To identify antenatal and intrapartum factors contributing to the aetiology of cerebral palsy (CP).
A case-control study using moderate/severe cases of cerebral palsy identified from the Victorian Cerebral Palsy Register and two controls per case identified through the Victorian Perinatal Data Collection Unit.
A number of previously identified risk factors for CP were confirmed in our data. New observations were (in specific sub-groups): protective effects of mother's negative Rhesus status, cigarette smoking at the first visit and episiotomy and an increased risk of CP associated with an abnormal antenatal cardiotocograph.
Although the result of the deliberate investigation of specific aspects of the antenatal and intrapartum period identified from a pilot study, our new findings must be interpreted with caution as they were not all based on specific a priori hypotheses, although some had been examined by other investigators. We would encourage their evaluation in other data sets.
"Although many factors have been implicated in the genesis of CP, such as low birthweight, preterm birth, and the presence of congenital malformations (Walstab et al. 2002), there has also been substantial interest in thrombophilia as a potentially important risk factor. "
[Show abstract][Hide abstract] ABSTRACT: Fifty-seven children with cerebral palsy (CP) and imaging evidence of vascular thrombosis (study group) and 167 children with CP and other imaging finds (control group)were selected. Sixty-one per cent of the study group were male and 53 (93%) had spastic hemiplegia compared with the control group, of whom 55% were male and 54 (32%) had a diagnosis of spastic hemiplegia. Mean age was 5 years 11 months (SD 5y 1mo) for the study group and 7 years 7 months (SD 4y 7mo) for the control group. Blood spots on Guthrie cards or buccal swabs were used to test both groups and their mothers for the factor V Leiden (fVL) mutation, which predisposes carriers to thrombophilia. Mothers were interviewed to gather antenatal, perinatal, demographic, and socio-economic data. The frequency of the fVL mutation in children with evidence of vascular thrombosis and their mothers was not statistically different from the frequency in children with CP with other imaging findings and their mothers. The frequency of the fVL mutation was significantly higher than the expected population frequency of 4% in the study group (10.5%, p=0.012) and in mothers of the control group (7.2%, p=0.036).
"Substances of abuse include illicit drugs, ethanol, and tobacco. Fetuses exposed to cocaine or cigarette smoke are at risk for neurodevelopmental impairment (Dempsey et al. 2000, Fried and Watkinson 2000, Frank et al. 2001, Singer et al. 2002, Walstab et al. 2002, Fried et al. 2003). The potential adverse effects of substance abuse on the developing visual system are unknown, despite some early studies indicating adverse effects of cocaine or other illicit drugs (Good et al. 1992, Struthers and Hansen 1992, Jan et al. 1996, Tsay et al. 1996). "
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to assess the association between cocaine or cigarette smoke exposure in utero and visual outcome. A total of 153 healthy infants (89 males, 64 females; gestational age range 34 to 42 weeks) were prospectively enrolled in a masked, race-matched study. Quantitative analyses of urine and meconium were used to document exposure to cigarette smoke and cocaine. Infants with exposure to other illicit drugs, excepting marijuana, were excluded. At 6 weeks of age, grating acuity and visual system abnormalities (VSA; eyelid oedema, gaze abnormalities, and visual inattention) of 96 infants from the original study sample were assessed with the Teller acuity card procedure and a detailed neurological examination. Neither cocaine nor cigarette smoke exposure was associated with acuity or VSA. However, VSAs were associated with abnormal neurological examination, independent of drug exposure and other risk factors (odds ratio 7.9; 95% confidence interval 2.0 to 31.5;p=0.004). This unexpected finding could prove a helpful clinical marker for the infant at risk for neurological abnormalities.
"Other associations with cerebral palsy include prolonged rupture of the membranes in infants of all gestations (Nelson and Ellenberg 1985) and in preterm babies (Murphy et al 1995), the presence of meconium stained fluid (Spinillo et al 1998b, Walstab et al 2002) and tight nuchal cord (Nelson and Grether 1998b). "
[Show abstract][Hide abstract] ABSTRACT: Cerebral palsy is the commonest physical disability in childhood, occurring in 2.0 to 2.5 per 1000 live births. Although the total number of children with cerebral palsy has remained stable or increased slightly since 1970, there has been a consistent rise in the proportion of cerebral palsy associated with preterm and very preterm births. Known causes of cerebral palsy--whether prenatal, perinatal or postnatal--must be distinguished from risk factors or associations. Much is known about such risk factors which, alone or in combination, may indirectly result in cerebral palsy. Causes and risk factors implicated in cerebral palsy are discussed in detail, together with directions for future research.
The Australian journal of physiotherapy 02/2003; 49(1):7-12. DOI:10.1016/S0004-9514(14)60183-5 · 3.48 Impact Factor
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