What is the issue?

'Cerebral palsy' is a term that includes a group of conditions affecting people's ability to move; it is the most common physical disability in childhood. Cerebral palsy is usually due to events before, during, or after childbirth that lead to injury to babies' developing brains. No single cause of cerebral palsy is known. For many children, the cause of cerebral palsy is unclear, but many risk factors are known. The biggest risk factor is preterm birth (birth before 37 weeks of pregnancy). Other risk factors during the neonatal period (birth to one month of life) include prolonged loss of oxygen during birth; brain injury; strokes or seizures; disorders of the heart, blood vessels, airways, and lungs; prolonged mechanical assistance for breathing; some infections; jaundice (yellow discolouration of the skin and eyes due to excess bilirubin in the blood); and some syndromes or abnormalities of chromosomes (structures that hold genes).

Why is this important?

As there are different risk factors for and causes of cerebral palsy, it is likely that different interventions may be needed to prevent cerebral palsy by reducing risk factors. This overview summarises evidence about preventing cerebral palsy that has been presented in Cochrane Systematic Reviews of interventions during the neonatal period.

What evidence did we find?

We searched for evidence on 27 November 2016, and identified 43 Cochrane Reviews assessing interventions during the neonatal period that reported some information on cerebral palsy. These Reviews were all of moderate to high quality, but the quality of the evidence about cerebral palsy ranged from very low to high. Three Reviews assessed interventions for newborn babies who may have had a lack of oxygen at or around the time of birth; 33 Reviews assessed interventions for babies born preterm or at low birthweight; and seven Reviews assessed interventions for other groups of newborn babies at risk of injury to their brains (such as newborn babies with low blood sugar at birth).

We found that one intervention was effective for cerebral palsy prevention. Newborn babies who may have had a lack of oxygen at or around the time of birth who had induced hypothermia (cooling of their body or just their brain) were less likely to develop cerebral palsy than babies who did not receive hypothermia (seven trials; 881 children; high-quality evidence). We found that one intervention was possibly effective for cerebral palsy prevention. Preterm newborns who received methylxanthines (caffeine) when weaning from machine-assisted breathing (extubation from mechanical ventilation) was planned were less likely to develop cerebral palsy than babies who received a placebo (one trial; 644 children; moderate-quality evidence). We found one intervention that was probably ineffective and may cause harm: Preterm newborns who received early (at less than eight days of age) corticosteroids to prevent chronic lung disease were more likely to develop cerebral palsy than babies who received a placebo (12 trials; 959 children; moderate-quality evidence). We found that five other interventions were probably ineffective (did not prevent or increased the chance of cerebral palsy) (moderate-quality evidence). Review authors did not find enough evidence to say whether the other interventions prevented, increased, or had no impact on cerebral palsy (low- or very low-quality evidence).

What does this mean?

This overview identified one intervention that was effective in preventing cerebral palsy (induced hypothermia for newborn babies who may have had a lack of oxygen), one that was possibly effective for preventing cerebral palsy (caffeine for preterm babies weaning from machine-assisted breathing), one that appeared to cause harm (corticosteroids at less than eight days of age for preterm babies to prevent chronic lung disease), and five that did not appear to make a difference. For the other interventions assessed, there was not enough evidence to allow conclusions. It is important that additional good quality trials assessing interventions that might impact cerebral palsy risk factors conduct long-term follow-up to measure the impact of these interventions. We identified over 100 other Cochrane Reviews that may in the future provide information on interventions during the neonatal period for preventing cerebral palsy if they include long-term follow-up.