reversed J shape, with steep increases in the risk for infants lighter and heavier than the optimum size. Patterns of size-at-birth specific risk for cerebral palsy differ between male and female infants, as do the patterns for more severe versus milder cases. Although these excess risks with abnormal size at birth imply antenatal precursors, it is not clear whether or how intrauterine growth is involved in any of the suspected causal pathways resulting in cerebral palsy. The implication for clinicians is that serial measures of in utero growth may provide an important indicator of fetal health.

The term cerebral palsy refers to a range of clinical symptoms, with related service requirements, resulting from lesions or abnormalities in the brain arising early in life. It is not a diagnosis; aetiology and pathology are variable. This article discusses the definition and differential classification of cerebral palsy, describes trends in its frequency over time stratified by associated variables, and briefly reviews the most recent findings concerning its aetiology.

The aim of this mental health promotion initiative was to evaluate the effectiveness of a universally delivered group behavioral family intervention (BFI) in preventing behavior problems in children. This study investigates the transferability of an efficacious clinical program to a universal prevention intervention delivered through child and community health services targeting parents of preschoolers within a metropolitan health region. A quasi-experimental two-group (BFI, n = 804 vs. Comparison group, n = 806) longitudinal design followed preschool aged children and their parents over a 2-year period. BFI was associated with significant reductions in parent- reported levels of dysfunctional parenting and parent-reported levels of child behavior problems. Effect sizes on child behavior problems ranged from large (.83) to moderate (.47). Positive and significant effects were also observed in parent mental health, marital adjustment, and levels of child rearing conflict. Findings are discussed with respect to their implication for significant population reductions in child behavior problems as well as the pragmatic challenges for prevention science in encouraging both the evaluation and uptake of preventive initiatives in real world settings.

Summary highlighted the contribution of birth defects. Over this time there has also been an increasing number of terminations of pregnancy for fetal abnormality. However, the effect of these terminations on mortality rates in Australia has not yet been estimated. The Western Australian Birth Defects Registry (BDR) records all birth defects that are diagnosed in stillbirths, livebirths and in pregnancies terminated because of a fetal abnormality. All cases on the BDR over the period 1980-98 were categorised into one of eight main birth defect groups and analysed in four time periods to show trends. Linkage provided information on deaths to one year of age, defined as perinatal plus postneonatal deaths. The proportion of terminations for fetal abnormality that would have resulted in a death before one year of age was estimated in two ways. The first method used the proportion of births with a birth defect in each diagnostic category that resulted in a death. The second method involved determination of likelihood of survival to one year of all terminations for fetal abnormality through independent review by two experts. Whilst mortality to one year of age for all birth defects has declined from 4.36/1000 births in 1980-84 to 2.75/1000 births in 1995-98, terminations of pregnancies for fetal abnormalities increased from 1.19/1000 births to 4.70/1000 births. After including the estimated mortality associated with terminations for fetal abnormality, the decline in mortality to one year of age associated with birth defects from 1980 to 1998 changed from a 37% reduction to a 15% reduction based on observed mortality 1980-84, and an 11% increase in mortality based on individual case review, highlighting the importance of considering terminations in mortality analyses.

Obtaining gestational data of acceptable validity on whole populations is a considerable challenge, which must be met in order to further epidemiological investigation involving perinatal factors. As the means of estimating gestational duration multiply, routinely available population data pertaining to gestational duration may be conflicting. This exacerbates its reputation for unreliability, which is due primarily to the generally occult nature of conception and secondly to the propensity for data entry errors of the data from which gestational duration is estimated. However, the key to improving reliability may paradoxically lie in the increasing variety of methods for estimating gestational duration, because agreement between independent observations increases the reliability that can be placed on estimates of factors that are inherently difficult to measure. This paper demonstrates that the acceptability of population data for gestational duration can be improved by simple rectification of recurring data entry errors and demanding compatibility of two independent estimates of gestational duration. Compared with the previous algorithm that relied primarily on last menstrual period data, the new algorithm, that considers both antenatal and neonatal indicators of gestational duration, decreased the proportion of births in a geographically defined birth cohort 1986-99 (n=354,216) without a gestational estimate, from 0.5% to 0.03%, halved the number of births of >400 g estimated to occur before 20 weeks, and almost eliminated gestational estimates of >45 weeks.

This population-based study determined the impact of co-twin gender on twin intrauterine growth in addition to their infant gender, maternal height, maternal age and parity on intrauterine growth rate of singletons and twins. All singletons and twins born in Western Australia during the period of 1980 to 1995 were considered for the study. The multiple linear regression models showed that 76% of the variance in the mean birthweight was explained by the selected variables for twins and 51% for singletons. Twins grew more slowly than singletons from 26 weeks gestation. Among twins, opposite-sex twin pairs grew consistently faster than like-sex twins. Primiparous twin pairs grew more slowly than subsequently born twins. These regression equations can be used to assess the appropriateness of intrauterine growth in twin pairs of various gender combinations.