On the origin and preventability of Cerebral Palsy: Epidemiologic evidence

Chercheur: Karine B. Nelson, MD, PhD

For a long time it was thought that birth asphyxia was the major cause of cerebral palsy (CP), and an important cause also of other developmental disorders in children.  Evidence available in early 2006 indicates that asphyxial birth is a minor cause of CP and not a substantial contributor to other neurologic disability in children without CP. Efforts to prevent asphyxia-related CP by the use of electronic fetal monitoring (cardiotocography) in labor have not succeeded in reducing the frequency of CP in any birth weight group, but have been associated with an increased rateof obstetrical intervention including surgical delivery during active labor. Research in the past two decades has identified more common contributors to CP in term and near-term infants, notably perinatal stroke (ischemic occlusion of cerebral arteries in the fetus or newborn) and exposure in utero to infection or inflammation. Recent efforts at secondary prevention of CP in term infants with hypothermia, and primary prevention in very premature infants with administration of MgS04, are encouraging. We have as yet no tools shown to be effective at primary prevention of the small proportion of CP that is related to birth asphyxia.