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October 1989, Vol 143, No. 10 >
Article | October 1989

Origins of Cerebral Palsy FREE

Richard L. Naeye, MD; Ellen C. Peters; Mary Bartholomew, MS; J. Richard Landis, PhD
[+] Author Affiliations

Accepted for publication June 6, 1988.

Reprint requests to Department of Pathology, M. S. Hershey Medical Center, Hershey, PA 17033 (Dr Naeye).


Am J Dis Child. 1989;143(10):1154-1161. doi:10.1001/archpedi.1989.02150220044018.
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References
Comments

• Analyses were undertaken to determine the causes of cerebral palsy in a prospective study of 43 437 full-term children. Presumed causes were found for about 71% of the 34 quadriplegic and 40% of the 116 nonquadriplegic patients with cerebral palsy. Risk estimates based on predictive models, adjusted for multiple factors, suggest that 53% of the quadriplegic patients with cerebral palsy could be attributed to congenital disorders, 14% to birth asphyxia, and 8% to other identified disorders. Thirty-five percent of the nonquadriplegic patients with cerebral palsy could be attributed to congenital disorders and 6% to other disorders. In the victims of cerebral palsy, characteristic consequences of birth asphyxia were more often the result of nonasphyxial disorders. These included meconium in the amniotic fluid, low 10-minute Apgar scores, neonatal apnea spells, seizures, persisting neurologic abnormalities, and slow head growth after birth.

(AJDC. 1989;143:1154-1161)

