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COMPROMISED BABY
CAUSATION
Author Freeman
JM; Nelson KB
Institution Department of Neurology, Johns Hopkins
Medical Institution, Baltimore, Maryland.
Title Intrapartum asphyxia
and cerebral palsy.
Source Pediatrics 1988 Aug; 82 (2): p240-9
ISSN 0031-4005
Abstract Signs of presumed hypoxia/asphyxia
of the fetus are not uncommon and can be detected during labor, in the delivery
room, and during the early neonatal period. Virtually no single sign or symptom
has sufficient correlation to enable prediction of later cerebral palsy with a
reasonable degree of medical certainty. To attribute cerebral palsy to prior asphyxia
with reasonable certainty, there must be evidence that a substantial hypoxic injury
occurred and that a sequence of events ensued which would prove the clinical impact
of that hypoxic insult. Few cases of cerebral palsy meet these criteria.
Author Blair
E; Stanley FJ
Institution National Health and Medical Research Council
Research Unit in Epidemiology and Preventive Medicine, Queen Elizabeth II Medical
Centre, Nedlands, Western Australia.
Title Intrapartum asphyxia:
a rare cause of cerebral palsy [published erratum appears in J Pediatr 1988 Aug;
113(2):420] [see comments]
Source J Pediatr 1988 Apr; 112 (4): p515-9
ISSN 0022-3476
Abstract Data on all children with spastic
cerebral palsy (N = 183) and on a matched group of control children (N = 549)
born in Western Australia between 1975 and 1980 were compared to investigate the
relationship between birth asphyxia and spastic cerebral palsy. Information on
perinatal events for both the children with cerebral palsy and the control subjects
was collected by means of epidemiologic methods to reduce bias. An association
between clinically observed perinatal signs of birth asphyxia and spastic cerebral
palsy was found (relative risk 2.84; 95% confidence interval 1.85 to 4.37). The
population-attributable risk proportion was 14.1%. The likelihood of birth asphyxia's
causing perinatal brain damage was assessed by two independent observers using
defined criteria. It was estimated that in only about 8% (15/183) of all the children
with spastic cerebral palsy was intrapartum asphyxia the possible cause of their
brain damage. The contribution of intrapartum events and obstetric mismanagement
to overall cerebral palsy rates is probably less than was previously thought.
Author Paneth
N
Institution Program in Epidemiology, College of Human Medicine,
Michigan State University, East Lansing.
Title The causes of cerebral
palsy. Recent evidence.
Source Clin Invest Med 1993 Apr; 16 (2):
p95-102
ISSN 0147-958X
Abstract Cerebral palsy (CP),
unlike many other neurodevelopmental disorders, is associated with abnormalities
of pregnancy and birth, particularly 'birth asphyxia' and low birthweight. Associations,
however, need not be causal, and some prenatally damaged infants manifest clinical
signs suggestive of birth asphyxia in the perinatal period. The lack of a clinically
reliable indicator of impaired fetal-placental gas exchange limits our confidence
that birth asphyxia plays a true causal role in cerebral palsy. Premature delivery
is the single most important antecedent of cerebral palsy, and the increase in
survival of very small infants resulting from newborn intensive care may augment
this contribution in the future. Cranial ultrasound imaging can describe patterns
of neonatal brain damage in the low birthweight infant that are highly predictive
of later cerebral palsy. Future research on the causes of cerebral palsy may benefit
from improvements in the neurological assessment of the fetus prior to labor and
from a clearer understanding of the role of endocrine factors, particularly thyroid
disorders, in neurologic development.
Author Anslow
P
Institution Department of Neuroradiology, The Radcliffe Infirmary
NHS Trust, Oxford, UK.
Title Birth asphyxia.
Source Eur
J Radiol 1998 Jan; 26 (2): p148-53
ISSN 0720-048X
Abstract The
term birth asphyxia covers a number of clinical and physiological definitions.
Birth asphyxia is a relatively common clinical event. In the majority of cases
the outcome in terms of brain damage and future development of the child is excellent.
However, a small number of children go on to develop patterns of brain damage
which are then associated with disability. The article seeks to provide a basic
understanding of the various mechanisms involved in producing injury.
Author Schneider
H
Institution Universitats-Frauenklinik, Bern, Switzerland.
Title -Neonatal asphyxia as the cause of brain damage in children?-.
Vernacular Title [Geburtsasphyxie als Ursache kindlicher Hirnschaden?]
