Cause Of Cerebral Palsy Research Articles

Perinatal Arterial Ischaemic Stroke In Neonate

Arterial ischemic stroke (AIS) is not uncommon in neonates, but in large part of developing world it has been missed and remains undiagnosed because of lack of resources and insufficient engagement by health care providers. The incidence of ischemic perinatal stroke ranges between 1 in 200 No, to 1 in 5000 births and is reported to be responsible for 30% to 50% of congenital hemiplegic cerebral palsy (CP) who were born at term or late preterm gestations. The true incidence of AIS from the developing world is not known as neuroimaging facilities are available in few centers; most of these cases remain undiagnosed. Over the past decades, ischemic perinatal stroke has emerged as an important cause of brain injury in the perinatal period and remains a leading cause of cerebral palsy. We are reporting a 3 days old male baby who presented with refractory seizures, subsequently diagnosed as arterial ischemic stroke

Neonatal periventricular leukomalacia: current perspectives

Neonatal periventricular leukomalacia: current perspectives Kunal P Ahya,1 Pradeep Suryawanshi2 1Department of Neonatology, Maahi Newborn Care Centre, Rajkot, Gujarat, 2Department of Neonatology, BVDU Medical College, Pune, Maharashtra, India Abstract: Significant advances in the neonatal ICU have improved the survival of extreme premature neonates; with this comes the importance of intact survival. Periventricular leukomalacia (PVL) is the commonest white matter brain injury in preterm infants. It has a typical distribution at the watershed areas adjacent to the lateral ventricles. PVL occurs because of ischemic injury to periventricular oligodendrocytes of the developing brain. It can be detected by cranial ultrasonography (CUS) as initial periventricular echodensities, followed later by cystic formation. Recent magnetic resonance imaging studies have shown that it helps in early visualization of PVL and also detection of non-cystic form of PVL, which is not picked up by CUS. It is the commonest cause of cerebral palsy, intellectual impairment or visual disturbances. Currently, no medical treatment is available for PVL; prevention and close developmental follow-up are the only options. Keywords: periventricular leukomalacia, preterm brain injury, cranial ultrasonography

Neonatal erythropoietin mitigates impaired gait, social interaction and diffusion tensor imaging abnormalities in a rat model of prenatal brain injury

Children who are born preterm are at risk for encephalopathy of prematurity, a leading cause of cerebral palsy, cognitive delay and behavioral disorders. Current interventions are limited and none have been shown to reverse cognitive and behavioral impairments, a primary determinant of poor quality of life for these children. Moreover, the mechanisms of perinatal brain injury that result in functional deficits and imaging abnormalities in the mature brain are poorly defined, limiting the potential to target interventions to those who may benefit most. To determine whether impairments are reversible after a prenatal insult, we investigated a spectrum of functional deficits and diffusion tensor imaging (DTI) abnormalities in young adult animals. We hypothesized that prenatal transient systemic hypoxia-ischemia (TSHI) would induce multiple functional deficits concomitant with reduced microstructural white and gray matter integrity, and tested whether these abnormalities could be ameliorated using postnatal erythropoietin (EPO), an emerging neurorestorative intervention. On embryonic day 18 uterine arteries were transiently occluded for 60min via laparotomy. Shams underwent anesthesia and laparotomy for 60min. Pups were born and TSHI pups were randomized to receive EPO or vehicle via intraperitoneal injection on postnatal days 1 to 5. Gait, social interaction, olfaction and open field testing was performed from postnatal day 25–35 before brains underwent ex vivo DTI to measure fractional anisotropy, axial diffusivity and radial diffusivity. Prenatal TSHI injury causes hyperactivity, impaired gait and poor social interaction in young adult rats that mimic the spectrum of deficits observed in children born preterm. Collectively, these data show for the first time in a model of encephalopathy of prematurity that postnatal EPO treatment mitigates impairments in social interaction, in addition to gait deficits. EPO also normalizes TSHI-induced microstructural abnormalities in fractional anisotropy and radial diffusivity in multiple regions, consistent with improved structural integrity and recovery of myelination. Taken together, these results show behavioral and memory deficits from perinatal brain injury are reversible. Furthermore, resolution of DTI abnormalities may predict responsiveness to emerging interventions, and serve as a biomarker of CNS injury and recovery.

