Imaging studies performed in children diagnosed with cerebral palsy frequently show abnormal indings. Wu and associates (2006) used CT or MR imaging to study 273 children who were born after 36 weeks' gestation and who were diagnosed later in childhood with cerebral palsy. lthough a third of these studies were normal, focal arterial infarction was seen in 22 percent; brain malformations in 14 percent; and periventricular white-matter injuries in 12 percent. In another study of 351 children with cerebral palsy-approximately half were born near term-MR imaging indings were abnormal in 88 percent (Bax, 2006). Similar findings were reported in an Australian study (Robinson, 2008).
CT and v1R imaging techniques have also been used in older children to help deine the timing of fetal or perinatal cerebral injury. Wiklund and coworkers (l991a,b) studied 83 children between ages 5 and 16 years who were born at term and who developed hemiplegic cerebral palsy. Nearly 75 percent had abnormal CT indings, and these investigators concluded that more than half had CT changes that suggested a prenatal injury. Approximately 20 percent were attributed to a perinatal injury. In a similar study, Robinson and associates (2008) used MR imaging. hey reported pathological indings in 84 percent of children with spastic quadriplegia. Remember, this is the neurological lesion that the 20 14 Task Force concluded correlated with neonatal encephalopathy.
The term intellectual disabiliy describes a spectrum of disabilities and seizure disorders that frequently accompany cerebral palsy. But, when either of these manifests alone, they are seldom caused by perinatal hypoxia (Nelson, 1984, 1986a,b). Severe mental disability has a prevalence of 3 per 1000 children, and its most frequent causes are chromosomal, gene mutation, and other congenital malformations. Finally, preterm birth is a common association for these (Moster, 2008).
he major predictors of seizure disorders are fetal malformations-cerebral and noncerebral; family history of seizures; and neonatal seizures (Nelson, 1986b). Neonatal encephalopathy causes a small proportion of seizure disorders. Reports from the Neonatal Research Network and other studies concluded that increasing severity of encephalopathy correlates best with seizures (Glass, 2011; Kwon, 201l).
According to the Centers for Disease Control and Prevention, the frequency of autism spectrum disorders is 14.6 per 1000 in 8-year-old children (Christensen, 2016). Although these may be associated with maternal metabolic conditions, none has been linked convincingly to peripartum events (Krakowiak, 2012).
his is a drug-withdrawal syndrome that most commonly fol lows in utero exposure to maternal opioids. It also may com plicate exposure to ethanol or benzodiazepines. The syndrome is characterized by hypertonia, autonomic instability, irritabil ity, poor sucking relex, and seizures (Finnegan, 1975). he incidence of abstinence syndrome has risen six-to sevenfold during the past decade, coincidental with the growing opioid use described in Chapter 1 (p. 9). For example, Tolia and col leagues (2015) reported that 4 percent of all neonatal intensive care unit (NICU) days in 2013 were attributed to care of these afected newborns.