Cerebral Palsy Risk Factors

Risk Factors for Cerebral Palsy

• Preconception risk factors: stillbirths, abortions, assisted reproductive technology, and advanced maternal age (> 40 years)
• Antenatal risk factors: fetal growth restriction, prematurity, birth defects, chronic maternal disorders (thyroid disease, pre-eclampsia, infection), substance abuse, chorioamnionitis, and placental abnormalities
• Perinatal birth risk factors: instrumental delivery, low birth weight, birth neonatal encephalopathy, and sepsis
• Postnatal risk factors: stroke, infection, accidental and non-accidental brain injury

Assessment of Cerebral Palsy at 5 Months of Corrected Age

• HINE (90% sensitivity) is a assessment method for CP
• MRI (86-89% sensitivity) is another assessment method for CP
• Developmental Assessment of Young Children (83% sensitivity) is also used for CP assessment

General Movements

• General movements are the best indicator of functional motor maturity
• They are serial gross movements with variability in speed and amplitude that involve all body parts
• Normal general movements are divided into preterm, writhing, and fidgety general movements
• Abnormal general movements are classified as poor repertoire, cramped-synchronized, and chaotic
• Prechtl's state-4 (actively awake) is optimal for assessing general movements
• Evaluating general movements during crying and non-nutritive sucking should be avoided

Predictive Power of General Movements

• Prechtl's qualitative assessment of general movement has excellent predictive power for neurological outcome at 12-15 months of age

Thermal Protection of the Newborn

• Newborns can easily lose their ability to maintain body temperature due to environmental temperatures.
• Thermal protection of the newborn is a set of continuous measures starting at birth to maintain a normal body temperature.

Thermoneutral Environment (TNE)

• TNE is a narrow environmental temperature range where the neonate has a minimum basal metabolic rate (BMR) and maintains normal body temperature.
• TNE varies by gestation and postnatal age.

Temperature Ranges

• Normal axillary temperature: 36.5-37.5°C
• Mild hypothermia or cold stress: 36-36.4°C
• Moderate hypothermia: 32-35.9°C
• Severe hypothermia: below 32°C
• Hyperthermia: above 37.5°C

Thermoneutral Environment by Gestation and Postnatal Age

• 2000-2499 g: 1-2 days old, TNE: 36°C
• 2500 g: 11 days to 4 weeks, TNE: 37.5°C
• 2500 g: 3 days to 3 weeks, TNE: 36°C
• 2500 g: 1-2 days old, TNE: 37.5°C
• >4 weeks, TNE: 36°C
• >3 weeks, TNE: 37.5°C
• ≥3 days old, TNE: 36°C