Prevalence of cerebral palsy in Uganda: a population-based study.

Few population-based studies of cerebral palsy have been done in low-income and middle-income countries. We aimed to examine cerebral palsy prevalence and subtypes, functional impairments, and presumed time of injury in children in Uganda. In this population-based study, we used a nested, three-stage, cross-sectional method (Iganga-Mayuge Health and Demographic Surveillance System [HDSS]) to screen for cerebral palsy in children aged 2-17 years in a rural eastern Uganda district. A specialist team confirmed the diagnosis and determined the subtype, motor function (according to the Gross Motor Function Classification System [GMFCS]), and possible time of brain injury for each child. Triangulation and interviews with key village informants were used to identify additional cases of suspected cerebral palsy. We estimated crude and adjusted cerebral palsy prevalence. We did χ2 analyses to examine differences between the group screened at stage 1 and the entire population and regression analyses to investigate associations between the number of cases and age, GMFCS level, subtype, and time of injury. We used data from the March 1, 2015, to June 30, 2015, surveillance round of the Iganga-Mayuge HDSS. 31 756 children were screened for cerebral palsy, which was confirmed in 86 (19%) of 442 children who screened positive in the first screening stage. The crude cerebral palsy prevalence was 2·7 (95% CI 2·2-3·3) per 1000 children, and prevalence increased to 2·9 (2·4-3·6) per 1000 children after adjustment for attrition. The prevalence was lower in older (8-17 years) than in younger (<8 years) children. Triangulation added 11 children to the cohort. Spastic unilateral cerebral palsy was the most common subtype (45 [46%] of 97 children) followed by bilateral cerebral palsy (39 [40%] of 97 children). 14 (27%) of 51 children aged 2-7 years had severe cerebral palsy (GMFCS levels 4-5) compared with only five (12%) of 42 children aged 8-17 years. Few children (two [2%] of 97) diagnosed with cerebral palsy were born preterm. Post-neonatal events were the probable cause of cerebral palsy in 24 (25%) of 97 children. Cerebral palsy prevalence was higher in rural Uganda than in high-income countries (HICs), where prevalence is about 1·8-2·3 cases per 1000 children. Children younger than 8 years were more likely to have severe cerebral palsy than older children. Fewer older children than younger children with cerebral palsy suggested a high mortality in severely affected children. The small number of preterm-born children probably resulted from low preterm survival. About five times more children with post-neonatal cerebral palsy in Uganda than in HICs suggested that cerebral malaria and seizures were prevalent risk factors in this population. Swedish Research Council, Promobilia.

Protocol for hospital based-surveillance of cerebral palsy (CP) in Hanoi using the Paediatric Active Enhanced Disease Surveillance mechanism (PAEDS-Vietnam): a study towards developing hospital-based disease surveillance in Vietnam

IntroductionThe epidemiology, pathogenesis, management and outcomes of cerebral palsy (CP) in low-income and middle-income countries including Vietnam are unknown because of the lack of mechanisms for standardised collection of data....

