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Selection of Neonates for Neuroprotective Therapies
One Set of Criteria Applied to a Population
Karin B. Nelson, MD;
Judith K. Grether, PhD
Arch Pediatr Adolesc Med. 1999;153:393-398.
Objectives To estimate the proportion of children with cerebral palsy (CP) who had signs of "birth asphyxia" in the early hours of life, and to examine the nature of the illnesses in those infants.
Design Population-based case-control study.
Setting All births in 4 northern California counties, 1983 through 1985.
Subjects Eighty-four full-term singleton children surviving to age 3 years with spastic CP and 366 full-term control children.
Main Outcome Measure Moderate or severe spastic CP.
Results Of 84 full-term children with spastic CP, 18 had 5-minute Apgar scores of less than 6, 20 required intubation for ventilation in the delivery room, and 5 had an initial blood pH of 7.00 or less. Three (3.6%) of the 84 children had all 3 signs evaluated, a prevalence of 0.019 per 1000 survivors. All 3 had neonatal seizures. When we relaxed the pH cutoff to 7.10 or less, there were 19 children with CP who met at least 2 criteria. Eight of these 19 infants were born in level I facilities. In these children there was evidence of maternal or infant infection (n = 7); abnormal coagulation factor, thrombosis, or thrombocytopenia (n = 8); or other complication predating birth (n = 9).
Conclusions Neuroprotective therapy offered to neonates with these early characteristics, even if perfectly effective, would be unlikely to prevent most CP. Most of these depressed infants with CP had nonasphyxial conditions that may have contributed to adverse neurological outcome.
From the Neuroepidemiology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Md (Dr Nelson); and the California Birth Defects Monitoring Program, California Department of Health Services, Emeryville, (Dr Grether).
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