Source Arch Gynecol Obstet 1995; 256 Suppl:S32-42
ISSN 0932-0067
Abstract The prevalence of cerebral palsy (CP) has increased over the
last 15 years in most countries. This is explained by an improved survival of
very low birth weight prematures. In term infants birth asphyxia is of minor significance
as a cause for CP. In only 10% of all CP cases following delivery at term, birth
asphyxia must be discussed as a possible cause. In premature deliveries events
during the perinatal period are of greater significance for the later development
of a CP. Only severe forms of oxygen deficit, leading to tissue damage in the
brain and other organs with clinical symptoms during the first days of life, are
of significance for the long term prognosis. Even in the presence of severe birth
asphyxia the causal relationship with a psychomotor handicap is not proven, since
brain damage may have developed during pregnancy before the onset of labour and
may be the cause of birth asphyxia. Brain damage and birth asphyxia may be the
result of a common pathology of pregnancy.
Author Yudkin
PL; Johnson A; Clover LM; Murphy KW
Institution Nuffield Department
of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford, UK.
Title Assessing
the contribution of birth asphyxia to cerebral palsy in term singletons.
Source Paediatr
Perinat Epidemiol 1995 Apr; 9 (2): p156-70
ISSN 0269-5022
Abstract In
a geographically-based study, we investigated the risk of cerebral palsy following
intrapartum asphyxia at term, and the contribution of intrapartum asphyxia at
term to the overall rate of cerebral palsy. We used stringent criteria for identifying
intrapartum asphyxia, while recognising that the initial hypoxial insult might
have occurred in the antenatal period. In the first part of the investigation,
a cohort of 160 term, singleton infants, with a low ( or = 3) 1-minute Apgar score,
was followed to the age of 5 years. Six infants in the cohort had presumed intrapartum
asphyxia, of whom two died in the neonatal period, three had spastic quadriparesis,
profound developmental delay and visual impairment, and one was unimpaired. The
frequency of cerebral palsy associated with birth asphyxia was estimated as one
in 3700 full-term livebirths. To assess the impact of birth asphyxia on the overall
rate of cerebral palsy, all cases of cerebral palsy born in the study period were
identified. Of the 30 cases, the three identified in the follow-up study were
the only ones whose impairment could be attributed to birth asphyxia in a full-term
birth. Birth asphyxia at term therefore was associated with 10% [95% confidence
interval (CI) 2.1, 26.5] of all cases of cerebral palsy and with 20% (95% CI 4.3,
48.1) of the 15 cases of cerebral palsy in children born at term.
Author Breart
G; Rumeau-Rouquette C
Institution Inserm unite 149, Paris, France.
Title [Cerebral palsy and perinatal asphyxia in full term newborn infants]
Vernacular Title [Infirmite motrice cerebrale et asphyxie perinatale
chez l'enfant ne a terme.]
Source Arch Pediatr 1996 Jan; 3 (1):
p70-4
ISSN 0929-693X
Abstract Actual data on the frequency
of cerebral palsy (CP) and "infirmite motrice cerebrale" (IMC), and their relationship
with perinatal asphyxia and perinatal managements, are presented. In France, the
frequency of IMC at 9 years of age, approximates 1 per thousand, for the 1972,
1976, 1981 generations. Three surveys, two English and one Australian, show an
association between perinatal asphyxia and CP. However computation of percent
attributable risk indicates that asphyxia can explain only one case of CP out
of six among term neonates. These surveys show also that 10% of CP only could
be prevented by improving perinatal managements. This, in addition to other factors
such as the increase in survival of very preterm babies, explains the absence
of a significant reduction of CP frequency despite improvements in the perinatal
care.
Author Nelson
KB; Ellenberg JH
Title Antecedents of cerebral palsy. Multivariate
analysis of risk.
Source N Engl J Med 1986 Jul 10; 315 (2): p81-6
ISSN 0028-4793
Abstract We examined prenatal and perinatal
factors predicting cerebral palsy, using multivariate analysis to investigate
which factors were most important and the proportion of cases for which they accounted.
Maternal mental retardation, birth weight below 2001 g, and fetal malformation
were among the leading predictors. Breech presentation was also a predictor, but
breech delivery was not. A third of the children with cerebral palsy who had breech
presentations had a major noncerebral malformation. Among 189 children with cerebral
palsy, 40 (21 percent) had at least one of three clinical markers suggestive of
asphyxia; only 17 of these 40 children (9 percent of all cases) lacked major congenital
malformation or other intrinsic defects that might have contributed to an unfavorable
outcome. When all the principal risk factors present by the time labor began were
considered, the 5 percent of the population at highest estimated risk was seen
to have contributed 34 percent of the cases. When all the risk factors present
during the period beginning before pregnancy and extending through the nursery
stay were included, the 5 percent at highest risk was seen to have contributed
37 percent of the cases. Thus, the inclusion of information about the events of
birth and the neonatal period accounted for a proportion of cerebral palsy only
slightly higher than that accounted for when consideration was limited to characteristics
identified before labor began.
Author Blair
E; Stanley FJ
Institution National Health and Medical Research Council
Research Unit in Epidemiology and Preventive Medicine, Queen Elizabeth II Medical
Centre, Nedlands, Western Australia.