The study of plasma homocysteine level as a risk factor for ischemic strokes in young patients

Background: According to the WHO, stroke is second leading cause of death for people above the age of 60 years &amp; fifth leading cause in people aged 15 to 59 years old. Each year, nearly six million people worldwide die from stroke. One in six people worldwide will have a stroke in their lifetime. Approximately one-quarter of 45-year-old men will have a stroke before they reach the age of 85. Stroke is also important condition in young people and can occur at any age, including in utero, neonatal period (it is the major cause of cerebral palsy), childhood and young adult life. One-quarter of all strokes occur in people below the age of 65.Methods: This prospective observational case control study was carried on 30 young ischemic stroke patients with 30 control match persons over a period of 20 months, from December 2011 to August 2013 at Tertiary Care Hospital Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India.Results: Total plasma fasting homocysteine level in case group was 30.10±14.8 µmol/L and control group was 13±5.3 µmol/L, (p=0.001). Elevated fasting homocysteine level was found in 76.66. 0% of ischemic stroke cases and in 10% of healthy controls (p=0.001). Serum homocysteine levels were higher in subjects having risk factors such as dyslipidemia (p value &lt;0.001), active lifestyle (p value &lt;0.05) and smoking (p value&lt;0.05). Serum homocysteine did not show any significant relation with age, sex, diabetes mellitus, diet pattern and defective coagulation (p value &gt;1).Conclusions: The present study revealed that hyperhomocysteinemia appears to be an important risk factor for young ischemic strokes. It is therefore important to use serum homocysteine level as an important tool to investigate all cases of young ischemic strokes and also in those who are at risk of developing it. Significant correlation has been found between homocysteine concentration and young ischemic strokes.

CUIDANDO DE UM FILHO COM DIAGNÓSTICO DE PARALISIA CEREBRAL: SENTIMENTOS E EXPECTATIVAS

Este estudo objetivou compreender a experiência da maternidade em mulheres que são mães de um filho com diagnóstico de Paralisia Cerebral. Participaram 26 mães, que responderam a uma entrevista semiestruturada. A Análise Textual Qualitativa da entrevista resultou nas categorias: “o momento do diagnóstico”; “a percepção em relação à maternidade”; “preocupações, dificuldades e desejos” e “expectativas para o futuro”. Elas atribuíram a causa da Paralisia Cerebral ao erro médico ou à negligência dos profissionais da saúde durante o pré-parto e o parto, à precariedade de recursos do hospital ou à própria responsabilidade. Entre as preocupações, estão o temor de adoecer e morrer, a falta de capacitação de profissionais da saúde, o receio de que o filho sofra algum tipo de exclusão na escola e a necessidade de promover o máximo de autonomia. Quanto às dificuldades, elas apontaram que o transporte público para locomoção dos seus filhos, as situações em que o filho não é bem aceito ou sofre preconceitos, as críticas recebidas em relação ao cuidado exercido e a falta de respeito por parte das pessoas nas ruas. Quanto às expectativas sobre o futuro, as mães salientaram a aspiração de poder trabalhar, voltar a estudar, investir no cuidado pessoal e dispor de momentos de lazer. O exercício da maternidade requer constante adaptação às necessidades de cuidado do filho com paralisia cerebral, é explícita a importância do apoio familiar e da orientação que as mães recebem dos profissionais da saúde.

Spectrum of clinical profile, co-morbidities and parental burden of cerebral palsy children in a tertiary care centre

Background: The cerebral palsy is the most common cause of severe physical disability in childhood. The developmental disabilities are a group of disorders differentiated by the pattern of delay among developmental streams. The four streams of development include language, problem solving, motor and social. Cerebral palsy (CP) is a disorder of development in which motor function abnormalities are a key feature. Severity varies from mild to severe. Cerebral palsy is a very challenging disability for parents and professionals. Cerebral palsy is a heterogeneous group of persistent disorders of movement and posture caused by non-progressive defects or lesions of immature brain, is the most common cause of childhood disability. The incidence of CP is 2 to 2.5 per thousand live births. During the past twenty years, there have been increases in the incidence and prevalence of CP that may be related to improved documentation of cases, advances in neonatal care and other factors.Methods: This study is a cross-sectional study. A total of 100 Cerebral Palsy cases were studied in Neuro-developmental clinic, in BMC and RI.Results: Clinical profile of our study shows 74% Spastic cerebral palsy cases (of which 38% were quadriparetic, 31% were diplegic and 5% were hemiparetic), 19% of Hypotonic CP, 1% of Dystonic CP and 6% of Mixed CP cases. Co morbidities in the form of Mental retardation was seen in 94%, feeding problem 64%, visual problems in 39%, seizure disorder in 39%, hearing problems in 18%, behavioral problems 16% of cases.Conclusions: Perinatal asphyxia was important preventable cause of cerebral palsy. Majority of cerebral palsy children were of spastic type. Mental retardation, feeding problem, hearing and vision impairment and seizures were major co morbidities in children with cerebral palsy. Nuclear type of family and high number of co morbidities of the disabled child correlated significantly with higher caregiver burden.

