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Did Your Newborn Suffer Cerebral
Palsy or Another Brain Injury Before
or During Labor and Delivery?

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Our Birth Brain Injury Resource Guide

the guide

Get a FREE guide of resources available throughout Ohio to children and families of children who were born with brain injuries.

Our guide can help you build a foundation of knowledge and tools that will help you help your child
now and in the future.

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Short and Long-Term Outcome for Hypoxic-Ischemic Encephalopathy

After a review of 13 studies which met criteria for mild, moderate, and severe hypoxic-ischemic encephalopathy (HIE) or neonatal encephalopathy (NE), none of the mild cases had an adverse outcome within three years of birth while 32% of those with moderate HIE had adverse results and 100% of severe HIE sufferers were impacted. In children with moderate NE or HIE, MRI and early amplitude integrated EEG (an EEG) were useful in predicting neurodevelopmental problems. With regard to the development of cerebral palsy (CP) after HIE, the most useful following conditions are needed in order to establish a probable cause and effect: (1) diagnosis of moderate or severe HIE, (2) spastic or dyskinetic types of quadriplegia, (3) absence of other causes, (4) umbilical artery pH less than 7.0.

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Cognitive Outcome

Elk & Elk

There is controversy as to whether peripartum asphyxia resulting in HIE can cause isolated cognitive deficits without the concomitant motor deficits. In cases of mild HIE or NE, school-aged children exhibited normal cognitive skills. However, for those children from ages 5 to 8 years who were diagnosed with moderate HIE without motor deficits, there was a demonstration of waning skills in the area of reading, writing, and math. These children with moderate HIE were often one grade behind their peers compared to those children with mild HIE. Memory impairment, especially regarding specific events or facts, verbal tasks, or visual recall issues have been demonstrated in school children diagnosed with moderate HIE and memory is associated with the normal functioning of the area of the brain known as the hippocampus.

However, many of the moderately affected HIE children who were cognitively impaired without motor dysfunction had early signs, symptoms, and interventions that bordered on the severe end of the spectrum. However, none of these moderate HIE children with cognitive deficits had neuroimaging or an EEG which may have demonstrated a more severe outcome or diagnosis.

In a study that looked at 15-19 year old children whose diagnosis of moderate HIE was based on an abnormal Apgar score of less than 7 at 5 minutes, it was found that 81% of them were cognitively impaired. Another study of teenagers with moderate HIE concluded that 30% had CP, 51% had cognitive dysfunction, and 19% were normal. In a study of 9 and 10 year old children, 34 with mild HIE and 46 with moderate HIE, the results revealed (after evaluating motor, intellectual, memory, and behavioral parameters) that in the moderate group, behavioral assessments by teachers were abnormal compared to controls. And, the diagnosis of ADHD was more common in those with moderate HIE.

Physical and Motor Outcomes

Severe CP as a result of HIE has huge ramifications for long-term medical management. The concerns are primarily related to the nutritional status as a result of the inability to chew or swallow and thus require gastrostomy tube feedings. Other problems include failure to thrive, aspiration pneumonia, orthopedic problems, scoliosis, seizures, chronic pain, brittle bones or osteoporosis, and decreased life expectancy. Seizures occur in 50% of those with hemiplegic CP, and this can be more serious than the gross or fine motor skill problems.

As a result of the medical problems, surgeries may be needed to place the gastrostomy tube into the stomach, as well as scoliosis surgery, orthopedic and hip surgery. Medications such a botulism toxin, baclofen, anticonvulsants are often needed. Wheelchairs, orthotics, special transportation, home care, physical therapy, and special education all require additional resources to help the person with these disabilities. The consequences to the family both financially, emotionally, and socially are enormous. One parent usually becomes the full-time caregiver and cannot work. This impacts their long-term financial stability and social network. The other siblings may not have their needs met or able to participate in extra-curricular activities as a result of the complicated and time-consuming care needed for the CP or other neurodevelopmental problems.

It costs $7600 annually for gastrostomy feedings, and it is estimated to cost over $5 million dollars over the course of a lifetime to care for a child with CP with severe feeding and learning disabilities. In fact, the cost to treat the intellectual-cognitive disabilities far exceeds the cost of the motor, visual or hearing loss issues. In 2003, the intellectual costs for evaluation and treatment in the US alone were in excess of $50 billion while the costs for the same with CP sufferers is in excess of $10 billion.

Social and Quality of Life

Quality of life issues such as whether there is chronic pain, seizures, the ability to eat, walk, or talk, and the ability to participate in society all greatly impact the individual, families, and society. With regard to employment, 29% of adults aged 21 through 35 with either CP, intellectual disabilities, seizures, or visual disabilities are employed compared to 82% of the rest of the population.

Adults with Hemiplegia are employed in 48% of cases while those with diplegia and quadriplegia are employed in 26% and 12% of cases, respectively.

The social impact of adults with CP or other HIE-related disabilities is that these individuals are less likely to date or get married. They often do not finish their basic education or higher education, do not drive, own a house, have insurance or participate in recreational activities. The siblings and family members are also limited in their social and recreational abilities, their lifetime income, and other quality of life issues that the rest of the population take for granted.