Potentially asphyxiating conditions and spastic cerebral palsy in infants of normal birth weight☆☆☆★★★ (original) (raw)
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Antenatal and Perinatal Antecedents of Moderate and Severe Spastic Cerebral Palsy
The Australian and New Zealand Journal of Obstetrics and Gynaecology, 1998
EDITORIAL COMMENT Motor vehicle drivers know they can, inadvertently of course, with their vehicles, kilf or maim; obstetricians, rightly or wrongl.y, largely believe that they can do the same -why else the emphasis on detection, interpretation and timely intervention (e.g. prompt delivery often by Caesarean section) when there is fetal distress (clinical or cardiotocographic) in labout; and employment of nontraumatic delivery when labour is obstructed. Is this analogy simplistic, ,false andor naive? This journal has published a consensus statement (A) from an authoritative team of panel members from all the relevant disciplines that concluded that 'while obstetric interventions in the presence of signs of possible hypoxia may prevent fetal death, there is no evidence that it will limit the prevalence or severity of cerebral palsy 'and that 'all expert witnesses and the public, should recognize that the belief that Caesarean section will prevent many cases of cerebral palsy is incorrect?' Where dear reader do you stand? This paper unequivocally concludes that in cases of moderate and severe spastic cerebral palsy in nonmalformed iilfants of birth-weights 22,500 g intrauterine hypoxidbirth asphyxia was associated with an increased risk of cerebral palsy (adjusted odds ratio 18.1). This finding was derived from the study of clinical items coded on perinatal forms, completed by midwives shortly after delivery, and gathered from the computerized data of the Victorian Perinatal Data Collection Unit, with appropriate matched controls from the same source. The authors have stressed that this set of data they have analyzed 'was collected as part of routine data collection f o r perinatal morbidity and mortality surveillance not epidemiological research into aetiology of cerebral palsy '. They have stated that intrauterine hypoxidirth asphyxia could reflect 'a perinatal event, or unmasking of the effects of antenatal influences'. We encourage the authors' plan to collect data from the actual clinical histories of cases and controls to obtain more specific information on potential risk factors and to investigate 'which are causal and which are the result of the event which caused the cerebral palsy? ' Norman A. Beischer Me1 bourne (A) Maclennan A, Stanley F, Blair E et al. Consensus statement on the ongins of cerebral palsy. Aust NZ J Obstet Gynaecol 1995; 35: 127-131.
Adverse obstetric events are associated with significant risk of cerebral palsy
American Journal of Obstetrics and Gynecology, 2010
OBJECTIVE-To examine adverse birth events on the development of cerebral palsy (CP) in California. STUDY DESIGN-A retrospective population-based study of children with CP (as of 11/31/2006), matched to their maternal/infant delivery records (1/1/1991 to 12/31/2001) was performed. Demographic data and intrapartum events were examined. Six adverse birth related events were chosen. Children without CP were controls. RESULTS-7242 children had CP (59% term) and 31.3% had one or more of the six adverse intrapartum events (12.9% in controls P< 0.0001). This held for both term (28.3% v. 12.7% controls) and preterm (36.8% v. 15.9%, controls) neonates (both P< 0.0001). Maternal (15.1% v. 6.6%) and neonatal (0.9% v, 0.1%) infection were increased in CP cases (P< 0.0001). CONCLUSION-Almost 1/3 of children with CP had at least one adverse birth-related event. Higher rates in the preterm group may partially explain the higher rates of CP in this group.
BJOG : an international journal of obstetrics and gynaecology, 2014
To determine the extent of cerebral palsy attributable to adverse obstetric events, and estimate the lifetime mortality and morbidity expectations of these individuals relative to age-matched members of the UK general population. Simulation model. All projected live births during 2014. Using published data regarding the incidence and aetiology of cerebral palsy, we simulated the outcomes of a hypothetical cohort of UK live births. Survival and quality of life (QoL) for those with cerebral palsy were compared with age-matched individuals representative of the UK general population, in order to estimate the number of quality-adjusted life years (QALYs) lost following asphyxia-related cerebral palsy. Incidence of asphyxia-related cerebral palsy, QALYS, QoL, and survival. A total of 207 (95% CI 169-245) cases of asphyxia-related cerebral palsy were projected amongst UK children born during the year 2014, with approximately 15.2 QALYs lost per case. If these results held true in a real b...