Protective effects of adipose-derived multipotent mesenchymal stromal cells of mice on periventricular leukomalacia model in vitro

Periventricular leukomalacia (PVL) is a form of white matter lesions of the brain that results from hypoxic-ischemic injury and/or inflammation of nervous tissue, and is one of the causes of cerebral palsy. On PVL models in vivo, we have demonstrated neuroprotective effect of transplantation of adipose-derived multipotent mesenchymal stromal cells (MMSCs). However, the mechanisms, which realize neuroprotective effect of transplanted MMSCs, remain unexplored.The aim was to assess the influence of adipose-derived MMSCs on cultured mouse brain slices at their contact co-culturing on PVL models in vitro.Methods. Periventricular leukomalacia in vitro was modelled by a 30-minute oxygen-glucose deprivation (OGD) of mouse brain slices, followed by the addition of 100 ng/ml LPS in culture medium. For co-cultivation we used adipose-derived MMSCs obtained from mice FVB-Cg-Tg (GFPU) 5Nagy/J, transgenic for green fluorescent protein (GFP). The viability of cultured sections cells was evaluated by analysing the level of lactate dehydrogenase (LDH) in the culture medium. Probable MMSCs differentiation into neurons and glial cells was studied using immunohistochemical staining of slices using specific antibodies to neurons and oligodendrocytes (NeuN and Oligodendrocytes, respectively).Results. Modelling of PVL in vitro on organotypic culture of brain slices led to a significant increase in level of cytosolic enzyme LDH in the culture medium. Co-cultivation of slices with MMSCs at PVL reduced the amount of this enzyme. Furthermore, it is shown that under conditions of PVL in vitro, MMSCs are able to differentiate into cells of nervous tissue.Conclusions. Adipose-derived MMSCs have protective effect when they are co-cultivated with the mice brain slices on PVL model in vitro.

Perspectives in neonatal and childhood arterial ischemic stroke

ABSTRACTIntroduction: Over the last decade considerable advances have been made in the identification, understanding and management of pediatric arterial ischemic stroke. Such increasing knowledge has also brought new perspectives and interrogations in the current acute and rehabilitative care of these patients.Areas covered: In developed countries, focal cerebral arteriopathy is one of the most common causes of arterial ischemic stroke in childhood and imaging features are well characterized. However, there are ongoing debates regarding its underlying mechanisms, natural evolution and proper management. The implementation of thrombolytic therapy in acute pediatric stroke has been shown to be efficient in anecdotal cases but is still limited by a number of caveats, even in large tertiary centers. Finally, neonatal stroke represents a unique circumstance of possible early intervention before the onset of any neurological disability but this appears meaningful only in a selective group of neonates.Expert commentary: While perinatal stroke, a leading cause of cerebral palsy, appears to be multifactorial, a large number of childhood ischemic stroke are probably essentially triggered by infectious factors leading to vessel wall damage. Current research is aiming at better identifying risk factors in both conditions, and to define optimal acute and preventive therapeutic strategies in order to reduce significant long-term morbidity.

Neurodevelopmental Disorders or Early Death in Siblings of Children With Cerebral Palsy.

