Neonatal encephalopathy and cerebral palsy

The incidence of cerebral palsy is 1-2 per 1000 births and has remained unchanged over the last 40 years. The occurrence of cerebral palsy is independent of either geographic or economic boundaries. It has also been remarkably resistant to eradication by the introduction of technology such as electronic fetal heart rate monitoring or the increase in cesarean delivery rates. Indeed, the great hope of electronic fetal heart rate monitoring was that intrapartum asphyxia would be promptly identified, delivery rapidly achieved, and neurologic injury of the infant averted. This would in fact parallel the thought processes advanced by the orthopedic surgeon Little, over a century ago, who taught that virtually all cerebral palsy was caused by intrapartum events, whether deprivation of oxygen, trauma, or the combination of the two. Unfortunately, despite an escalation of the cesarean delivery rate from approximately 6% in 1970 to a rate approaching 30% nationally today, the incidence of cerebral palsy in the USA has remained constant. These facts then would seem to support the evolving concept that cerebral palsy results from the combination of the genetic make-up of the individual and the subsequent collision of that individual during development with the environment that they are exposed to, both intrauterine as well as extrauterine for the first several days, months, or years of life.