title: Cerebral Palsy after Neonatal Encephalopathy: How Much Is Preventable?
abstract: OBJECTIVE
  To determine the expected proportion of term cerebral palsy (CP) after neonatal encephalopathy (NE) that could theoretically be prevented by hypothermia and elucidate the perinatal factors associated with CP after NE in those who do not meet currently used clinical criteria required to qualify for hypothermia ("cooling criteria").
  
  
  METHODS
  Using the Canadian CP Registry, we categorized children born at ≥ 36 weeks with birth weight ≥ 1800 g with CP after moderate or severe NE according to the presence or absence of cooling criteria. Maternal, perinatal, postnatal, and placental factors were compared between the 2 groups. A number needed to treat of 8 (95% CI 6-17) to prevent one case of CP was used for calculations.
  
  
  RESULTS
  Among the 543 term-born children with CP, 155 (29%) had moderate or severe NE. Sixty-four of 155 (41%) met cooling criteria and 91 of 155 (59%) did not. Shoulder dystocia was more common in those who did not meet cooling criteria (OR 8.8; 95% CI 1.1-71.4). Low birth weights (20% of all singletons), small placentas (42%), and chorioamnionitis (13%) were common in both groups.
  
  
  CONCLUSIONS
  The majority of children with CP after NE did not meet cooling criteria. An estimated 5.1% (95% CI 2.4%-6.9%) of term CP after NE may be theoretically prevented with hypothermia. Considering shoulder dystocia as an additional criterion may help recognize more neonates who could potentially benefit from cooling. In all cases, a better understanding of the antenatal processes underlying NE is essential in reducing the burden of CP.
authors.affiliation: Department of Neurology/Neurosurgery, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Jarred
authors.initials: J
authors.lastname: Garfinkle
authors.affiliation: Department of Pediatrics, McGill University, Montreal, Quebec, Canada; Division of Neonatology, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Pia
authors.initials: P
authors.lastname: Wintermark
authors.affiliation: Department of Neurology/Neurosurgery, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
authors.forename: Michael I
authors.initials: MI
authors.lastname: Shevell
authors.affiliation: Department of Pediatrics, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Platt
authors.affiliation: Department of Neurology/Neurosurgery, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada. Electronic address: maryam.oskoui@mcgill.ca.
authors.forename: Maryam
authors.initials: M
authors.lastname: Oskoui
mesh_terms: D002547:Cerebral Palsy / Q000453:epidemiology / Q000517:prevention & control*; D002821:Chorioamnionitis / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000453:epidemiology; D004420:Dystocia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data*; D020925:Hypoxia-Ischemia, Brain / Q000453:epidemiology*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D010920:Placenta / Q000473:pathology; D011247:Pregnancy; D011792:Quebec / Q000453:epidemiology; D012042:Registries; D012720:Severity of Illness Index