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PRU-MHC: Policy Research Unit in Maternal Health & Care (2010 - 2018)

4Child - Monitoring rates of cerebral palsy, particularly in high risk subgroups

This was a long-term programme of work arising from 4Child - Four counties database of cerebral palsy, vision loss and hearing loss in children.4Child was one of only three active registers in the UK that carried out surveillance and monitoring of cerebral palsy which had a continuous unbroken data collection since the 1980s. Until closure of the register we provided annual surveillance reports of rates of cerebral palsy overall and in particular high risk subgroups including low birth weight infants and children born as one of a multiple pregnancy. We also provided surveillance reports of rates of vision loss and hearing loss in children (see project 1.1.8). Following on from the five years funding to 4Child under the Department of Health Disease Active Research Registers Initiative, funding for two further years, to March 2010, has been obtained from the Department of Health managed by the Healthcare Quality Improvement Partnership (HQIP).

In addition to surveillance and monitoring activities the data from 4Child were used in various research projects including the DPhil work of Dr Chris Morris. For this project a sample of children with cerebral palsy was draw from 4Child as the basis of a survey population. Children and their parents were sent a questionnaire which was used to answer a series of research questions including: whether the abilities of children with cerebral palsy explain their activities and participation in social situations; a comparison of professionals' and families' classification of gross motor function using the GMFCS; and an assessment of the reliability of the Manual Ability Classification System. Recent work has included a capture-recapture study of cerebral palsy to assess the completeness of the register. A paper from this analysis has been submitted for publication. Data from the register have also been used in a study to examine the relationship between the target time for decision to delivery interval for emergency caesarean section and outcomes for the neonate and at three years; a paper from this analysis has also been published.

Data about cerebral palsy from 4Child are anonymously pooled with data from the other UK cerebral palsy registers under the auspices of the UKCP collaboration (see projects 1.1.10 and 1.1.11).4Child also contributes data to a European-wide collaboration in which data are anonymously pooled across European partner cerebral palsy registers (SCPE). One major advantage of the SCPE collaboration is the ability to approach questions about small sub-groups of children with cerebral palsy for whom individual registers have insufficient numbers to conduct research, for example extremely low birthweight infants (see publication 2007-03).

During 2009 and 2010 we have been unsucessful in trying to obtain further funding for the continuation of the 4Child register. As a consequence the 4Child register ceased operations and closed to the registration of new cases on 31st Januayr 2011. The register had been in operation since its inception in 1984. Over 100 peer reviewed publications and annual reports each year have been produced from the register. These published outputs have made an important contribution to our understanding of the causes and consequence of cerebral palsy, vision loss and hearing loss. The register data will still be available for analyses and future studies and we shall continue to contribute to the SCPE and UKCP collaborations.

NPEU Contact:
Jenny Kurinczuk (