Temporal and demographic trends in cerebral palsy - Fact and fiction

Steven L. Clark, Gary Hankins

Research output: Contribution to journalArticle

182 Citations (Scopus)

Abstract

The rate of cerebral palsy has not decreased in developed countries over the past 30 years, despite the widespread use of electronic fetal heart rate monitoring and a 5-fold increase in the cesarean delivery rate over the same period of time. However, neonatal survival has improved during these decades. These observations have lead to the hypothesis that increased survival of premature, neurologically impaired infants may have masked an actual reduction in cerebral palsy among term infants as a result of the use of electronic monitoring and the avoidance of intrapartum asphyxia. A review of the medical literature, as well as a demographic analysis of term and preterm birth rates in the United States, refutes this hypothesis on four grounds. First, cerebral palsy prevalence has been separately analyzed in term infants and shows no change over 30 years. Second, the prevalence of cerebral palsy is the same or lower in underdeveloped countries than in developed nations; in the former, the availability of emergency cesarean delivery based on electronic monitor data is limited or absent. Third, the increase in prevalence of cerebral palsy among low-birth-weight infants and the increase in cesarean sections based on presumed fetal distress were not simultaneous events - the former preceded the latter by a decade. Improved neonatal survival since the 1980s has been associated with a stable or decreasing rate of neurologic impairment and thus could not have obscured improvement from reduced term asphyxia. Finally, compared with the number of infants born by cesarean section for fetal distress, there are simply not enough infants born in the most vulnerable weight groups to make any impact on even a minimal improvement of outcome in the group delivered by cesarean section for presumed fetal distress. Except in rare instances, cerebral palsy is a developmental event that is unpreventable given our current state of technology.

Original languageEnglish (US)
Pages (from-to)628-633
Number of pages6
JournalAmerican Journal of Obstetrics and Gynecology
Volume188
Issue number3
DOIs
StatePublished - Mar 1 2003

Fingerprint

Cerebral Palsy
Demography
Fetal Distress
Cesarean Section
Asphyxia
Developed Countries
Term Birth
Fetal Heart Rate
Birth Rate
Premature Birth
Low Birth Weight Infant
Nervous System
Emergencies
Technology
Weights and Measures

Keywords

  • Cerebral palsy
  • Electronic fetal heart rate monitoring
  • Premature birth

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Temporal and demographic trends in cerebral palsy - Fact and fiction. / Clark, Steven L.; Hankins, Gary.

In: American Journal of Obstetrics and Gynecology, Vol. 188, No. 3, 01.03.2003, p. 628-633.

Research output: Contribution to journalArticle

Clark, Steven L. ; Hankins, Gary. / Temporal and demographic trends in cerebral palsy - Fact and fiction. In: American Journal of Obstetrics and Gynecology. 2003 ; Vol. 188, No. 3. pp. 628-633.
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