Can Cerebral Palsy be Prevented?

Certain medical advances (such as vaccines), early and improved care of pregnant women, and nutrition have lowered the numbers of babies born with CP in poorer countries. However, in developed countries (like the United States) the number of babies with CP has remained much the same over the last 50 years (Nelson, 2003). This is a complex issues as certain causes of CP have been reduced (e.g. brain injury from neonatal jaundice, brain injury from maternal rubella) but other causes have emerged (e.g. increased survival of very premature infants).

Today, More can be Done to Prevent CP Than Ever Before:

Rh Factor Test

Pregnant women who have Rh negative blood type can be treated to prevent problems with blood incompatibility with their infant while in the womb. All pregnant women are tested to determine their blood type. If a woman is found to be Rh negative, she can be immunized early in pregnancy and again within 72 hours of giving birth (or after the pregnancy terminates) to help reduce the risk of blood incompatibility during current or future pregnancies. Rh blood incompatibility can be a contributing factor to development of CP.  If the woman who is Rh negative has developed an incompatibility with a baby’s blood, various treatments can be used during and after pregnancy to optimize the baby’s health reducing the risk of CP for that child.

Treating Jaundice

Many babies develop jaundice (a yellow discoloration of the skin during the first few days of life). In many babies, this jaundice does not cause a problem and is a normal part of the body’s maturation. However, sometimes the jaundice is severe because of underlying issues such as blood group incompatibility, prematurity, or other concerns. The bilirubin in the blood (the substance that causes the yellow color) can cross into the brain and is toxic to certain brain cells causing brain injury that could result in CP. If a baby is developing jaundice, the babies clinician will monitor it and, if it’s rising to a dangerous range, treat it by exposing the baby’s skin to special lights (“phototherapy”), insuring good hydration and in severe cases, performing an “exchange blood transfusion.”

Immunization and Prevention of Maternal Infection

Insuring all women are immunized against rubella reduces the risk of congenital rubella, which can cause CP. Someday, vaccines may be developed against other infections that can happen during pregnancy and result in infant brain injury. These include cytomegalovirus (CMV) and toxoplasmosis. Until then, women can reduce their risk by avoiding these infections when possible (e.g. not changing a cat’s litter box since cats can carry toxoplasmosis, avoiding exposure to infants who are known to be secreting CMV virus). Maternal herpes infection can also result in infection in the infant, which in some cases results in brain infection causing brain injury related CP. If a mom has active herpes during deliver, the baby can be assessed and treated early should infection occur.

Prenatal Care

It is important for women to get proper health care prior to conception, to be evaluated by a high-risk perinatologist if they anticipate pregnancy complications, and to have early and continuous prenatal care throughout the pregnancy. Prematurity (being born too soon) may result in brain injury and subsequent CP. The following steps can help prevent premature births:

  • Reducing exposure of pregnant women to virus and other infections
  • Recognizing and treating bacterial infection of the reproductive and urinary tracts
  • Avoiding unnecessary exposure to X-rays, drugs, alcohol, cigarettes and medications
  • Controlling maternal health problems such as diabetes, anemia and hypertension
  • Optimal maternal nutrition including maternal vitamin supplements
  • Ensuring optimal evaluation for women who have had miscarriages or prior premature infants. In some cases, treatments can be offered to reduce  risk of recurrence (e.g. hydroxyprogesterone treatment in women with high risk of premature delivery, treatments for cervical incompetence or uterine malformations)
  • Early recognition and treatment of preterm labor. With early recognition, sometimes the preterm labor can be stopped. If not, treating mothers who are 23-32 weeks of gestation and have anticipated delivery with magnesium sulfate, may provide some neuro-protection for the infant. However guidelines are still emerging regarding this so obstetric practices vary across centers.

Birth Asphxia Treatment

Birth asphyxia (having low oxygen delivery to the brain during the birth is a risk factor associated with the development of CP. If an infant is suspect of having low oxygen delivery to the brain during the birthing process, it is critical that the infant receive the best possible medical stabilization and support to minimize the extent of brain injury. Some specialized neonatal intensive care units will provide for emerging treatments (e.g. neonatal head or body cooling) to reduce the risk of CP.

Reduce risk of head injury

Since anything that causes brain injury can result in CP, insuring optimal safety for infants is important in prevention. This includes not shaking infants (to avoid brain injury from shaken baby syndrome), providing families supports to reduce potential for child abuse, insuring proper restraint in vehicles (e.g. car seats), reducing risks of falls, optimal vaccination (to reduce risk of meningitis from certain germs) and insuring early recognition of infections that affect the nervous system (e.g. meningitis and encephalitis). 

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Why did this happen to my baby?

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Resources:

Brain Injury Research Foundation
www.birf.info

National Institute of Neurological Disorders and Stroke
www.ninds.nih.gov

Children’s Hemiplegia and Stroke Association
www.chasa.org