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Preterm birth & Cerebral Palsy

Preemie Issues - a quick look

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Preterm infants are at greater risk for both short and long term difficulties. The tinier and earlier a preemie is born the greater the risk for complications.


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Preemie Babies are not just tiny...

Premature babies are not just tiny; they are at risk for a number of health concerns, including breathing difficulties, brain injury, eye disorders, infection, bowel problems and heart dysfunction.
The issues surrounding preterm birth can be complex but we have tried to cover everything you may want to know. If you have any questions please ask them in our forums.


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Preterm birth & Cerebral Palsy

Most preemies will grow up without any major difficulties but the tiniest prems are at an increased risk for motor difficulties, including cerebral palsy.

Overview of Cerebral Palsy

The most frequent neurological outcome associated with preterm birth is cerebral palsy (CP). Cerebral Palsy is an umbrella term used to describe a group of motor disorders, which occur as a result of a non-progressive defect or damage to the developing brain in a baby or infant.

(Mathur & Inder, 2009) (Bax et al., 2005)

Key Points about Cerebral Palsy

  • No pre-birth test for CP
  • Cause of CP is often unknown
  • CP is non-progressive
  • CP disorders affect the development of movement and posture
  • CP is NOT contagious
  • There is no known cure for CP

preterm birth and cerebral palsy

Incidence of Cerebral Palsy

The chance of premature babies developing cerebral palsy is closely related to the degree of prematurity. The rate of CP is higher for babies born earlier (lower gestational age).

Incidence:


  • 1 in 400 babies is diagnosed with CP
  • Babies most at risk of CP are those born preterm or with low birth weights
  • The incidence of CP for very low birth weight babies is approximately 72 per 1000
  • The incidence of CP for babies born 2500 grams or more is approx 1.2 per 1000
  • Preterm infants born at 24 to 26 weeks gestation: approximately 20%
  • Preterm infants born at 32 weeks’ gestation: approx 4%
  • Almost 17 million people around the world have cerebral palsy

Types of Cerebral Palsy

CP is a neurodevelopmental condition that persists through the lifespan.

A special committee recently formed a definition of CP so that it met the needs of clinicians and researchers, as well as health officials. The Executive Committee for the definition of Cerebral Palsy presented the following definition,

“Cerebral palsy (CP) describes a group of disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal brain. The motor disorders of CP are often accompanied by disturbances of sensation, cognition, communication, perception, and/or behaviour, and/or by a seizure disorder.”

(Bax, et al., 2005)

Anatomical Classification of Cerebral Palsy

CP is considered a clinically descriptive term rather than an aetiological diagnosis. The traditional classification terms of CP are hemiplegia or diplegia, for the pattern of affected limbs, with the modifier describing the predominant type of tone or movement abnormality (e.g. spastic or dyskinetic).

Location Description
Hemiplegia Upper and lower extremity on one side of body
Diplegia Four extremities, legs more affected than the arms
Quadriplegia Four extremities plus the trunk, neck and face
Triplegia Both lower extremities and one upper extremity
Monoplegia One extremity (rare)

Learn more about Optimizing Preemie Positioning in the NICU

What Causes Cerebral Palsy

Although the cause of CP is often not known a number of factors may play a role, such as;

  • Genetic influences 
  • Fetal growth patterns 
  • Brain maldevelopment 
  • Antenatal factors (things that occur before birth), and 
  • Intrapartum factors (things occurring during labour and delivery)
(Petterson, Stanley, & Henderson, 1990)(Blair & Stanley, 1990)(Evrard, Marret, & Gressens, 1997)(Gaffney, Sellers, Flavell, Squier, & Johnson, 1994)

Spastic motor deficits are the major obvious neurological outcomes of brain injury in the preterm infant. These consist primarily of spastic quadriparesis and characteristically affect the lower extremities more than the upper. Spastic diplegia is most typically associated with preterm birth and is associated with periventricular leukomalacia. The areas of the brain typically affected are those involved in functions of the lower extremities (legs). Some researchers have suggested that hemiplegia and more complex spastic CP result from more extensive brain injuries such as periventricular haemorrhagic infarction or injuries to multiple areas and tend to affect both the upper and lower extremities.