Risk factors for cerebral palsy in children born at term
Acta Obstetricia et Gynecologica Scandinavica, 2011
Two of every 1000 live-born children develop cerebral palsy (CP). The aetiology of CP is often unclear and because CP is a symptom complex rather than a disease, clinically defined at 4-5 years of age, it is not surprising that there are considerable problems associated with epidemiological studies of its aetiology. The only reason for the CP concept is that it emanates from an insult to a growing, developing brain and a dynamic clinical picture from static pathology. Evidence suggests that 70 -80% of CP cases are due to prenatal factors and that birth asphyxia plays a relatively minor role (, 10%). Some antenatal risk factors are repeatedly observed to be related to CP: low gestational age, male gender, multiple gestation, intrauterine viral infections and maternal thyroid abnormalities. Recently, intrauterine infection/inflammation with a maternal response (consisting of chorioamnionitis) and a fetal inflammatory response (consisting of funicitis or elevated interleukin-6 in fetal plasma) has been found to be related to white matter injury and CP. Some risk factors are associated with CP at all gestational ages whereas others mostly affect term or preterm infants, e.g. intrauterine growth restriction seems to be a risk factor in term infants. There also seems to be an association between autoimmune and coagulation disorders and CP.
Antenatal and Intrapartum Risk Factors for Cerebral Palsy in Term and Near-term Newborns
Archives of Iranian medicine
Cerebral palsy (CP) is one of the main disabilities in term-born infants. This study attempts to investigate the maternal and neonatal factors associated with CP. This case-control study consisted of singleton term and near-term (36 or more weeks of gestation) newborns in Tehran health-care centers and was conducted over a 24-month period. Logistic regression analysis analyzed the data with SPSS 16.0. During the study period there were 53 infants in the case group and 106 in the control group. The main factors associated with CP were perinatal asphyxia [odds ratio (OR): 97.72; CI: 21.2-450.07], maternal age >35 years (OR: 20.89; CI: 1.05-412.62), and high risk pregnancy (OR: 0.2; CI: 0.04-0.932). Several maternal, antenatal and intrapartum factors increase the risk for CP. Identifying and avoiding risks for CP may lead to lower infant neurologic morbidity.
Cerebral Palsy risk factors associated with pregnancy and delivery
GPH International Journal, 2023
Objective: To identify and analyze the risk factors associated with pregnancy and delivery that contribute to the development of cerebral palsy in children. Material and Methods: To better understand what factors lead to cerebral palsy in children, a cross-sectional study was conducted at the CRP pediatric hospital in Savar, Dhaka. The study's sample size of 56 was reached by a convenience sample of mothers of children with cerebral palsy. In-person interviews were conducted utilizing a survey instrument translated into Bengali or the native tongue and then pilot tested. Excel and SPSS were used for statistical analysis. Informed consent and confidentiality were ensured under ethical guidelines. Results: The data shows past socioeconomic variables. Population age distribution: 37.50% 29-35. 88.1% were Muslim. 59% rural residential areas. 35.70% SSC education. 85.7% had two or more children, 45.6% under three. 55% were males, 45% female. 41% of pregnancies had issues, and 24.9% of women underwent abortions. Normal births were 51.80% and cesarean sections 48.20%. Post-birth statistics included crying immediately (34%), yellowish eyes (50%), fever with seizures (61%), head injuries (48%), and birth hypoxia (38%). 35.70% were born at home, 30.40% in hospitals (17.90% public, 16.10% private). Figure 3 showed hypertension (20%), diabetes (16%), and anemia (23%). Age, religion, education, number of children, past abortions, delivery method, and birthplace were correlated. Diabetes, hypertension, anemia, and birthplace were unrelated. Conclusion: Awareness of cerebral palsy is poor despite its prevalence. In developed country physiotherapy is considered as an important treatment for cerebral palsy children. Quantitative research was used to survey pediatric patients and identify risk variables in this study. Factors shared by many were old age, illiteracy, and origins in rural areas. Risk recognition and mitigation must be prioritized.
Antenatal antecedents of moderate and severe cerebral palsy
Paediatric and Perinatal Epidemiology, 1995
Aetiological relationships between cerebral palsy, preterm birth, small-for-gestational-age (SGA) birth and selected feto-maternal factors were investigated in a case-control study of all moderate and severe cerebral palsy cases born in Western Australia between 1980 and 1986 (n = 215). Cases were individually matched to three controls of the same gender and plurality born in the same year. Two of the controls were matched to the index cases for gestational age, one of which was also matched for birthweight. Pre-eclampsia and urinary tract infections were not significantly associated with cerebral palsy. The significant association of anteparturn haemorrhage with cerebral palsy was accounted for by its associations with preterm birth. Congenital malformations and non-cerebral palsy neurological disorder were significantly associated with cerebral palsy; these associations were only partially accounted for by adjusting for preterm birth and small-for-gestational-age birth. This study shows that some of the risk of cerebral palsy associated with the antenatal antecedents of some common feto-maternal factors is mediated through preterm birth, confirming the importance of interrelationships between antenatal antecedents in the aetiology of some cerebral palsy. Perinatal and post-neonatal causes now account for only around 20% of all cerebral palsy. Future reductions in cerebral palsy incidence may therefore depend on acquiring greater knowledge of interrelationships between antenatal antecedents.