Incidence Of Cerebral Palsy Research Articles

Cerebral Palsy and Intellectual Disability in the Children of Women With Chronic Kidney Disease

BackgroundThis study examined the risk of adverse maternal and neonatal outcomes, especially cerebral palsy and intellectual disability, in pregnant women with and without chronic kidney disease and their children. MethodIn total, 156 pregnancies involving 139 women with chronic kidney disease who were treated at our center between 2001 and 2010 were identified. We also selected 3067 women without chronic kidney disease who delivered their infants without suffering any medical complications during the same period as control groups. Long-term neonatal prognosis was assessed based on the frequencies of cerebral palsy and/or intellectual disability. ResultsThe pregnant women had the following types of chronic kidney disease: immunoglobulin A nephropathy (n = 54), glomerulonephritis (n = 17), chronic renal failure (n = 16), nephrotic syndrome (n = 12), nephritis (n = 11), diabetic nephropathy (n = 10), congenital malformations and deformations (n = 10), purpura nephritis (n = 7), and others (n = 19). Of the children who were born to mothers with chronic kidney disease, one developed cerebral palsy, and another developed cerebral palsy with intellectual disability. Seven of the children who were born to mothers without chronic kidney disease developed cerebral palsy. The posterior probability of these conditions was 0.01900 and 0.002610 in the children born to mothers with and without chronic kidney disease, respectively. A primiparous mother (odds ratio [OR]: 4.07, 95% confidence interval [CI]): 2.78 to 5.95), preeclampsia (OR: 6.44, 95% CI: 3.92 to 10.59), grade 1 to 4 intraventricular hemorrhaging (OR: 7.71, 95% CI: 2.05 to 28.92), and an Apgar score of less than 7 at five minutes (OR: 0.51, 95% CI: 0.27 to 0.96) were found to influence the risk of cerebral palsy and/or intellectual disability in children born to women with chronic kidney disease. ConclusionWe found that the incidence of cerebral palsy and/or intellectual disability is 7.2-fold higher in children born to women with chronic kidney disease than in those born to women without chronic kidney disease.

Incidence of cerebral palsy in Himeji over a 25-year period

Incidence of cerebral palsy in Himeji over a 25-year period

Early intervention impact on neurodevelopmental outcome of very preterm infants and VLBW infants at 1 year corrected age

Objective To evaluate neurodevelopmental outcome of very preterm( gestational age < 32 weeks) and very low birth weight infant (VLBWI) (weight< 1 500 g) and to examine the effectiveness of an early intervention program till 12 months corrected age. Methods Seventy followed-up very preterms and VLBWI in Jinan Maternity and Childcare Hospital were enrolled in this study from January 2012 to and were divided into two groups by birth weight.All infants received 20 items of behavioral neurological assessment at 1 to 12 months corrected age and tested mental and psychomotor development with the use of CDCC at 6, 12 months corrected age.The preterms who were abnomal in the 20 items of behavioral neurological assessment would receive early intervention (including kinesitherapy, physiotherapy, cereal circulation therapeutic equipment) by physiotherapists and their parents who received an intervention program training and were strongly encouraged to participate in the intervention sessions.The intervention method was adjusted according to the neurological assessment.The SPSS statistical software package for Windows, version 15.0, was used to run Fisher's exact test and t-test on the data presented, and P value of less than 0.05 was regarded as statistically significant. Results The average gestational age of infants was (30.4±1.8) weeks, and average birth weight (1 463.7±307.5)g.The incidence of extrauterine growth restriction was 57.1% at first follow-up.The incidence of neurodevelpmental impairment NDI) and cerebral palsy tendency at 6 corrected months were 14.3%, 8.6% respectively.At 12 months corrected age, the incidence of NDI decreased to 2.9% and cerebral palsy to 2.9%.There was significant difference in the incidence of NDI between 6 and 12 corrected months.There was no significant difference in the incidence of psychomotor developmental index <70, mental developmental index<70, NDI and cerebral palsy between the two groups. Conclusion The early intervention program can improve VLBWI neurodevelopmental outcomes at 12 months' corrected age and reduce the incidence of cerebral palsy. Key words: Very low gestational age infant; Very low birth weight infant; CDCC; Neurodevelopmental impairment; Cerebral palsy; Early intervention

Stromal Cell-Derived Factor-1α Plays a Crucial Role Based on Neuroprotective Role in Neonatal Brain Injury in Rats.

