Exxcellence pearls: neonatal encephalopathy

Question 0

What is the incidence of cerebral palsy?

What is the incidence of mental retardation?

Answer 0

2 per 1000 births.

Approximately 4 per 1000 births.

Question 1

Define cerebral palsy.

Answer 1

Non-progressive motor spasticity of early onset.

Question 2

What percentage of cerebral palsy cases are associated with oxygen deprivation during delivery?

Answer 2

10%

Question 3

What is the most important risk factor for cerebral palsy?

Answer 3

Preterm birth

Question 4

What features are suggestive of birth asphyxia but not specific criteria?

Answer 4

Sentinel hypoxic event occurring immediately before or during labor.
Sudden or sustained fetal bradycardia or absent fetal heart rate variability with persistent late or variable decelerations
Apgar score of 0-3 beyond 5 minutes.
Onset of multi-system involvement within 72 hours of birth.
Early imaging showing acute nonfocal cerebral abnormality.

Question 6

List the essential criteria outlined by ACOG/AAP sufficient to cause cerebral palsy.

Answer 6

1. Metabolic acidosis in umbilical cord arterial blood (pH less than 7 and greater than or equal to 12 mmol/L)
2. Early onset of moderate to severe neonatal encephalopathy
3. Cerebral palsy of the spastic quadriplegic or dyskinetic type
4. Exclusion of other causes such as trauma, coagulation disorders, infectious conditions, genetic disorders