To explore the presence of shared underlying causes of cerebral palsy (CP) and other neurodevelopmental disorders, by examining risks of other disorders in siblings of children with CP. We used Norwegian national registries to identify 1.4 million pairs of full siblings (singletons) and 28 000 sets of twins born from 1967 to 2006, identify stillbirths and neonatal deaths, and find individuals with CP, epilepsy, intellectual disability, autism spectrum disorders, attention-deficit/hyperactivity disorder, blindness, deafness, schizophrenia, and bipolar disorder. Associations between CP in 1 sibling and neurodevelopmental disorders or early death in other siblings were estimated using logistic regression models. There were 5707 neonatal survivors (beyond 28 days) with CP (2.5/1000). These children had substantial comorbidity (eg, 29% had epilepsy). Singleton siblings of (singleton) children with CP had increased risks of neurodevelopmental problems, including epilepsy (odds ratio [OR], 1.8 [95% confidence interval (CI), 1.5-2.5]), intellectual disability (OR, 2.3 [95% CI, 1.8-2.9]), autism spectrum disorders (OR, 1.6 [95% CI, 1.1-2.2]), attention-deficit/hyperactivity disorder (OR 1.3 [95% CI, 1.1-1.6]), blindness (OR 2.4 [95% CI, 1.1-5.4]), and schizophrenia (OR 2.0 [95% CI, 1.2-3.2]). There was no increase in risk of bipolar disorder (OR 1.0 [95% CI, 0.6-1.6]). Families with children with CP also had increased risk of losing another child in the perinatal period (stillbirth OR, 1.8 [95% CI, 1.5- 2.3]; neonatal death OR, 1.7 [95% CI, 1.3-2.2]). Associations were stronger within sets of twins. Siblings of a child with CP were at increased risk for a variety of other neurodevelopmental morbidities, as well as early death, indicating the presence of shared underlying causes.

Profile of children with cerebral palsy attending outpatient physiotherapy clinics in southwest Nigeria

Cerebral palsy (CP) is a major cause of childhood disability. The objective of this study was to investigate the causes, types, severity, history of pregnancy, delivery, maternal care, demographic and clinical characteristics of children with CP and their parents as seen in outpatient physiotherapy clinics of the selected hospitals in Southwest Nigeria. A cross-sectional survey of children with CP and their parents was conducted in twelve hospitals in Southwest Nigeria. Information about the participants was obtained from hospital case records, physical examination and interviews. Data were summarized using descriptive and Chi-square tests with Alpha level put at 0. 05. Two hundred and thirteen children with CP were seen, aged 18 months to 12 years, and most of them were male (59.2%). The majority (41.0%) of the mothers were in the age range of 28 to 33 years. Jaundice (39.9%), asphyxia (26.8%) and infection (17.4%) were the leading causes of CP and spastic CP was the most common type (81.7%). Quadriplegic CP presentation was predominant (67.1%), and leading co-morbidities were mental retardation (31%) and speech impairment (26.3%). About 50% of the children severely affected by CP fell within Levels 4 and 5 of the Gross Motor Function Classification System (GMFCS) of CP severity. It was concluded that cerebral palsy in Southwest Nigeria is mainly associated with jaundice, asphyxia and infections. Spastic cerebral palsy was most common and quadriplegic affectation was predominant. It is recommended that factors promoting perinatal problems should be curtailed. Keywords: cerebral palsy, jaundice, asphyxia, infections, childhood disabilities