Owing to progress in perinatal medicine, the survival of preterm newborns has markedly increased. However, the incidence of cerebral palsy has risen in association with increased preterm birth. Cerebral palsy is largely caused by cerebral hypoxic ischemia (HI), for which there are no effective medical treatments. We evaluated the effects of stromal cell-derived factor-1α (SDF-1α) on neonatal brain damage in rats. Left common carotid (LCC) arteries of seven-day-old Wistar rat pups were ligated, and animals were exposed to hypoxic gas to cause cerebral HI. Behavioral tests revealed that the memory and spatial perception abilities were disturbed in HI animals, and that SDF-1α treatment improved these cognitive functions. Motor coordination was also impaired after HI but was unimproved by SDF-1α treatment. SDF-1α reduced intracranial inflammation and induced cerebral remyelination, as indicated by the immunohistochemistry results. These data suggest that SDF-1α specifically influences spatial perception abilities in neonatal HI encephalopathy.

Cerebral palsy and brain cooling

This month in The Journal there are 3 articles that discuss cerebral palsy (CP) and the use of hypothermia to decrease brain injury in newborns. Garfinkel et al used a Canadian CP registry to estimate that about 5% of CP could be prevented with the effective use of therapeutic hypothermia of asphyxiated term infants delivered in Canada. This low effectiveness results from the multiple factors pointed out in the editorial by Berg. Most cases of CP are not the result of the acute sentinel asphyxial events associated with deliveries, and many of the infants do not qualify for hypothermia treatment. Furthermore, the therapy is not highly effective. This discouraging overall effect of therapeutic hypothermia is compounded in low and middle-income countries (LMIC) as pointed out by the Commentary by Tagin et al. Hypoxic ischemic encephalopathy is responsible for an estimated 25% of all neonatal deaths worldwide, and asphyxia is responsible for a large number of fresh stillborns in LMIC countries. Although therapeutic hypothermia is an effective therapy in high resource environments, it has not been demonstrated to be effective in LMIC in a few trials. Although the therapy is relatively simple to deliver in any modern neonatal intensive care unit, there are multiple obstacles to its effective use in LMIC. Identification of the infant that qualifies for hypothermia treatment by the criteria used in high resource environments requires trained personnel and infrastructure, and, thus, is not easily accomplished. More lives could be saved by upgrading obstetric services to decrease stillborns and providing effective resuscitation, than by developing the infrastructure necessary for the rapid identification and treatment of the asphyxiated infant with hypothermia. Therapies to improve outcomes that are effective in one environment may not work in another. Even though therapeutic hypothermia is a major advance as the first treatment that can decrease brain injury in asphyxiated term infants, its overall impact on the incidence of CP and birth asphyxia will be small within the context of worldwide infant mortality. Article page 25▶ Article page 58▶ Editorial page 8▶ Cerebral Palsy after Neonatal Encephalopathy: How Much Is Preventable?The Journal of PediatricsVol. 167Issue 1PreviewTo determine the expected proportion of term cerebral palsy (CP) after neonatal encephalopathy (NE) that could theoretically be prevented by hypothermia and elucidate the perinatal factors associated with CP after NE in those who do not meet currently used clinical criteria required to qualify for hypothermia (“cooling criteria”). Full-Text PDF Neuroprotection for Perinatal Hypoxic Ischemic Encephalopathy in Low- and Middle-Income CountriesThe Journal of PediatricsVol. 167Issue 1PreviewPerinatal hypoxic ischemic encephalopathy (HIE) is associated with approximately one-quarter of global neonatal deaths.1 In 2010, there were an estimated 1.15 million cases of neonatal encephalopathy, of which 96% of were from low- and middle-income (LMI) countries.2 In the developed world, therapeutic hypothermia is now widely accepted as the standard of care for treating newborns with moderate to severe HIE.3 Therapeutic hypothermia has been found to reduce the risk of death or major neurodevelopmental disability at age 18 months (risk ratio [RR], 0.76; 95% CI, 0.69-0.84) and to increase survival with normal neurologic function (RR, 1.63; 95% CI, 1.36-1.95). Full-Text PDF Prevention of Cerebral Palsy: Which Infants Will Benefit from Therapeutic Hypothermia?The Journal of PediatricsVol. 167Issue 1PreviewCan cerebral palsy (CP) be prevented? The answer depends on the etiology of CP. Although the causes of CP are largely related to early brain injury, both the nature of that injury and the later manifestations can differ based on the gestational and postnatal ages at which the injury occurs, as well as its source. Full-Text PDF

