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Neonatal encephalopathy and cerebral palsy

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Most children with neonatal encephalopathy do not develop cerebral palsy and most children with cerebral palsy have not had neonatal encephalopathy. A study in Western Australia (

) has provided more information about cerebral palsy following or not following neonatal encephalopathy.

The case control study included 840 term infants born between June 1993 and December 1996; 276 with moderate or severe neonatal encephalopathy and 564 control infants. Neonatal encephalopathy was defined as either seizures or at least two of four other criteria (abnormalities of consciousness, tone, feeding, or respiration, each of presumed central origin and lasting for at least 24 hours) in the first week of life. Twenty-five infants with neonatal encephalopathy died in the neonatal period. Survivors were followed up for 6 years and 32 (13%) developed cerebral palsy (15/178 (8%) of those with moderate neonatal encephalopathy and 17/73 (23%) of those with severe neonatal encephalopathy). Data from the Western Australian Cerebral Palsy Register showed that over the period of the study there were 82 995 live term births and 131 children were identified as having cerebral palsy by the age of 5 years. Of these 131 children 99 did not have a history of neonatal encephalopathy.

Children with cerebral palsy after neonatal encephalopathy were more likely to be severely affected. They were twice as likely (47% vs 25%) to have severe cerebral palsy when compared with children with cerebral palsy not preceded by neonatal encephalopathy, and more likely to have spastic quadriplegia or dyskinetic cerebral palsy. They were more likely to have epilepsy or cognitive impairment and their cognitive impairment was more likely to be severe. They were also more likely to be non-verbal, to have a severe composite disability score, and to die within a few years of the diagnosis of cerebral palsy.

About one in eight of the survivors of moderate or severe neonatal encephalopathy at term developed cerebral palsy. About three quarters of term-born children with cerebral palsy had not had neonatal encephalopathy. Cerebral palsy is likely to be more severe in the survivors of neonatal encephalopathy.

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