Review of life expectancy in children with cerebral palsy: Should we preserve life in severely disabled children?

Yusra Al-Talib*, Andrew Curran **
Alder Hey Children’s Hospital, University of Liverpool, UK*, Alder Hey Children’s Hospital, University of Liverpool, UK**
Cerebral palsy (CP) is a leading cause of childhood disability in the UK affecting posture, movement and function. Patients with CP have variable life expectancies depending on the severity of the disorder. The preservation of life in these patients has for long been a matter of debate with some even arguing strongly against it. However, a patient’s quality of life may be determined by the level of attention and care provided as opposed to the level of physical impairment caused by CP.

Aim: This literature review aims to determine mortality predictors and life expectancy in CP with a secondary outcome of establishing arguments for the preservation of life in severe forms of childhood CP.
Methods: Key terms were used to search Ovid Medline and PubMed. Limitations included English language and papers published within the last 20 years, and relevant papers were hand-picked.
Results: An overall 20-year survival of 89% (95% CI 87-90%) was found in all forms of non-post-neonatal CP. Significant mortality predictors included poor independent ambulation, severe intellectual impairment and inability to feed which are consistent with severe CP. A 3.4% fall in annual mortality was also noted in severe forms of CP compared to 1% in milder forms.
Conclusion: Severity of disability appears to be the primary determinant of survival in children with CP. Preservation of life in these patients can be justified by the lower mortality rates recently observed in severe forms of CP which may be attributable to the provision of greater care and improved quality of life.
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