Prediction of Fetal Compromise in Labor

OBJECTIVE:: The majority of intrapartum fetal hypoxia occurs in uncomplicated pregnancies. Current intrapartum monitoring techniques have not resulted in a reduction in the incidence of cerebral palsy in term neonates. We report the development of a composite risk score to allow risk stratification of normal pregnancies before labor. METHODS:: Six hundred one women were recruited to this prospective observational study. All women underwent an ultrasound examination before active labor, during which fetal biometry and fetal Doppler flow resistance indices were measured. A composite risk score, amalgamating data from the umbilical artery, middle cerebral artery, and umbilical vein, was then developed and correlated with intrapartum outcomes. RESULTS:: In cases with the highest composite risk scores, the incidence of fetal compromise (the primary outcome) was 80.0% compared with just 15.3% in cases with the lowest risk scores (relative risk 5.2, 95% confidence interval 2.7-10.1). These cases were also at increased risk of cesarean delivery (53.3% compared with 3.4%, P<.001) and of developing a fetal heart rate pattern considered pathologic by National Institute for Health and Clinical Excellence criteria (P=.003). No significant variation in Apgar scores or umbilical artery pH was observed. CONCLUSION:: Intrapartum fetal compromise remains a significant global health issue. The composite risk score reported here can identify fetuses at both high risk and low risk of a subsequent diagnosis of intrapartum fetal compromise. This may enable more judicious use of current intrapartum fetal monitoring techniques, which are hampered by low specificity.

Cerebral Palsy Among Children Born Moderately and Late Preterm

OBJECTIVE: To compare the incidence of and risk factors for cerebral palsy (CP) in moderately preterm (MP) (32+0–33+6 weeks) and late preterm (LP) (34+0–36+6 weeks) infants with those in very preterm (VP) ( METHODS: The national register study included all live-born infants in Finland from 1991 to 2008. Infants who died before the age of 1 year, had any major congenital anomaly, or had missing data were excluded. A total of 1 018 302 infants were included in the analysis and they were analyzed in 4 subgroups (VP, MP, LP, and term) and 3 time periods (1991–1995, 1996–2001, and 2002–2008). RESULTS: By the age of 7 years, 2242 children with CP were diagnosed (0.2%). CP incidence was 8.7% in the VP, 2.4% in the MP, 0.6% in the LP, and 0.1% in the term group. The risk of CP was highest in the study period 1991–1995 in all groups. Factors predictive of an increased CP risk in the MP and LP groups included resuscitation at birth (odds ratio 1.60; 95% CI 1.01–2.53 and 1.78; 1.09–2.90), antibiotic treatment during the first hospitalization (1.63; 1.08–2.45 and 1.67; 1.13–2.44), 1-minute Apgar score CONCLUSIONS: The incidence of CP is higher in LP and MP infants compared with term infants. There is a nonlinear decrease in incidence over time and with increasing gestational age.

Is in utero Fetal Neurological Assessment Comparable to Postnatal Neurological Assessment?

ABSTRACT The traditional concept that brain damage is caused during birth or early neonatal period has been challenged. This is supported by the fact that the incidence of cerebral palsy stayed unchanged despite the global increase of cesarean sections. Consequently, the medicolegal importance of fetal neurological research is essential and needed. Years of research have provided us with important knowledge about association of fetal movements with brain development. The basic studies were done by two-dimensional ultrasound. The implementation of four-dimensional ultrasound in evaluation of fetal behavior has opened new and unexplored possibilities of evaluating the quality of fetal movements and a detailed assessment of fetal facial expressions. It is known that early postnatal neurological assessment, regarding future prediction of neurological optimality, has great limitations do to wonderful brain plasticity. Taking this very important limitation in to the account we could conclude that the preliminary studies comparing prenatal and postnatal neurological assessment are comparable. More importantly they emphasize the fact that the study of fetal behavior is most probably the right path in the study of fetal neurological development. How to cite this article Vasilj O. Is in utero Fetal Neurological Assessment Comparable to Postnatal Neurological Assessment? Donald School J Ultrasound Obstet Gynecol 2015; 9(1):91-95.