Epidemiology of Neonatal Stroke: A Population-Based Study

Abstract BACKGROUND: Neonatal stroke (NS) is a known cause of cerebral palsy, epilepsy and cognitive deficits in up to 50% of patients. Understanding its epidemiology can help in early identification of affected patients and in improving outcomes. OBJECTIVES: To obtain population-based data on the incidence, clinical presentation, treatment, imaging features and outcomes of patients with all types of neonatal stroke. DESIGN/METHODS: Full term neonates born to mothers living in Nova Scotia between 2007 and 2013 and diagnosed with NS were identified through the province’s Perinatal Follow-up Program Database. Neonates with significant congenital anomalies or hypoxic ischemic encephalopathy were excluded. Perinatal data and neonatal course were reviewed. Neurodevelopmental outcomes were assessed at 18 months of age using the standardized cognitive adaptive test/clinical linguistic auditory milestone scale (CAT/CLAMS). RESULTS: Twenty-nine neonates (47 per 100,000 live births) with NS were identified during the study period. The mean gestational age was 39±1 weeks and mean birth weight was 3278±579 g. In twenty-two (76%), NS was due to neonatal arterial ischemic stroke (NAIS), 2 (7%) to cerebral sinovenous thrombosis, and 5 (17%) to intracerebral hemorrhage. Seizures were the most common presenting sign. [table] The median length of stay in hospital was 7 days (4-21). At 18 months of age, only 2 patients (7%) were found to have cerebral palsy and one had epilepsy (3%). CONCLUSION: The majority of patients with NS had NAIS and presented with seizures on the first day of life. The incidence of NS in Nova Scotia is higher than reported in the literature, however the neurodevelop-mental outcomes are better.

Diffusion Tensor Imaging Abnormalities in the Cerebral White Matter Correlate with Sex-Dependent Neurobehavioral Deficits in Adult Mice with Neonatal Ischemia

Background: Neonatal white matter injury (NWMI) is the leading cause of cerebral palsy in prematurely born children. In order to develop a test bed for therapeutics, we recently reported a mouse model of NWMI by using a modified Rice-Vannucci model of neonatal ischemia on postnatal day 5 (P5) in CD-1 mice. We have previously shown that these mice illustrate initial neuroinflammation and oligodendroglial differentiation arrest followed by long-term dysmyelination, periventricular astrogliosis and axonal injury, resembling human NWMI. The objective of this study was to determine the sex-dependent long-term effects of neonatal brain injury on neurobehavioral and advanced in vivo neuroimaging indices in this mouse model, and to correlate these variables with histopathology. Methods: After right common artery ligation on P5, in vivo T2-weighted imaging and diffusion tensor imaging (DTI) were performed on ligated and control animals at 4 and 8 weeks. Common sets of regions of interest were used to compare fractional anisotropy (FA) values between ischemic and control mice. Behavioral testing (open field, startle response and grip strength) was performed at adult age. Finally, the animals were sacrificed for immunohistochemical (IHC) assessment of major white matter tracts. Results: DTI revealed significant sex-dependent changes in FA values ipsi- and contralateral to the ligation. Behavioral testing showed decreased reaction to acoustic stimuli in males but not females. Similarly, increased number of rearings and lack of novelty-induced habituation in the open field were encountered only in the male subgroup. Several regional correlations were found between FA values and these behavioral alterations. IHC studies revealed degeneration of mature oligodendrocytes and damage of white matter tracts in ligated animals, as previously reported in this model, and showed regional correlation with in vivo FA values and behavioral alterations. Conclusions: Our findings suggest structural sex-dependent long-term abnormalities after neonatal ischemia. These changes lead to behavioral deficits resembling common problems of patients with cerebral palsy.

Cerebral Palsy in 1-12 Year Old Children in Southern Iran.

Cerebral palsy (CP) is a non-progressive CNS disorder due to an insult to the growing brain, usually occurring in the first two years of life. During the recent years, its etiology has been changed; perinatal and postnatal insults are not considered as its main causes in developed countries any more. The aim of this study was to evaluate the causes of CP in children in southern Iran. Overall, 200 children with CP aged 1-12 yr old referring to Pediatric Neurology Clinic affiliated to Shiraz University of Medical Sciences, Shiraz, Iran between 2012 and 2013 were enrolled. In addition, 200 healthy age and sex-matched children were considered as the control group. Exclusion criteria were isolated movement disorders with no other evidence of CP, progressive neurologic disorders, metabolic disorders, and incomplete or uncertain past history. After collecting the data on pregnancy period, prenatal history and past medical problems, they were analyzed with appropriate statistical methods. Maternal age, medical problems during pregnancy period, route of delivery, head circumference at birth, neonatal admission, neonatal jaundice, and prematurity were the main risk factors for CP. The distribution of risk factors of CP is different from that of developed countries in our region. Pre- and peri-natal etiologies are still among the common causes of CP in Iran.

