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Why have we failed to reduce the frequency of cerebral palsy?
1Western Australian Research Institute for Child Health, Princess Margaret Hospital for Children, Subiaco.
Insights
Cerebral palsy rates are not decreasing despite increased obstetric interventions. Rising rates in low birthweight infants correlate with improved survival, and few cases stem from preventable birth asphyxia.
Area of Science:
- Neurology
- Obstetrics
- Pediatrics
Background:
- Cerebral palsy (CP) remains a significant concern in child neurology.
- The role of obstetric care in CP etiology is debated.
- Advances in neonatal care impact CP prevalence in vulnerable populations.
Purpose of the Study:
- To evaluate the impact of obstetric interventions on cerebral palsy rates.
- To investigate the causal link between birth asphyxia and cerebral palsy.
- To assess the effectiveness of fetal monitoring and Cesarean sections in reducing CP.
Main Methods:
- Systematic review of the Western Australian Cerebral Palsy Register and over 150 publications.
- Analysis of studies with sound methodology from countries with modern obstetric practices.
- Examination of population data on cerebral palsy prevalence and obstetric/neonatal interventions.
Main Results:
- Cerebral palsy proportions have not declined despite increased obstetric and neonatal interventions for birth asphyxia.
- Cerebral palsy rates in low birthweight infants are increasing in developed nations, coinciding with higher survival rates.
- Evidence suggests few cerebral palsy cases are caused by birth asphyxia, and these may not be preventable through obstetric care.
Conclusions:
- Increased obstetric and neonatal interventions have not reduced overall cerebral palsy rates.
- Rising CP in low birthweight infants is linked to improved neonatal survival.
- Birth asphyxia is an infrequent cause of CP, and obstetric interventions have limited preventive impact.
Objective:
To review the data on children with cerebral palsy in relation to quality of obstetric care.
Data Sources And Study Selection:
In our Institute, a regular Medline print-out, certain key journals and Current Contents are perused to create an updated computerised file of publications on the epidemiological, aetiological and other aspects of cerebral palsy. For this study we reviewed data from the Western Australian Cerebral Palsy Register, more than 150 publications from which studies were chosen for sound methodology in countries with modern obstetric practices, and recent population data on cerebral palsy.
Data Extraction And Synthesis:
Three major areas were studied to see: (i) if the prevalence of cerebral palsy has fallen with increasing use of obstetric and neonatal interventions aimed at reducing birth asphyxia; (ii) if there is any evidence that cerebral palsy is caused by birth asphyxia; and (iii) if there is any evidence that intrapartum fetal monitoring or caesarean section reduces the prevalence of cerebral palsy.
Conclusions:
We concluded that: cerebral palsy proportions are not falling in spite of significant increases in obstetric and neonatal interventions aimed at reducing asphyxia; cerebral palsy proportions in low birthweight infants are rising in most developed countries, coincident with increases in the neonatal survival of low birthweight babies; few cases of cerebral palsy seem to be caused by birth asphyxia and those that are may not have been preventable by obstetric care; and parents will continue to sue if obstetricians keep promising perfection from obstetric care in the face of 2.0-2.5 cases of cerebral palsy per 1000 children born.