Causal pathways to cerebral palsy in term and near-term singletons: Analysis of a total population case control study

Abstract

BACKGROUND Two in three children with cerebral palsy are singletons born after at least 35 weeks gestation, for whom aetiological information is limited and birth prevalence unchanging. This thesis explores the aetiology of cerebral palsy in these infants. METHODS 1) A systematic review collated risk factors for cerebral palsy in term births. 2) A total population case-control study of cerebral palsy and perinatal death from Western Australian births 1980-1995 augmented by a birth defects register linkage was analysed to assess risk factors including those identified in the systematic review. RESULTS Of the four major risk factors chosen for detailed analysis, a greater proportion of cerebral palsy in term and near-term born singletons could be attributed to birth defects, particularly if associated with fetal growth restriction, than to acute hypoxic events during labour and delivery or to inflammation or growth restriction in the absence of birth defects. CONCLUSION Most term and near term singletons with cerebral palsy are not neurologically depressed in the newborn period. Their aetiological pathways are diverse; however the major finding from this thesis is that birth defects and growth restriction are the dominant risk factors. The research agenda needs to shift to include a focus on them.