Intra- and interobserver agreement among obstetric experts in court regarding the review of abnormal fetal heart rate tracings and obstetrical management

The objective of the study was to evaluate the intra- and interobserver agreement among obstetric experts in court regarding the retrospective review of abnormal fetal heart rate tracings and obstetrical management of patients with abnormal fetal heart rate during labor. A total of 22 French obstetric experts in court reviewed 30 cases of term deliveries of singleton pregnancies diagnosed with at least 1 hour of abnormal fetal heart rate, including 10 cases with adverse neonatal outcome. The experts reviewed all cases twice within a 3-month interval, with the first review being blinded to neonatal outcome. For each case reviewed, the experts were provided with the obstetric data and copies of the complete fetal heart rate recording and the partogram. The experts were asked to classify the abnormal fetal heart rate tracing and to express whether they agreed with the obstetrical management performed. When they disagreed, the experts were asked whether they concluded that an error had been made and whether they considered the obstetrical management as the cause of cerebral palsy in children if any. Compared with blinded review, the experts were significantly more likely to agree with the obstetric management performed (P < .001) and with the mode of delivery (P < .001) when informed about the neonatal outcome and were less likely to conclude that an error had been made (P < .001) or to establish a link with potential cerebral palsy (P = .003). The experts' intraobserver agreement for the review of abnormal fetal heart rate tracing and obstetrical management were both mediocre (kappa = 0.46-0.51 and kappa = 0.48-0.53, respectively). The interobserver agreement for the review of abnormal fetal heart rate tracing was low and was not improved by knowledge of the neonatal outcome (kappa = 0.11-0.18). The interobserver agreement for the interpretation of obstetrical management was also low (kappa = 0.08-0.19) but appeared to be improved by knowledge of the neonatal outcome (kappa = 0.15-0.32). The intra- and interobserver agreement among obstetric experts in court for the review of abnormal fetal heart rate tracing and the appropriateness of obstetrical care is poor, suggesting a lack of objectivity of obstetrical expertise as currently performed in court.

Psychosocial impact of caring for children with cerebral palsy on the family in a developing country

Having a child with cerebral palsy (CP) in developing countries of the world is particularly burdensome. This study investigated psychosocial impact on the family caring for a child with CP, examined possible association of severity of gross motor function impairment on the psychosocial impact and compared impact scores of families with CP child with that of fam- ilies with no CP child. Participants consisted of 117 parents/caregivers of children with CP and 117 parents/caregivers of children without CP whose children attended purposively selected secondary and tertiary health institutions in South-West region of Nigeria. Impact on family (IOF) scale was used to assess psychosocial impact while gross motor function classification system for CP was used to rate severity of motor function impairment in children with CP. Participants were mostly of low income 59 (25.2%) and middle income 85 (36.3%) categories. Children were mostly in the 1−3 year age range 116 (49.6%). Birth asphyxia was most reported cause of CP and no social support service was reported. Significantly higher mean subscale and total IOF scores were observed in families with CP child (37.4 ± 8.91) compared with families with no CP child (20.8 ± 4.98) P = 0.000. Significant differences did not exist in mean total IOF scores and severity of motor function impairment in children with CP (P = 0.16). Presence of a child with CP imposes tremendous psychosocial challenges on the family irrespective of severity of motor function impairment. Implementation of an effective and accessible social support system by Nigerian policy makers is imper- ative.

