Cerebral palsy (CP) is a brain disorder that affects body movement and muscle coordination. Cerebral palsy is caused by changes in the developing brain that disrupt its ability to control movement and maintain posture and balance. The term cerebral refers to the brain. Palsy refers to problems with movement.
CP has historically been associated with birth asphyxia (lack of oxygen and blood flow to the baby’s brain). While the term “birth asphyxia” given to parents by paediatricians when a baby is delivered with low Apgar scores, requires resuscitation, or if neonatal fits occur umbilical arterial blood cord gases, when available, may not confirm significant ‘asphyxia’, hypoxia ( low oxygen) by not showing a severe metabolic acidosis (too much acid in your blood). Even if confirmed, this does not indicate the timing of the metabolic disturbance, or its cause. While birth asphyxia secondary to intrapartum complications has been long considered as the leading cause of CP; however, numerous large population-based studies have established that birth asphyxia accounts for less than 10% of CP cases (1).
There are also other possible causes. Genetic screening is showing about a third of cerebral palsy cases have one of many rare genetic variants that cause cerebral palsy through various metabolic pathways. A systematic review and meta-analysis of 13 small studies using exome sequencing (examining that part of human’s genes responsible for protein synthesis) found genetic variations that may cause CP in more than 30% of cases (2). Other possible causes include problems with the formation of the brain in the womb, infections or fevers in the pregnant parent, stroke, or injury before, during, or just after birth. In many cases, the cause of cerebral palsy is unknown.
There is increased risk of CP if Intrauterine foetal growth retardation, premature birth, multiple births, infection during pregnancy, exposure to toxic substances in pregnancy.
While the condition can be apparent soon after birth sometimes it is not be detected until months or years later.
The introduction of “no win – no fee” litigation in Australia and the very generous potential payouts in cerebral palsy cases (millions of dollars) has been a major factor on the rapid escalation of obstetricians medical insurance rates and the practice of defensive obstetrics contributing to a rise in Caesarean delivery rates over more recent years.
- Ellenberg JH, Nelson KB. The association of cerebral palsy with birth asphyxia: a definitional quagmire. Dev Med Child Neurol. 2013;55(3):210-216. doi:10.1111/dmcn.12016
- Gonzalez Mantilla et al JAMA Pediatr 2023;177:472-8