Title Intrapartum asphyxia:
a rare cause of cerebral palsy [published erratum appears in J Pediatr 1988 Aug;
113(2):420] [see comments]
Source J Pediatr 1988 Apr; 112 (4): p515-9
ISSN 0022-3476
Abstract Data on all children with spastic
cerebral palsy (N = 183) and on a matched group of control children (N = 549)
born in Western Australia between 1975 and 1980 were compared to investigate the
relationship between birth asphyxia and spastic cerebral palsy. Information on
perinatal events for both the children with cerebral palsy and the control subjects
was collected by means of epidemiologic methods to reduce bias. An association
between clinically observed perinatal signs of birth asphyxia and spastic cerebral
palsy was found (relative risk 2.84; 95% confidence interval 1.85 to 4.37). The
population-attributable risk proportion was 14.1%. The likelihood of birth asphyxia's
causing perinatal brain damage was assessed by two independent observers using
defined criteria. It was estimated that in only about 8% (15/183) of all the children
with spastic cerebral palsy was intrapartum asphyxia the possible cause of their
brain damage. The contribution of intrapartum events and obstetric mismanagement
to overall cerebral palsy rates is probably less than was previously thought.
Author Bohr
L; Greisen G
Institution Neonatalklinikken GN, H:S Rigshospitalet,
Juliane Marie Centret.
Title [Prognosis after perinatal asphyxia
in full-term infants. A literature review]
Vernacular Title [Prognosen
for mature nyfodte med perinatal asfyksi. En litteraturgennemgang.]
Source Ugeskr
Laeger 1998 May 4; 160 (19): p2845-50
ISSN 0041-5782
Abstract Reviewing
the literature published during the last 30 years we found comparable systematic
studies of outcome for 1042 term infants born alive after likely intrapartum hypoxia-ischaemia.
Fifty-two percent had no sequelae, 8% had developmental delay without associated
handicaps, 4% had a single handicap, 11% were multihandicapped and 14% were dead
as a consequence of the intrapartum hypoxia-ischaemia. The frequency of single
handicaps exceeded the frequency found among the controls and in population studies.
The frequency of children with developmental delay did not differ from that found
among the controls. Outcome is closely related to the severity of hypoxic-ischaemic
encephalopathy in the newborn.
Author Nelson
KB; Grether JK
Institution Neuroepidemiology Branch, National Institute
of Neurological Disorders and Stroke, Bethesda, Maryland, USA.
Title Potentially
asphyxiating conditions and spastic cerebral palsy in infants of normal birth
weight.
Source Am J Obstet Gynecol 1998 Aug; 179 (2): p507-13
ISSN 0002-9378
Abstract OBJECTIVE: Our purpose was to
examine the association of cerebral palsy with conditions that can interrupt oxygen
supply to the fetus as a primary pathogenetic event. STUDY DESIGN: A population-based
case-control study was performed in four California counties, 1983 through 1985,
comparing birth records of 46 children with disabling spastic cerebral palsy without
recognized prenatal brain lesions and 378 randomly selected control children weighing
or = 2500 g at birth and surviving to age 3 years. RESULTS: Eight of 46 children
with otherwise unexplained spastic cerebral palsy, all eight with quadriplegic
cerebral palsy, and 15 of 378 controls had births complicated by tight nuchal
cord (odds ratio for quadriplegia 18, 95% confidence interval 6.2 to 48). Other
potentially asphyxiating conditions were uncommon and none was associated with
spastic diplegia or hemiplegia. Level of care, oxytocin for augmentation of labor,
and surgical delivery did not alter the association of potentially asphyxiating
conditions with spastic quadriplegia. Intrapartum indicators of fetal stress,
including meconium in amniotic fluid and fetal monitoring abnormalities, were
common and did not distinguish children with quadriplegia who had potentially
asphyxiating conditions from controls with such conditions. CONCLUSION: Potentially
asphyxiating conditions, chiefly tight nuchal cord, were associated with an appreciable
proportion of unexplained spastic quadriplegia but not with diplegia or hemiplegia.
Intrapartum abnormalities were common both in children with cerebral palsy and
controls and did not distinguish between them.
Author Depp
R
Institution Department of Obstetrics and Gynecology, Jefferson
Medical College, Philadelphia, PA 19107, USA.
Title Perinatal asphyxia:
assessing its causal role and timing.
Source Semin Pediatr Neurol
1995 Mar; 2 (1): p3-36
ISSN 1071-9091
Abstract Perinatal
asphyxia, whether prenatal, intrapartum, or neonatal is thought to be a significant
contributor to newborn morbidity and mortality as well as long-term neurological
deficits. Development of an intrapartum tool/test that can reliably identify and
discriminate between varying degrees of fetal acidemia and suggest whether it
is respiratory or metabolic in nature would be highly desirable. This article
critically reviews the available experience with the currently available monitoring
techniques and the significance of abnormalities of fetal and intrapartum measurements
with respect to the predictive value of the observations available to the clinician.
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