Perinatal Risk Factors And Research Progress In Cerebral Palsy

Cerebral palsy is the most common physical disability of childhood and is defined as "a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behaviour; by epilepsy, and by secondary musculoskeletal problems". The first description of cerebral palsy as a clinical entity is attributed to William John Little. He proposed for the first time an association between perinatal asphyxia and poor neurological outcomes later in life.Later, Sigmund Freud proposed that cerebral palsy could begin earlier in life, during in-utero brain development, and prenatal factors are the leading cause of cerebral palsy. However, the notion that complications during labour and delivery are the leading cause of cerebral palsy was widely accepted. Not until almost one century later did large population-based studies show that only a minority of cerebral palsy cases result from birth asphyxia, prenatal factors are the leading cause of cerebral palsyThe risk factors of CP are diverse and there are some differences between premature and mature infants.In premature infants, gestional age, PVL, intrauterine infection&asphyxia are the leading cause of cerebral palsy. Yet, in mature infants, FGR,asphyxia&neonatal infection in the highest flight. CP represent the interplay between genetic (ie, sex and genes) and environmental (ie, prematurity, maternal-fetal infection, IUGR, and asphyxia) factors.The causes of CP are heterogeneous with no single etiology predominating.Most cases are divide into two parts:(1) congenital malformations of the brain,ie, cerebral dysgenesis,and also has some non-cerebral malformations.(2) an acquired injury to the not-yet mature brain,ie, white-matter injury (WMI), stroke, asphyxia, and infection. The ischemic pathway and/or the inflammatory pathway are the common final etiological pathways of CP.According to the occurrence time of brain injury, the risk factors can to be divided three classes:prenatal,intrapartum and neonatal risk factors. Determine the time when the brain damage happens not only has important clinical significance, and also has important meaning in judiciary. For CP caused by postnatal factors and congenital anomalies of the brain, etiological factors are usually clear. But it is difficult to determine CP is caused by prenatal or ntrapartum factors, and asphyxia is the bone of contention. CT, MRI,histological, biochemical and microbial examination are helpful for found ing the risk factors and determining brain damage occurred period.Criteria to define an acute intrapartum hypoxic event as sufficient to cause cerebral palsy were first proposed by the American College of Obstetricians and Gynecologists (ACOG). Most recently, the criteria have again been reviewed and knowledge updated by the ACOG andAmerican Academy of Pediatrics (AAP) Task Force on Neonatal Encephalopathy and Cerebral Palsy.Four essential criteria must be met:(1) evidence of metabolic acidosis in fetal umbilical cord arterial blood obtained at delivery (pH<7and base deficit of≥12mmol/1),(2)early onset of severe or moderate neonatal encephalopathy in infants born at34or more weeks of gestation,(3) cerebral palsy of the spastic quadriplegic or dyskinetic type, and (4) exclusion of other identifiable etiologies, such as trauma, coagulation disorders, infectious conditions, or genetic disorders.