The child with cerebral palsy in a developing country – diagnosis and beyond

Cerebral palsy (CP) is one of the leading causes of childhood disability worldwide, with the greatest burden found in the developing countries of the world. A longitudinal study was carried out on all consecutive new cases of CP who presented at the neuro-developmental clinic in Nigeria over a period of 6 months to evaluate the continuum of care available to children with CP following diagnosis. At the end of 1-year post-enrolment into the study, all cases were evaluated for survival, on-going rehabilitative care, functional improvement and reasons for default. Eighty-two children were enrolled into the study. Mean age was 25.3 ± (SD=25.5) months and the leading causes of CP were birth asphyxia (39.0%), bilirubin encephalopathy (24.4%) and post infectious brain damage (18.3%). By the end of 1 year, 61 (74.4%) had defaulted from follow up, 11 (13.4%) had died and only 21 (25.6%) were still receiving rehabilitative care. The major reasons for default were financial constraints, no improvement in condition and the hospital being too far from place of residence. Presence of severe functional impairment and absence of epilepsy were associated with an increased risk of default from medical care. In conclusion, CP remains a major cause of neurodisability in Nigeria. There is a high default rate with majority of children lacking ready access to medical care and education. There is an urgent need for improvement in medical services in the country and social support for children with CP and their families.

Perinatal infections and cerebral palsy

There are many causes of cerebral palsy (CP) apart from hypoxic events during the perinatal period. Perinatal infections and systemic inflammatory response syndrome of the mother and infant can affect the development of CP significantly. The majority of premature infants are vulnerable to CP and the association between intraamniotic infections, preterm rupture of fetal membranes and the effect of preterm birth predispose the infant to CP. Incidence of intraventricular hemorrhage, white matter disease and periventricular leukomalacia has increased after preterm labor resulting from intraamniotic infections. Bacterial vaginosis, fever, periodontal disease of the mother, as well as bacterial, viral, protozoan and fungal infections of the newborn infant are effective during the development of CP. The balance between proinflammatory and anti-inflammatory cytokines and the combined effects of genetic predisposition, hypoxia, cytokines and bacterial products may initiate the unfavorable process. Treatments directed towards cytokines and bacterial products have not been effective until now. Fetuses and neonates should be protected from perinatal infections as much as possible and all infections should be treated promptly in order to prevent short-term and long-term adverse outcomes.

Predictors of caregiver depression and family functioning after perinatal stroke.

BackgroundPerinatal stroke is a leading cause of cerebral palsy and lifelong neurological morbidity. Studies on perinatal stroke outcomes are increasing, although examinations of its broader impact on parents and families have been limited. A recent study found that parents of children with moderate and severe outcomes have increased risk for psychosocial concerns, including depressive symptoms and poor family functioning. Other parents adapt remarkably well, but how this occurs is unknown. The primary aim of this study was to examine predictors of parent and family outcomes, namely caregiver depression and family functioning. The secondary aim was to explore potential mediators and moderators of the relationship between condition severity and parent and family outcomes.MethodsParents were recruited from a large, population-based perinatal stroke research cohort, and they completed measures assessing their demographics, social supports, stress levels, marital quality, feelings of guilt and blame, psychological well-being, and family functioning. Bivariate analyses compared these variables. Predictor variables, mediators, and moderators were chosen according to the strength of their relationship with the outcome variables (i.e., caregiver depression and family functioning) and theory. Hierarchical regression, mediator, and moderator analyses were conducted accordingly.ResultsA total of 103 parents participated in this study (76 mothers, 27 fathers; mean age of 39.2 years; mean child age of 7.46 years). Condition severity, anxiety, social support, and blame independently predicted caregiver depression while condition severity, stress levels, and marital quality independently predicted family functioning. Blame regarding the cause of their child’s condition also mediated the relationship between condition severity and caregiver depression.ConclusionsAdverse parental outcomes can be predicted in perinatal stroke populations. Moreover, anxiety and stress management techniques, marital support, and psychoeducation regarding the unpreventable nature of perinatal stroke may be utilized in the future to enhance family outcomes.