Antenatal Magnesium Sulfate for Neuroprotective Effects In Preterm Infants

&lt;title&gt;Abstract Fetal or neonatal brain injury can result in lifelong neurologic disability. Although survival rates for preterm infants have increased dramatically with the advent of modern perinatal and neonatal intensive care, but the rates of neurologic abnormalities in survivors, particularly motor disorders such as cerebral palsy, have not diminished. Antenatal magnesium sulfate may reduce the rates of cerebral palsy in survivors of preterm birth. There are five randomized controlled trials of magnesium sulfate administered to women at risk of preterm delivery before 34 weeks of gestation which have reported neurological outcomes for the child. From meta-analysis of these randomized trials, the rate of cerebral palsy was reduced by magnesium sulfate (RR, ᄋ·69; 95% CI, ᄋ·54-ᄋ·87; five trials; 6,145 infants) as did the moderate/severe cerebral palsy incidence (RR, 0.64; 95% CI, ᄋ·44-ᄋ·92; three trials; 4387 infants). There was no statistically significant difference between the rates of neonatal adverse outcomes of the magnesium administration group and the control group. In most prospective randomized studies, no significant difference in the severe mother-side side effects between the magnesium sul- fate administration group and the control group.&lt;/p&gt;&lt;p&gt;Antenataᅵ magnesium sulfate therapy is neuroprotective against motor dysfunction in offspring for the preterm infant; however the possibility of an increase in the fetal or neonatal death rate was not completely excluded.&lt;/p&gt;

40: Duration of mechanical ventilation is an independent risk factor for cerebral palsy

Several antepartum and intrapartum risk factors are associated with cerebral palsy (CP); however, need and duration of neonatal mechanical ventilation (MV) may contribute to CP. One function of MV is to protect the brain from hypoxemia and asphyxia; however, MV use has been associated with adverse effects on the brain of a preterm infant. Currently, there is limited information regarding the duration of MV and incidence of CP; our objective, was to investigate this association.

Cerebral palsy among children born moderately and late preterm.

To compare the incidence of and risk factors for cerebral palsy (CP) in moderately preterm (MP) (32(+0)-33(+6) weeks) and late preterm (LP) (34(+0)-36(+6) weeks) infants with those in very preterm (VP) (<32(+0) weeks) and term infants (≥37 weeks). The national register study included all live-born infants in Finland from 1991 to 2008. Infants who died before the age of 1 year, had any major congenital anomaly, or had missing data were excluded. A total of 1 018 302 infants were included in the analysis and they were analyzed in 4 subgroups (VP, MP, LP, and term) and 3 time periods (1991-1995, 1996-2001, and 2002-2008). By the age of 7 years, 2242 children with CP were diagnosed (0.2%). CP incidence was 8.7% in the VP, 2.4% in the MP, 0.6% in the LP, and 0.1% in the term group. The risk of CP was highest in the study period 1991-1995 in all groups. Factors predictive of an increased CP risk in the MP and LP groups included resuscitation at birth (odds ratio 1.60; 95% CI 1.01-2.53 and 1.78; 1.09-2.90), antibiotic treatment during the first hospitalization (1.63; 1.08-2.45 and 1.67; 1.13-2.44), 1-minute Apgar score <7 (1.70; 1.15-2.52 and 1.80; 1.21-2.67) and intracranial hemorrhage (7.18; 3.60-14.3 and 12.8; 5.58-29.2). The incidence of CP is higher in LP and MP infants compared with term infants. There is a nonlinear decrease in incidence over time and with increasing gestational age.

