Cerebral Palsy

The term cerebral palsy refers to a motor coordination problem due to an injury to the brain, which controls both voluntary movement and coordination. It is characterized by either weakness or stiffness of the arms and legs and can be associated with seizures and/or some degree of mental retardation. There are several different types of cerebral palsy, based on either a description of the effect on the child’s movement or the area of the brain that is effected. The overall incidence of cerebral palsy is reported to be about 2.5 per 1,000 live births in the U.S. The most common reason or cause for cerebral palsy is prematurity, where the baby is delivered before the brain in fully developed, and babies who are born prematurely in the range of 26-30 weeks gestational age have a significantly increased risk of developing cerebral palsy.

However, baby’s born at term (>37 weeks) can also develop cerebral palsy if there is significant hypoxia or asphyxia associated with the delivery. Because any degree or type of cerebral palsy can have life long consequences to both the baby and the family, any circumstance when a baby is diagnosed with cerebral palsy requires a careful investigation of the facts and circumstances surrounding the labor and delivery to determine if the hypoxia or asphyxia could have been prevented. In many cases, evidence in the medical records, including the fetal monitor strip, will show significant problems during labor that should have led to an earlier delivery which would have prevented the outcome of cerebral palsy.

The diagnosis of cerebral palsy is generally made after birth, when there is evidence of either developmental delay or a movement disorder or both. Although many babies who are born severely asphyxiated at birth, and who demonstrate problems with feeding and/or have seizures will clearly develop a full picture of cerebral palsy, the American Academy of Pediatrics recommends that its members do not diagnose a child with cerebral palsy before age two. Thus, many child who have or will show all of the clinical signs and symptoms of cerebral palsy do not get officially diagnosed until after age two, and thus they may not qualify for some public programs and benefits which require a diagnosis of cerebral palsy.

Thus, in any case where there have been significant problems during labor and or delivery, and the baby requires admission to the NICU because of birth depression, the parents should be aware of the potential for long term consequences to the child and should insist on complete evaluation by a pediatric neurologist or developmental pediatrician to plan a course of therapy or other interventions early in the child’s life.