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This Perinatal Forum concentrated on Cerebral Palsy. The Review was authored by

Kara Dent, Research Fellow, West Midlands Perinatal Institute, and
Mike Watkinson, Consultant Neonatologist, Birmingham Heartlands Hospital

January 2001

Introduction

Cerebral Palsy (CP) is an umbrella term that covers a group of non-progressive motor disorders. Increasing litigation has 'encouraged' investigation into the possible causal pathways of CP. Historically, intrapartum asphyxia was thought to be the main culprit but evidence shows it to be responsible for perhaps as little as 10% of all cerebral palsy cases (1,2,3,4). It is not clear whether antenatal events make a fetus more susceptible to intrapartum and postnatal insult or whether these are mutually exclusive pathways. This review concentrates on antenatal causes and possible interventions. There are a number of causes and causal pathways that may or may not be linked. Despite advances in perinatal care leading to a marked decrease in perinatal mortality, there has been no significant change in cerebral palsy rates over the last 2 decades (5,6) (1.5 - 2.5 / 1000 births (2).

LITIGATION One recent Cerebral Palsy case in Ireland cost IR£2.1 million with 4 million in legal fees. With this in mind, it is hoped in Ireland that no-fault compensation is introduced by July 2001

Definitions

CP has been variously defined as:

• "a persistent, but not necessarily unchanging disorder of movement and posture due to a non-progressive disorder of the immature brain" (7) and
• " a persistent disorder of movement and posture caused by non-progressive defects or lesions of the immature brain" (8)

References

1. Ellenburg J. Cluster of perinatal events identifying infants at high risk for death or disability. J Pediatr 1988;113:546-52 (Abstract).

2. Stanley F, Blair E, Alberman E. Pathways to cerebral palsy involving signs of birth asphyxia. In: Cerebral Palsies: Epidemiology and Causal Pathways. Clin Devlop Med 2000;151:22-39.

3. MacLennan A. A template for defining a causal relation between acute intrapartum events and cerebral palsy: international consensus statement. BMJ 1999;319:1054-9 (Abstract).

4. Bakketeig LS. Only a minor part of cerebral palsy cases begin in labour. Br Med J 2000;319:1016-7, (Abstract)

5. Wu Y. Chorioamnionitis as a risk factor for cerebral palsy. JAMA 2000;284(11):1417-24, (Abstract)

6. Stanley F, Blair E, Alberman E. How common are the cerebral palsies? In: Cerebral Palsies: Epidemiology and Causal Pathways. Clin Devlop Med 2000;151:22-39, (Abstract).

7. Brett EM. 'Cerebral Palsy' in Paediatric Neurology. Ed: Brett EM. Churchill Livingstone, London 1997 pp291-330

8. Aicardi J, Bax M. Cerebral Palsy. In Diseases of the Nervous System in Childhood. Ed: Aicardi J. Mackeith Press, London 1998 pp 210-239