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| Cerebral Palsy |
What is an Cerebral Palsy?
WHAT CAUSES CEREBRAL PALSY?
We do not know the cause of most cases of cerebral palsy. That is, we are unable to determine what caused cerebral palsy in most children who have congenital CP. We do know that the child who is at highest risk for developing CP is the premature, very small baby who does not cry in the first five minutes after delivery, who needs to be on a ventilator for over four weeks, and who has bleeding in his brain. Babies who have congenital malformations in systems such as the heart, kidneys, or spine are also more likely to develop CP, probably because they also have malformations in the brain. Seizures in a newborn also increase the risk of CP. There is no combination of factors which always results in an abnormally functioning individual. That is, even the small premature infant has a better than 90 percent chance of not having cerebral palsy. There are a surprising number of babies who have very stormy courses in the newborn period and go on to do very well. In contrast, some infants who have rather benign beginnings are eventually found to have severe mental retardation or learning disabilities.
CEREBRAL PALSY IN THE NEWBORN
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Many children with cerebral palsy have a congenital malformation of the brain, meaning that the malformation existed at birth and was not caused by factors occurring during the birthing process. Not all of these malformations can be seen by the physician, even with today's most sophisticated scans, but when CP is recognized in a newborn, a congenital malformation is suspected. When a diagnosis of CP is made, the mother and father often feel guilty and wonder what they did to cause their child to have this disorder. While it is certainly true that good prenatal care is an essential part of preventing congenital problems, it must be stated that congenital problems, or "birth defects," often occur even when the mother has strictly followed her physician's advice in caring for herself and the developing infant. Though the causes of "birth defects" are usually unknown, we do know that the developing brain can be affected by several factors. When the fetus is exposed to certain chemicals or infections through the expectant mother, for example. The developing brain can be injured if the expectant
mother suffers severe physical trauma, the fetal brain can be injured, too, but this is rare. Finally, prematurity and a low birth weight have been shown to be related to an increased incidence of specific disorders. Many chemicals are known to adversely affect the developing brain, alcohol being the most commonly used. The term Fetal Alcohol Syndrome describes the long-term, multi-system effect of alcohol on a child whose mother abused alcohol during the pregnancy. When a fetus is exposed to large amounts of alcohol, several body systems, including the neurological system will almost certainly suffer damage. Cigarette smoking by the mother has been shown to decrease birth weight, and low birth weight is associated with several disorders, including cerebral palsy. Severe malnutrition in the mother can adversely affect brain growth in the fetus, and it, too, can result in a low birth weight. The use of cocaine or crack by the expectant mother is associated with blood vessel complications, and these complications affect many organs as well as the central nervous system. Cocaine use is increasing and thus becoming more prevalent as cause of brain damage in infants. Most infants whose mothers used cocaine during pregnancy develop mental retardation rather than cerebral palsy, however. Infections such as rubella (German measles), toxoplasmosis, and cytomegalovirus (CMV), ( if a woman has them during pregnancy), also may injure the brain of the fetus. Rubella can be prevented by immunization, prior to becoming pregnant, and the chances of becoming infected with toxoplasmosis can be minimized by not handling the feces of cats and by avoiding raw or uncooked meat.
Congenital infection with human immunodeficiency virus (HIV, the virus that causes AIDS) also causes brain damage in children, though it usually causes mental retardation rather than CP. It is likely that many other infections in the expectant mother injure the developing fetus, but they are not recognized as causative factors because the woman who has the infection either does not recognize the symptoms of infection or is symptom-free. Premature infants are at a much higher risk for developing cerebral palsy than full-term babies, and the risk increases as the birth weight decreases. Between 5 and 8 percent of infants weighing less than 1500 grams (3 pounds) at birth develop cerebral palsy, and infants weighing less than 1500 grams are 25 times more likely to develop cerebral palsy than infants who are born at full term weighing more than 2500 grams
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