Cerebral Palsy Risk Factors

Study Notes

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

Description

Identify the preconception, antenatal, and perinatal risk factors that contribute to the development of cerebral palsy. Learn about the role of maternal age, fetal growth, and birth defects in this condition.