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Cerebral palsy rates fall amid healthcare advances
New research finds its birth prevalence has dropped by a third in 20 years, with GPs playing a crucial role in screening and antenatal care.
Around 3.4% of children with cerebral palsy live in remote or very remote areas.
Australia’s birth prevalence of cerebral palsy has dropped from 2.1 to 1.5 cases per 1000 live births over 20 years, but those living remotely are still being disproportionately impacted.
Those are the findings of a new study, published in the Medical Journal of Australia, which analysed data from 10,855 children with cerebral palsy born in Australia between 1995 and 2016.
It found the birth prevalence of pre‐ or perinatally acquired cerebral palsy fell from 2.0 to 1.4 cases per 1000 live births over the same period.
‘The birth prevalence of cerebral palsy declined markedly in Australia during 1995–2016, reflecting the effects of advances in maternal and perinatal care,’ the study concluded.
‘Our findings highlight the need to provide equitable, culturally safe access to antenatal services for women, and to health and disability services for people with cerebral palsy, across Australia.
‘Equity of access to disability services across Australia should be a priority.’
RACGP Specific Interests Child and Young Person’s Health Chair Dr Tim Jones said while there is still work to be done, this decline in diagnosis gives him hope families will continue seeing better outcomes for their children.
‘As GPs, we are so well placed to pick this condition up early because we have the ability to deliver continuous monitoring in that first year of life,’ he told newsGP.
‘It’s a sensitive topic – there’s a lot of stigmas around cerebral palsy and it’s one of those feared terms that can be mentioned if you’re thinking about it in a child, so we have to approach it cautiously.
‘When we’re touching base with our parents antenatally, it’s so important to talk about routine developmental surveillance, and in particular, regular developmental checks with a new baby, and really making sure no one gets lost, because in a busy system, that still happens.’
Dr Ka-Kiu Cheung, Chair of RACGP Specific Interests Antenatal and Postnatal Care, said the changing diagnosis rates come alongside changes in medicine and approaches to pregnancy care in recent years.
‘We used to do a lot more care towards the end of pregnancy, a lot more scans, and tests, and monitoring, but that whole pyramid is now starting to invert,’ she told newsGP.
‘Now, we’re actually doing a lot more screening and intervention at the start of pregnancy to try and prevent things like preterm birth and early preeclampsia.
‘Definitely, there’s more and more in our space to be aware of as GPs because there’s a big difference between a baby who’s born at 28 weeks versus one who is born at 37 weeks.’
The study also revealed that 3.4% of children with cerebral palsy live in remote or very remote areas, a larger proportion than for all Australians, which is 2.0%.
The proportion of children in these areas who required wheelchairs for mobility was 31.3%, compared to 26.1% in major cities or regional areas.
‘These findings highlight the need to further investigate the role of remoteness and to strive for equitable and culturally safe access across Australia to antenatal services for women, and to health and disability services for people with cerebral palsy,’ the research said.
Dr Cheung said systemic changes are needed to help those GPs offer the highest quality care possible to their pregnant patients.
‘What previously was just blood pressure checks and a listen to baby has now become really complex consultations around personalising risks for a woman, instituting appropriate screening after you do counseling, planning management with a woman and her family,’ she said.
‘That complexity has really made that 15-minute consultation hard, because often you either need multiple consultations to get through that information, or it’s easily a one-hour conversation if you have it all in one go.
‘We really need to think about how we fund GPs to do that really important work, but also enable all GPs to feel confident doing that work.’
Moving forward, Dr Jones said it is important GPs remember that given the right support, children diagnosed with cerebral palsy have ‘even more ability to heal, repair, and recover’.
‘Having a team matters, and the most important thing to recognise is that cerebral palsy is a complicated diagnosis to make – but don’t wait,’ he said.
‘If you’re not sure, ask your colleagues, ask a friend, but absolutely get that child assessed and appropriately supported, and make sure the parents know that you’re acting.
‘Our rehabilitation teams are working really hard to get those good outcomes, but they don’t have the resources they need, so build those links as GPs to delivers good paediatric rehabilitation in your area.’
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