REFERENCES

1 +
Freeman JM, Nelson KB.  Intrapartum asphyxia and cerebral palsy . Pediatrics . 1988;;82: 240-250.
2 +
American Academy of Pediatrics, Committee on Fetus and Newborn.  Use and abuse of the Apgar score . Pediatrics . 1986;;28:1148-1149.
3 +
Brann AW Jr.  Factors during neonatal life that influence brain disorders . In: Freeman J, ed. Prenatal and Perinatal Factors Associated With Brain Disorders . Bethesda, Md: US Dept Health and Human Services; 1985;:302-316.
4 +
Niswander K, Gordon M, Drage J.  The effect of intrauterine hypoxia on the child surviving to 4 years . Am J Obstet Gynecol . 1975;;121:892-899.
5 +
Lilienfeld A, Parkhurst E.  Study of the association of factors of pregnancy and parturition with the development of cerebral palsy: a preliminary report . Am J Epidemiol . 1951;;53:262-282.
6 +
Eastman N, Kohl S, Maisel J, Kavaler F.  The obstetrical background of 753 cases of cerebral palsy . Obstet Gynecol Surv . 1962;;17:459-500.
7 +
Chefetz M.  Etiology of cerebral palsy: role of reproductive insufficiency and the multiplicity of factors . Obstet Gynecol . 1965;;25:635-647.
8 +
Durkin M, Kaveggia E, Pendleton E, Neuhause G. Opitz JM.  Analysis of etiological factors in cerebral palsy with severe mental retardation: analysis of gestational, parturitional and neonatal data . Eur J Pediatr . 1976;;123:67-81.
9 +
Ruth VJ, Raivio KO.  Perinatal brain damage: predictive value of metabolic acidosis and the Apgar score . Br Med J . 1988;;297:24-27.
10 +
Blair E, Stanley FJ.  Intrapartum asphyxia: a rare cause of cerebral palsy . J Pediatr . 1988;; 112:515-519.
11 +
Paneth N, Stark RI.  Cerebral palsy and mental retardation in relation to indicators of perinatal asphyxia . Am J Obstet Gynecol . 1983;;147:960-966.
12 +
Finer NN, Robertson CM, Richards RT, Pinnell LE, Peters KL.  Hypoxic-ischemic encephalopathy in term infants: perinatal factors and outcome . JPediatr . 1981;;98:112-117.
13 +
Sarnat HB, Sarnat MS.  Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study . Arch Neurol . 1976;; 33:696-705.
14 +
Hagberg B, Hagberg G.  Prenatal and perinatal risk factors in a survey of 681 Swedish cases . In: Stanley F, Alberman A, eds. Epidemiology of the Cerebral Palsies: Clinics Develop Med, No. 87 . London, England: Heinemann Medical Books Ltd; 1984;:116-133.
15 +
Nelson KB, Ellenberg JH.  Antecedents of cerebral palsy . N Engl J Med . 1986;;315:81-86.
16 +
Stanley FJ.  Perinatal risk factors in the cerebral palsies . Clin Dev Med . 1984;;87:98-104.
17 +
Robertson CM, Finer NN.  Term infants with hypoxic-ischemic encephalopathy: outcome at 3.5 years . Dev Med Child Neurol . 1985;;27:473-484.
18 +
Voorhies TM, Lipper EG, Lee BCP, Vannucci RC, Auld PAM.  Occlusive vascular disease in asphyxiated newborn infants . J Pediatr . 1984;;105:92-96.
19 +
Finer NN, Robertson CM, Peters KL.  Factors affecting outcome in hypoxic-ischemic encephalopathy in term infants . AJDC . 1983;;137:21-25.
20 +
Sykes GS, Molloy PM, Johnson P, et al.  Do Apgar scores indicate asphyxia? Lancet . 1982;; 1:494-496.
21 +
Lumley J.  Does continuous intrapartum fetal monitoring predict long-term neurological disorders? Paediatr Perinat Epidemiol . 1988;;2:299-307.
22 +
Niswander K, Henson G, Elbourne D, et al.  Adverse outcome of pregnancy and the quality of obstetric care . Lancet . 1984;;2:827-831.
23 +
Niswander KR, Gordon M. The Women and Their Pregnancies . Philadelphia, Pa: WB Saunders Co; 1972;.
24 +
Naeye RL, Tafari N. Risk Factors in Pregnancy and Diseases of the Fetus and Newborn . Baltimore, Md: Williams & Wilkins; 1983;.
25 +
Naeye RL.  When and how does antenatal brain damage occur?  In: Iffy L, ed. Second Perinatal Practice and Malpractice Symposium . New York, NY: Healthmark Committee; 1986;:125.
26 +
Broman S.  The collaborative perinatal project: an overview . In: Mednick SA, Harway M, Finello KM, eds. Handbook of Longitudinal Research . New York, NY: Praeger Publishers; 1984;;2:185-215.
27 +
The Collaborative Study on Cerebral Palsy, Mental Retardation and Other Neurological and Sensory Disorders of Infancy and Childhood Manual . Bethesda, Md: US Dept of Health, Education and Welfare; 1966;.