Cerebral Palsy Among Children Born Moderately and Late Preterm

OBJECTIVE: To compare the incidence of and risk factors for cerebral palsy (CP) in moderately preterm (MP) (32+0–33+6 weeks) and late preterm (LP) (34+0–36+6 weeks) infants with those in very preterm (VP) ( METHODS: The national register study included all live-born infants in Finland from 1991 to 2008. Infants who died before the age of 1 year, had any major congenital anomaly, or had missing data were excluded. A total of 1 018 302 infants were included in the analysis and they were analyzed in 4 subgroups (VP, MP, LP, and term) and 3 time periods (1991–1995, 1996–2001, and 2002–2008). RESULTS: By the age of 7 years, 2242 children with CP were diagnosed (0.2%). CP incidence was 8.7% in the VP, 2.4% in the MP, 0.6% in the LP, and 0.1% in the term group. The risk of CP was highest in the study period 1991–1995 in all groups. Factors predictive of an increased CP risk in the MP and LP groups included resuscitation at birth (odds ratio 1.60; 95% CI 1.01–2.53 and 1.78; 1.09–2.90), antibiotic treatment during the first hospitalization (1.63; 1.08–2.45 and 1.67; 1.13–2.44), 1-minute Apgar score CONCLUSIONS: The incidence of CP is higher in LP and MP infants compared with term infants. There is a nonlinear decrease in incidence over time and with increasing gestational age.

Cerebral palsy: intrapartum causal criteria used in courts.

In spite of advances in obstetrics and neonatology, the reported incidence of cerebral palsy in developed countries is about two per 1000 live births (Graham et al. Am J Obstet Gynecol 2008;199:587–95). The linked paper by Leigh et al. suggests that almost one in seven cases are the result of intrapartum hypoxia, and the UK Confidential Enquiry into Stillbirths and Deaths in Infancy (1999) found that 50% of 567 of such cases investigated were possibly or probably preventable. In the UK, during 2000–2010, awards for cerebral palsy judged preventable by better care totalled £1 263 581 324: 41% of all obstetric settlements (Ten Years of Maternity Claims. NHS Litigation Authority, 2012). In the case of McKenzie vs Fife Acute Hospitals NHS Trust [2006] ScotCS_63, the judgment included a ‘threefold test’ for duty of care. The harm must be: (a) reasonably foreseeable; (b) there must be a ‘relationship of proximity’ (duty of care) between the plaintiff/claimant and the defendant; and (c) it must be ‘fair, just and reasonable’ to impose liability. Evidence from the International Cerebral Palsy Task Force (MacLennan BMJ 1999;319:154–9) was used to support a causal relationship between acute intrapartum hypoxia and cerebral palsy. The case met all of the three essential criteria: (a) intrapartum metabolic acidosis (pH < 7.00 and base deficit ≥12 mmol/l); (b) early onset severe or moderate neonatal encephalopathy at ≥34 weeks of gestation; and (c) subtype spastic quadriplegia or dyskinetic cerebral palsy. The case also met four of the five non-specific criteria: (a) sudden, rapid, and sustained deterioration of the fetal heart rate; (b) APGAR score of 0–6 for >5 minutes; (c) early multisystemic dysfunction; and (d) early imaging evidence of acute cerebral abnormality. Only one criterion was difficult to establish: evidence of an identified sentinel hypoxic event, such as (a) listed above. The plaintiff's lawyers successfully argued that the prolonged use of Syntocinon®, compounded by misinterpretation of the cardiotocogram, was sufficient to cause damaging hypoxia, however. The judge was satisfied that, on the balance of probabilities, there was an act of omission, as had steps been taken earlier to discontinue the Syntocinon® infusion and expedite delivery the damage would have been avoided. There was a failure to exercise the due diligence that was expected from a reasonably prudent and skilled professional. A similar finding was reached in the more recent case of Jack Clayton vs Yeovil District Hospital (http://www.dailymail.co.uk/health/article-2218209/Oxytocin-How-drug-used-speed-births-starve-baby-oxygen.html), highlighting the medico-legal cost of using a powerful drug without due diligence. Obstetricians and midwives must remember that although many cases of cerebral palsy have genetic, environmental, and antenatal causes, this does not obviate their duty to avoid substandard care that will result in them being held responsible for damaging intrapartum hypoxia. None to declare.

