Respiratory disease in cerebral palsy: the overlooked impact of neonatal lung disease

Background Respiratory disease is a leading cause of hospitalisations in children with cerebral palsy (CP). Over 40% of individuals with CP are born preterm; however, the relationship between prematurity, CP and respiratory disease is unknown. Objectives To establish the impact of gestational age (GA) and bronchopulmonary dysplasia (BPD) on respiratory hospitalisations in children with CP. Study design A 30-year (1986–2015) retrospective data linkage cohort study in children with CP. Results A total of 1915 individuals with CP (mean age 15 years and 5 months, 57% male) recorded 5566 respiratory admissions. Higher rates of respiratory admissions were seen in those born preterm (<37 weeks). Preterm infants with CP and BPD had 4.4 (incidence rate ratio 95% CI 3.3 to 6.0) times more respiratory-related admissions (after controlling for age, CP severity, epilepsy, speech impairment and gastrostomy) compared with individuals with CP born at term. Preterm infants with CP and BPD had respiratory-related hospitalisations at a younger age (median: 2 years 4 months vs term birth 20 years, p<0.001). Conclusion Preterm birth and BPD are risk factors for earlier and higher rates of respiratory-related admissions in individuals with CP. Perinatal and neonatal events should be considered when assessing respiratory health in CP.