Neonatal Signs as Predictors of Cerebral Palsy

Abstract

Signs of neonatal neurologic dysfunction, recorded in about 40,000 infants, were evaluated prospectively for their ability to predict later motor handicap. Increases of 10- to 33-fold in risk of cerebral palsy (CP) were observed in surviving children with any 1 of the following characteristics: birth weight < 2,000 g, head circumference > 3 SD above or below the mean, 5 min Apgar score of 3 or less, diminished activity or diminished cry lasting for > 1 day, thermal instability, need for gavage feeding, hypotonia or hypertonia, single or multiple apneic episodes, or hematocrit < 40%. Of worse portent, with relative risks > 50, were neonatal seizures or Apgar scores of 3 or less at 10 min or later. These characteristics were also markers of considerable risk of early death. For 0.5% of surviving infants, an overall impression of abnormality of brain function during the nursery period was recorded by the attending physician; there was a 99-fold increase in CP among these children.