Cerebral Palsy

Question 1

Normal UV and UA cord gas pH

Answer 1

UV = 7.17-7.48
UA = 7.05-7.38

Ie. 7-7.5

Question 2

Normal UA and UV base excess?

Answer 2

UA= -2.5 to -9.7
UV = -1 to -8.9

Question 3

Types of cerebral palsy (4)

Answer 3

spastic (70-80%)
athetoid cerebral palsy (10-20%)
ataxic (5-10%)
mixed (10%)

Question 4

Risk of CP with grade II and III HIE?

Answer 4

II = 24%
III = 94%

Question 5

Risk of CP with 5 min Apgar 10, or <3?

Answer 5

10 = 0.1%
<3 = 10%

Question 6

Risk of HIE, CP and death with lactate <6.8?

Answer 6

HIE 66%
CP 17%
death 21%

average Apgar at 5min = 4. average lactate 17.8.

Question 7

Risk of HIE, death, CP with base excess >20?

Answer 7

HIE = 70%
CP = 33%
death = 26%

average 5 min Apgar is 4.

Question 8

Risk of cerebral palsy at 24-26 weeks, 27-31 weeks?

Answer 8

24-26= 7%
27-31 = 4.3%

Question 9

What are the spectrum of disorders associated with HIE?

Answer 9

cerebral palsy
cognitive dysfunction
sensory deficits: hearing, visual/perceptual
speech delay
attention and learning
psychiatric:
- ADHD
- ASD 25% BW <1500g, 20-40% <28/40

Question 10

essential criteria for diagnosis of cerebral palsy due to intrapartum hypoxic event?

Answer 10

1. evidencece of a metabolic acidosis in intrapartum fetal, umbilical arterial cord, or very early blood samples’- pH<7, BE >12
2. early onset of severe or moderate neonatal encephalopathy in infants 34 weeks or more
3. Cerebral palsy of the spastic quadriplegic or dyskinetic type

Question 11

suggestive criteria for diagnosis of cerebral palsy due to intrapartum hypoxic event? (5)

Answer 11

• sentinel hypoxic event immediately before or during labour
• sudden rapid and sustained deterioration of FHR patter after sentinel event, where it was previously normal
• Apgar scores of 0-6 for longer than 5 minutes
• early evidence of multi system involvement
• early imaging evidence of acute cerebral abnormality

Question 12

Evaluate global importance of preventing preterm birth

Answer 12

15 million babies per year globally
outcomes severe = death, CP, cognitive, learning
prevention possible: diet, substance use, growth, routine care, urine, infections, comorbidities
secondary prevention: mgso4, steroids, antibiotics
neonatal care: expensive, resource consuming, specialised equipment + therapies.

Prevention strategies effective, cost-effective and reasonable.

Question 13

incidence of preterm birth in NZ

Answer 13

8.4%

Question 14

Define extreme, very and moderate to late preterm birth

Answer 14

23-28 = extreme
28-32 = very
32-37 = moderate to late

Question 15

Proportion of preterm birth occurring <28w, 28-32w, 32-37w?

Answer 15

5%
10%
85%