Long term developmental outcomes of pre-school age children following laser surgery for twin-to-twin transfusion syndrome

BackgroundLaser therapy is now a well recognised treatment for twin-to-twin transfusion syndrome (TTTS). We investigated the early childhood neurodevelopmental outcome of children post laser treatment for TTTS in our centre. MethodsChildren of women who had laser therapy for TTTS between March 2006 and June 2008 were assessed at 30–69months of age with WPPSI-III and a general health questionnaire. Major neurodevelopmental impairment (NDI) was reported as IQ<70 or cerebral palsy (CP). Borderline cognitive impairment was defined by IQ 70–79. ResultsAmongst the 37 pregnancies treated, 62 infants were discharged home and the overall foetal survival rate was 84%. A total of 50 children (84%) from 31 pregnancies were assessed. Average age at assessment was 47months. Two children with late treatment of congenital hypothyroidism were excluded. The majority of pregnancies were Quintero Stage III (74%). There was a significant trend for worse outcome with higher Quintero stage. The average gestational age at birth was 32weeks. The majority (39, 78%) of children were found to be neurodevelopmentally normal; 9 (18%) had borderline cognitive development; and 2 (4%) had a major NDI, including one with cerebral palsy (2%). ConclusionsThere was a modest level of neurocognitive impairment post laser therapy for TTTS, mainly borderline cognitive development, lesser so major NDI. There was a low incidence of cerebral palsy. Routine developmental and neurological follow-up of these children is recommended.

PO-0444 From 1990 To 2011: Does Cerebral Palsy Still Affect Preterm Children?

<h3>Background and aims</h3> The incidence of cerebral palsy in preterm children is correlated to gestational age, and has been reported to decrease. The objective of this study is to analyse the incidence and risk factors for CP, as well as the subtype and severity of CP over a 22 year period. <h3>Methods</h3> Retrospective analysis of a cohort of very preterm infants born between 1990 and 2011, with 1996 infants hospitalised in our level III NICU, and a decrease in mortality from 25 to 8%. Follow-up was offered to the 1717 (86%) survivors. Cerebral palsy was diagnosed at the 18 months visit and was confirmed at a later appointment. In the first years children were evaluated with the Griffiths Mental Development Scales, and with the Bayley Scales, 2nd edition later on. Severity was assessed with cognitive as well as sensorial function, and with the Gross Motor Function Classification system. <h3>Results</h3> 1626 children were evaluated, 74 presented with cerebral palsy (4.5%), among them 32% with spastic quadriplegic, 39% spastic diplegic, 26% spastic hemiplegic and 1% ataxic subtypes. The rate of CP, the mean gestational age (28 weeks, SD 13 days) and birthweight (1162 SD 382 g) of the children with CP did not change across the years. Preliminary results show a change of subtype and diminishing severity of CP across the years. <h3>Conclusions</h3> Despite improvements in neonatal care and increased survival, CP incidence has not changed over a period of 22 years, but its quality and severity have changed.

PO-0723 The Outcomes Of Triplets And Quadruplets Born In A Single Level Iii Centre Over A 10 Year Period

Background Multiple pregnancies are an increasing entity worldwide. This is associated with an increase in the number of pregnancies complicated by preterm birth and intrauterine growth restriction, which in turn results in higher infant mortality and morbidity rates. An increased risk of cerebral palsy in multiples has been reported, being higher the higher the number of foetuses. Aims and methods The primary aim of our retrospective study was to determine two year outcomes of triplets and quadruplets born in the Coombe Women and Infants University hospital (CWIUH) over a ten year period and in particular the need for early intervention services. A retrospective chart review of all triplets and quadruplets born between January 2002 and December 2011 was performed. Results 125 infants from triplet pregnancies and eight infants from quadruplet pregnancies were live born in CWIUH during this period. One chart was unavailable for analysis. Therefore 132 infants were included in the study. Median gestational age was 33+2 (26+2 to 36+2) weeks. Median birth weight was 1800 (620 to 2960) g. The median length of stay in our neonatal unit was 23 (0 to 91) days. Two babies died at two months of age. Four (3%) were referred to early intervention services, one with spastic quadriplegia and three with mild left hemiplegia. Eleven (8%) were followed up by a community paediatrician following discharge from the neonatal clinic at two years of age. Conclusion To our knowledge this is the first study to look at the outcomes of triplets and quadruplets in Ireland. Our outcomes are similar to those reported in the international literature which quotes an incidence of cerebral palsy in triplets of approximately 4%.

Cerebral palsy litigation: change course or abandon ship.

