Primary prevention

The etiology of CP appears to be multifactorial, and prevention requires several approaches depending on the precise etiology. Prevention may be effective where resources exist to diagnose and treat risk factors.

Maternal risk factors such as iodine deficiency, thyroid diseases, and infections should be screened for and treated early. It is important to prevent TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes simplex) infections by vaccination where possible and institute quick treatment when encountered. Unnecessary exposure to antenatal x-rays and unnecessary drug exposure should be avoided. Rh-negative mothers can be treated with immunoglobulins, and infants with jaundice should be treated with phototherapy and transfusions as needed.

Premature births should be prevented, where possible, and aggressive treatment of neonatal complications sought and instigated. Treatments attempt to prevent inflammatory changes that accompany dramatic events such as asphyxia or neonatal stroke in an effort to limit damage to the neural structures.[55]

Magnesium sulfate for fetal neuroprotection

Guidelines recommend that magnesium sulfate should be started within (or as close to as is possible) 4 hours of the expected delivery time of a planned or expected preterm birth.[56][57][58] The Food and Drug Administration recommends against the use of parenteral magnesium sulfate for more than 5 to 7 days to stop preterm labor. Prolonged use may lead to low calcium levels and bone problems in the developing baby or fetus, including osteopenia and fractures.[59]

There is high-quality evidence to support the use of prenatal neuroprotective magnesium sulfate infusions for women at risk of preterm birth.[60][61][62][63] [ Cochrane Clinical Answers logo ] [ Cochrane Clinical Answers logo ] ​​ Compared with placebo, magnesium sulfate significantly reduced CP in children born to women at risk of preterm birth (risk ratio 0.68, 95% CI 0.54 to 0.87; five randomized controlled trials; 6145 children).[61][62] However, studies included in the meta-analysis assessed the outcome of CP in early childhood (typically ages ≤2 years) when the diagnosis may not always have been certain. 

In one placebo-controlled randomized trial, magnesium sulfate given to pregnant women at imminent risk of birth before 30 weeks' gestation was not associated with significant reductions in CP or abnormal motor function in their children when assessed at ages 6 to 11 years.[64]

One Cochrane review concluded that high-quality randomized controlled trials were required to assess the effect of magnesium sulfate for neuroprotection of the term fetus.[65]

Corticosteroids

An overview of Cochrane reviews concluded that a single course of maternal corticosteroids (administered to accelerate fetal lung maturation in women at risk for preterm birth) may reduce CP (low-quality evidence), but that repeat doses are unlikely to be more effective than a single course.[63]

Postnatal corticosteroids given to preterm babies (at age 8 days or earlier) for preventing chronic lung disease may increase the risk of CP compared with placebo or no treatment.[66]

Therapeutic hypothermia

When started within 6 hours of birth, therapeutic hypothermia has been found to be neuroprotective.[63][66][67] Compared with standard care, therapeutic hypothermia reduced CP among newborns with hypoxic ischemic encephalopathy (risk ratio 0.66, 95% CI 0.54 to 0.82).[66][67] [ Cochrane Clinical Answers logo ]  

Putative neuroprotective interventions

Prophylactic methylxanthines (caffeine) for preterm infants having endotracheal extubation may be associated with a reduction in CP risk (compared with placebo).[63][66]

One study reported that recombinant human erythropoietin reduced long-term neurologic disability when given to very premature infants, but other studies showed no clear benefit.[66][68]​​

Preventive antibiotics (for women in preterm labor when their waters have not broken, and immediate birth for preterm babies with suspected compromise) have been shown to be probably ineffective and could cause harm.[61]

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