Cerebral Palsy - Infection at Delivery?

Cerebral palsy, premature birth and poorly responsive newborns are caused far more commonly by infections in the mother than by medical incompetence. Millions of dollars have been awarded because juries have decided that medical incompetence at birth causes cerebral palsy. Research shows that this condition in full-term babies is associated with infections in the mother that occur long before a baby is born (1,7).

A recent study from Denmark shows that another factor associated with cerebral palsy is having a baby earlier than expected; this is also is associated with infection in the mother or father (2). Both parents of babies born prematurely were found to have a very high incidence of beta strep group B and chlamydia, two bacteria that are spread through sexual contact.

Further studies show that children with cerbral palsy often had infections in the fluid that surrounded their bodies during birth (6). The courts used to rely on the Apgar test to assess the alertness of a newborn baby. They used to think that low Apgar tests often indicate that the baby suffers from lack of oxygen at birth. If they were not resuscitated immediately, the babies brain would be damaged, causing cerebral palsy. However, lack of oxygen at birth has not been shown to be the major cause of cerebral palsy (3,4,5). Newborn babies of normal weight/ who have low Apgar scores often are infected or have mothers who have had an infection during pregnancy. So the Apgar test that most courts use to determine low oxygen levels and a doctor's culpability for causing cerebral palsy, may really be a test associated with a uterine infection that occurred long before the mother gave birth. In cases of premature birth or babies with low Apgar scores, doctors should culture the mother's cervix and father's urethra for infectious agents. The father's semen should be checked for white blood cells, another sign of infection.

1)Grether JK, Nelson KB. Maternal infection and cerebral palsy in infants of normal birth weight. JAMA 1997(July 16);278:207-211.

2) N Kjaergaard, D Hansen, ES Hansen, HC Schoenheyder, N Uldbjerg, H Madsen. Pyospermia and preterm, prelabor, rupture of membranes. Acta Obstetricia et Gynecologica Scandinavica 76: 6(JUL 1997):528-531.

3) NEJM 1986;315:81-86.

4) Dev Med Child Neurol 1993;35:191-221.

5) Am J Perinatol 1994;11:377-381.

6) TM Oshea, KL Klinepeter, RG Dillard. Prenatal events and the risk of cerebral palsy in very low birth weight infants. American Journal of Epidemiology 147: 4 (FEB 15 1998):362-369.

7) JK Grether, KB Nelson, JM Dambrosia, TM Phillips. Interferons and cerebral palsy. Journal of Pediatrics, 1999, Vol 134, Iss 3, pp 324-332.

Checked 8/9/05

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