Low birth score linked to cerebral palsy

8^th October 2010 - New research suggests that there is a strong link between babies who achieve a low score during a routine test of their condition at birth and the risk of cerebral palsy.

The test - known as the Apgar score - is a quick way of determining the condition of a baby immediately after delivery. The baby is assessed in five different categories (complexion, pulse rate, reaction when stimulated, muscle tone, and breathing) on a scale from zero to two. The five numbers are then added together to obtain a score from zero to 10.

Scores of three and below are usually regarded as critically low, four to six fairly low, and seven to 10 generally normal.

Rare condition

Cerebral palsy is a rare disease affecting about one in every 400 children. Approximately 1,800 babies are diagnosed with the condition in Great Britain each year. Frequently, cerebral palsy - which is characterised by impaired movement, posture and co-ordination - is not diagnosed until early childhood.

A research team, led by the Norwegian Institute of Public Health in Oslo say a low Apgar score is strongly associated with later diagnosis of cerebral palsy.

Their findings were based on data from 988 children taken from Norway’s register of births and a register of cerebral palsy in children.

Strong association

The researchers say that prevalence of cerebral palsy in children with an Apgar score of less than 3 was more than 100-times higher than in children with a score of 10. The association was high in children with normal birth weight and modest in children with low birth weight, they say.

They found that a low Apgar score was also associated with all subgroups of spastic cerebral palsy, but that the association was strongest for quadriplegia.

“Despite the strong association of low Apgar score with cerebral palsy, it is encouraging that almost 90% of children with an Apgar score of less than 4 at birth did not develop cerebral palsy,” say the authors of the study, which appears in the online edition of the BMJ.

‘Important clue’

In an accompanying editorial, Professor Nigel Paneth from Michigan State University in the US says that a low Apgar score in a baby of normal weight  “is an important clue that the baby has an increased risk of death and disability, even though most infants with such scores recover quickly and do well”.

Paneth continues that “Such babies should be watched closely for the persistence or development of signs of brain damage, especially in the light of robust evidence that babies with brain injury may benefit from head or body cooling”.