Many cases of cerebral palsy (CP) are caused by complications that occur around the time of delivery (these are known as birth injuries). Based on this, Sandra Julsen Hollung and colleagues hypothesized that improvements in obstetrical and neonatal care could decrease the rate of cerebral palsy.
Studying the Impact of Healthcare Standards on Cerebral Palsy
For their study, published in the European Journal of Paediatric Neurology, Hollung et al. took data from the Medical Birth Registry of Norway. They included 707,916 live births, of which 1,664 had a diagnosis of cerebral palsy on record. The authors analyzed the prevalence of cerebral palsy per 1,000 live births, as a function of birth year.
Results: Improvements in Care Lowered Risk of Cerebral Palsy
Hollung et al. found that from 1999 to 2010, the rate of cerebral palsy declined from 2.62 to 1.89. In addition, the following issues/risk factors also became less prevalent:
- Severe motor impairment
- Intellectual impairment
- Speech problems
- Perinatal mortality
- Preterm births
- Multiple births
The authors conclude that these improvements in the rate of cerebral palsy and associated issues are mostly the result of advancements in obstetrical and neonatal care, which have improved perinatal health indicators on a population-wide level.
The Importance of Therapeutic Hypothermia
In particular, Hollung et al. stress that cerebral palsy is often the result of hypoxic-ischemic encephalopathy (HIE), a type of birth injury that results from a reduction in oxygen and/or blood flow to a baby’s brain. They note that therapeutic hypothermia, which can minimize permanent damage if administered shortly after hypoxic-ischemic injury occurs, was introduced to Norway in 2007. That same year, there was a decrease in babies that developed the more severe subtypes of cerebral palsy.
Hollung, Sandra Julsen, et al. “Decreasing prevalence and severity of cerebral palsy in Norway among children born 1999 to 2010 concomitant with improvements in perinatal health.” European Journal of Paediatric Neurology (2018).