The cardinal driver of cerebral palsy litigation is electronic fetal monitoring, which has continued unabated for 40 years. Electronic fetal monitoring, however, is based on 19th-century childbirth myths, a virtually nonexistent scientific foundation, and has a false positive rate exceeding 99%. It has not affected the incidence of cerebral palsy. Electronic fetal monitoring has, however, increased the cesarian section rate, with the expected increase in mortality and morbidity risks to mothers and babies alike. This article explains why electronic fetal monitoring remains endorsed as efficacious in the worlds’ labor rooms and courtrooms despite being such a feeble medical modality. It also reviews the reasons professional organizations have failed to condemn the use of electronic fetal monitoring in courtrooms. The failures of tort reform, special cerebral palsy courts, and damage limits to stem the escalating litigation are discussed. Finally, the authors propose using a currently available evidence rule—the Daubert doctrine that excludes “junk science” from the courtroom—as the beginning of the end to cerebral palsy litigation and electronic fetal monitoring’s 40-year masquerade as science.

41: Variation in Incidence of Cerebral Palsy (CP) in Preterm Infants in the Canadian Neonatal Follow-Up Network (CNFUN): 2009–2011

41: Variation in Incidence of Cerebral Palsy (CP) in Preterm Infants in the Canadian Neonatal Follow-Up Network (CNFUN): 2009–2011

Prediction of fetal compromise in labor.

The majority of intrapartum fetal hypoxia occurs in uncomplicated pregnancies. Current intrapartum monitoring techniques have not resulted in a reduction in the incidence of cerebral palsy in term neonates. We report the development of a composite risk score to allow risk stratification of normal pregnancies before labor. Six hundred one women were recruited to this prospective observational study. All women underwent an ultrasound examination before active labor, during which fetal biometry and fetal Doppler flow resistance indices were measured. A composite risk score, amalgamating data from the umbilical artery, middle cerebral artery, and umbilical vein, was then developed and correlated with intrapartum outcomes. In cases with the highest composite risk scores, the incidence of fetal compromise (the primary outcome) was 80.0% compared with just 15.3% in cases with the lowest risk scores (relative risk 5.2, 95% confidence interval 2.7-10.1). These cases were also at increased risk of cesarean delivery (53.3% compared with 3.4%, P<.001) and of developing a fetal heart rate pattern considered pathologic by National Institute for Health and Clinical Excellence criteria (P=.003). No significant variation in Apgar scores or umbilical artery pH was observed. Intrapartum fetal compromise remains a significant global health issue. The composite risk score reported here can identify fetuses at both high risk and low risk of a subsequent diagnosis of intrapartum fetal compromise. This may enable more judicious use of current intrapartum fetal monitoring techniques, which are hampered by low specificity. II.

Are 1st-trimester β-human chorionic gonadotrophin and pregnancy-associated plasma protein A levels predictive of intrapartum fetal compromise in a selected normal population?

The incidence of cerebral palsy in term infants has not changed over the last 30years. Current intrapartum monitoring techniques are limited by their inherent poor specificity. Changes in fetal haemodynamics in the term fetus, similar to those seen in fetal growth restriction, have been associated with an increased risk of subsequent intrapartum fetal compromise. Alterations in first-trimester β-hCG and PAPP-A levels are predictive of fetal growth restriction. In this study, we aimed to establish whether first-trimester β-hCG and PAPP-A levels were predictive of fetal compromise in labour and whether these first-trimester markers could be correlated with fetal haemodynamics at term in a low-risk population. Over a two-year period, 427 women with low risk, uncomplicated pregnancies were recruited to this study. All participants underwent a prelabour ultrasound examination during which fetal biometry and haemodynamics were assessed. First-trimester β-hCG and PAPP-A levels were recorded from the case notes. All cases were followed up within 48hours of delivery, and first-trimester β-hCG and PAPP-A levels correlated with intrapartum outcomes and fetal haemodynamics. No significant relationship between first-trimester β-hCG and PAPP-A levels and subsequent intrapartum fetal compromise was observed. Weak but significant correlations were observed between β-hCG levels and umbilical venous flow rate, as well as PAPP-A levels and uterine artery pulsatility index. β-hCG and PAPP-A levels measured during the first trimester are not predictive of subsequent intrapartum fetal compromise within a low-risk population.