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Cerebral Palsy and the Application of the International Criteria for Acute Intrapartum Hypoxia

From the ¹Discipline of Obstetrics and Gynaecology, the University of Adelaide, and the ²South Australian Birth Defects Register, Department of Genetic Medicine, at the Women’s and Children’s Hospital, Adelaide, South Australia.

OBJECTIVE: To apply objective criteria for the identification of acute intrapartum hypoxia in a cohort of cerebral palsy cases and to identify other cerebral palsy–related pathologies.

METHODS: A cohort of all 235 neonates with cerebral palsy from a single Australian tertiary care center born between 1986 and 2003. Cases were identified from the South Australian Cerebral Palsy Register. Maternal and pediatric case notes were audited with application of the 2003 American College of Obstetricians and Gynecologists/American Academy of Pediatrics criteria to identify acute intrapartum hypoxia.

RESULTS: Data were available for analysis in 213 cases (91%). Major antenatal or pediatric cerebral palsy–related pathologies were identified in 98.1% of all these cases. An isolated acute intrapartum hypoxic event was defined as likely in only 2 of the 46 neonates born at term and none born preterm. Neonatal nucleated red blood cell counts were often high in neonates born preterm and following antenatal pathologies.

CONCLUSION: Cerebral palsy was seldom preceded by acute intrapartum hypoxia but antenatal cerebral palsy–related pathologies are often detectable. The objective American College of Obstetricians and Gynecologists/American Academy of Pediatrics criteria are useful to audit cerebral palsy causation and exclude primary intrapartum hypoxia.

LEVEL OF EVIDENCE: II-3

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