CEREBRAL PALSY IN THE NEWBORN

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.

any premature infants suffer bleeding within the brain, called intraventricular hemorrhages, intracranial hemorrhages. Again, the highest frequency of hemorrhages is found in the babies with the lowest weight: the problem is rare in babies who weigh more than 2000 grams (4 pounds). This bleeding may damage the part of the brain that controls motor function and thereby lead to cerebral palsy. If the hemorrhage results in destruction of normal brain tissue (a condition called periventricular leukomalacia) and small cysts around the ventricles and in the motor region of the brain, then that infant is more likely to have CP than an infant with hemorrhages alone. Does prematurity "cause" cerebral palsy, or do some infants who are born prematurely have abnormal brains from the beginning, leading to their premature births? We do not know the answer to this question.