CEREBRAL-PALSY AND NEONATAL ENCEPHALOPATHY

A retrospective cohort study was carried out to test the hypothesis th at children born at term with cerebral palsy with signs of neurologica l dysfunction preceded by depression at birth (termed neonatal encepha lopathy) differ from those without such signs in the frequency of ante natal and perinatal factors, and in the severity and characteristics o f their impairment and disability. The study was carried out in the ar ea covered by Oxford Regional Health Authority. Antenatal, intrapartum , neonatal factors, and the later clinical status of the two groups of children were used as the main outcome measures. Although most matern al and antenatal characteristics were similar in the two groups, the m others of children with a history of neonatal encephalopathy were more likely to be primigravidae (odds ratio (OR) 2.0; 95% confidence inter val (CI) 1.0 to 4.3) and to have a pregnancy of greater than 41 weeks' gestation (OR 3.5; 95% CI 1.0 to 12.1). Intrapartum complications wer e more frequent in the neonatal encephalopathy group: meconium stainin g of the amniotic fluid (OR 3.5; 95% CI 1.5 to 7.8), an ominous first stage cardiotocograph (OR 10.2; 95% CI 2.9 to 36.4), with a longer med ian duration of abnormality (200 v 48 minutes). At 5 years of age thos e with neonatal encephalopathy were more likely to have developed spas tic quadriplegia (OR 4.8; 95% CI 2.2 to 10.5), to have visual impairme nt (OR 3.0; 95% CI 1.0 to 8.6), and to be non-walking (OR 4.0; 95% CI 1.8 to 8.8) than those without neonatal encephalopathy. Children with cerebral palsy who were born at term and have neonatal encephalopathy are more Likely to have had signs of intrapartum asphyxia and are more likely to have a more severe form of cerebral palsy than those withou t a history of neonatal encephalopathy. Although this group represents only one in 10 of all cases of cerebral palsy, some of these may be o bstetrically preventable.