(Ancel, et al., 2006)(Fawke, 2007; Volpe, 1997, 1998)(Petterson, Stanley, & Henderson, 1990)(Blair & Stanley, 1990)(Evrard, Marret, & Gressens, 1997)(Gaffney, Sellers, Flavell, Squier, & Johnson, 1994)

Learn more about Optimising motor development

How is Cerebral Palsy Treated

There are a number of treatments and therapies used to help people with CP, a list of those is provided here. It is important to consider that treatments and therapies may not be suitable for an individual’s specific needs. The majority of these therapies apply to adults and children but please check with the governing body or individual practitioner first.

Preemiehelp does not endorse or recommend any of the following treatments or therapies and we advise that you consult with your doctor and/or paediatrician before undertaking or paying for any treatment for your baby or child.

Therapies:

  • Alexander technique
  • Bobath
  • Botox™ to act as a muscle relaxant
  • Bowen technique soft tissue therapy
  • Complementary therapies from acupuncture to yoga
  • Conductive education special education for children and adults with motor disorders
  • Cycloidal vibration therapy mechanical vibration to reduce spasms
  • Dolphin therapy
  • G therapy a homeopathic treatment
  • Hippotherapy “therapy on a horse”
  • Hydrotherapy (hydro-physiotherapy) a series of gentle exercises
  • Hyperbaric oxygen therapy (HBOT)
  • Intrathecal baclofen (ITB) a drug produced as a muscle relaxant
  • Lycra dynamic splinting
  • Massage
  • Occupational therapy
  • Portage learning basic skills
  • Physiotherapy
  • Rebound therapy use of a trampoline
  • Scotson technique neuro-respiratory therapy
  • Selective dorsal rhizotomy complex neurosurgical technique
  • Speech and language therapy
  • Suit therapy (the Adeli suit, the Thera suit)
SCOPE

Cerebral Palsy Support Groups

There are a number of support groups for individuals and families of people with Cerebral Palsy. If you know of others, drop us a line.

Australia

United States

Canada

United Kingdom

New Zealand

 


Technical Reference List

(SCPE), S. o. C. P. i. E. (2002). Prevalence and characteristics of children with cerebral palsy in Europe. Developmental Medicine and Child Neurology, 44(9), 633-640.
Ancel, P.-Y., Livinec, F., Larroque, B., Marret, S., Arnaud, C., Pierrat, V., et al. (2006). Cerebral palsy among very preterm children in relation to gestational age and neonatal ultrasound abnormalities: the EPIPAGE cohort study. Pediatrics, 117(3), 828-835.
Bax, M., Goldstein, M., Rosenbaum, P., Leviton, A., Paneth, N., Dan, B., et al. (2005). Proposed definition and classification of cerebral palsy, April 2005. Developmental Medicine and Child Neurology, 47(8), 571-576.
Blair, E., & Stanley, F. (1990). Intrauterine growth and spastic cerebral palsy. I. Association with birth weight for gestational age. American Journal of Obstetrics and Gynecology, 162(1), 229-237.
Evrard, P., Marret, S., & Gressens, P. (1997). Environmental and genetic determinants of neural migration and postmigratory survival. Acta Paediatrica. Supplement, 422, 20-26.
Fawke, J. (2007). Neurological outcomes following preterm birth. Semin Fetal Neonatal Med, 12(5), 374-382.
Gaffney, G., Sellers, S., Flavell, V., Squier, M., & Johnson, A. (1994). Case-control study of intrapartum care, cerebral palsy, and perinatal death. BMJ, 308(6931), 743-750.
Mathur, A., & Inder, T. (2009). Magnetic resonance imaging--insights into brain injury and outcomes in premature infants. J Commun Disord, 42(4), 248-255.
Petterson, B., Stanley, F., & Henderson, D. (1990). Cerebral palsy in multiple births in Western Australia: genetic aspects. American Journal of Medical Genetics, 37(3), 346-351.
SCPE. (2000). Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE). Developmental Medicine and Child Neurology, 42(12), 816-824.
Volpe, J. J. (1997). Brain injury in the premature infant--from pathogenesis to prevention. Brain and Development, 19(8), 519-534.

 

 



AlbertEinstein_iconOne of the greatest minds in history, Albert Einstein was born preterm.

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Preemie, Premmie, or Prem?

Most babies spend between 38 and 42 weeks in their mother’s uterus. So, technically a preterm birth, preemie, premmie, or prem, is an infant who is born less than 37 completed gestational weeks. 


Read More: Defining Preterm birth


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