28 +
Nelson KB, Ellenberg JH.  Obstetric complications as risk factors for cerebral palsy or seizure disorders . JAMA . 1984;;251:1843-1848.
29 +
Nelson KB, Ellenberg JH.  Antecedents of cerebral palsy, I: univariate analysis of risks . AJDC . 1985;;139:1031-1038.
30 +
Mannino FL, Trauner DA.  Strokes in neonates . J Pediatr . 1983;;102:605-610.
31 +
Hensleigh PA, Fainstat T, Spencer R.  Perinatal events and cerebral palsy . Am J Obstet Gynecol . 1986;;154:978-981.
32 +
Lupton BA, Hill A, Roland EH, Whitefield MF, Flodmark O.  Brain swelling in the asphyxiated term newborn: pathogenesis and outcome . Pediatrics . 1988;;82:139-146.
33 +
Naeye RL.  Causes of perinatal mortality excess in prolonged gestations . Am J Epidemiol . 1978;;108:429-433.
34 +
Gallery EDM, Hunyor SN, Gyory AZ.  Plasma volume contraction: a significant factor in both pregnancy-associated hypertension and chronic hypertension in pregnancy . Q J Med . 1979;;48:593-602.
35 +
Goodlin RC, Dobry CA, Anderson JC, Woods RE, Quaife M.  Clinical signs of normal plasma volume expansion during pregnancy . Am J Obstet Gynecol . 1983;;145:1001-1009.
36 +
Grunberger W, Leodolter S, Parashalk O.  Maternal hypotension: fetal outcome in treated and untreated cases . Gynecol Obstet Invest . 1979;;10: 32-38.
37 +
Morris N, Osborn SB, Wright HP.  Effective circulation of the uterine wall in late pregnancy . Lancet . 1955;;1:323-324.
38 +
Naeye RL.  How and when does antenatal hypoxia damage fetal brains?  In: Kubli F, Patel N, Schmidt W, Linderkamp O, eds. Perinatal Events and Brain Damage in Surviving Children . New York, NY: Springer-Verlag NY Inc; 1988;:83-91.
39 +
Blidner IN, McClermont S, Anderson GD, Sinclair JC.  Size-at-birth standards for an urban Canadian population . Can Med Assoc J . 1984;; 130:133-140.
40 +
Hastings RP, ed. SUGI Supplemental Library User's Guide . 5th ed. Cary, NC: SAS Institute; 1986;.
41 +
Bruzzi P, Green SB, Byar DP, Brinton LA, Schairer C.  Estimating the population attributable risk for multiple risk factors using case-control data . Am J Epidemiol . 1985;;122:904-914.
42 +
Benichou J, Gail MH. Variance calculations and confidence intervals for estimates of the attributable risk based on logistic models. Biometrika. In press.
43 +
Dijxhoorn MJ, Visser GHA, Fidler JJ, Touwen BCL, Huisjes HJ.  Apgar score, meconium and acidaemia at birth in relation to neonatal neurological morbidity in term infants . Br J Obstet Gynaecol . 1986;;93:217-222.
44 +
Dijxhoorn MJ, Visser GHA, Huisjes HJ, Fidler JJ, Touwen BCL.  The relationship between umbilical pH values and neonatal neurologic morbidity in full-term appropriate for dates infants . Early Hum Dev . 1985;;11:33-42.
45 +
Perkins RP.  Perspectives on perinatal brain damage . Obstet Gynecol . 1987;;69:807-819.
46 +
Svenningsen L, Eidal K.  Lack of correlation between umbilical arterial pH, retinal hemorrhages and Apgar scores in the newborn . Acta Obstet Gynecol Scand . 1987;;66:639-642.
47 +
Niswander KR.  Asphyxia in the fetus and cerebral palsy . Yearbook of Obstetrics and Gynecology . Chicago, Ill: Year Book Medical Publishers Inc; 1983;:107-125.
48 +
Fenichel G. Neonatal Neurology . New York, NY: Churchill Livingstone Inc; 1985;.
49 +
Myers RE.  Two patterns of perinatal brain damage and their conditions of occurrence . Am J Obstet Gynecol . 1972;;112:246-276.
50 +
Myers RE, Adamsons K.  Obstetric considerations of perinatal brain injury . In: Scarpelli EM, Cosmi EV, eds. Reviews in Perinatal Medicine . Baltimore, Md: University Park Press; 1981;;4:222-245.
51 +
Myers RE, Wagner KR, DeCourten GM.  Lactic acid accumulation in tissue as cause of brain injury and death in cardiogenic shock from asphyxia . In: Lauerser NH, Hockberg HM, eds. Perinatal Biochemical Monitoring . Baltimore, Md: Williams & Wilkins; 1981;:11.
52 +
Myers RE.  Experimental models of perinatal brain damage: relevance to human pathology . In: Gluck L, ed. Intrauterine Asphyxia and the Developing Fetal Brain . Chicago, Ill: Year Book Medical Publishers Inc; 1977;:37-97.
53 +
MacDonald D, Grant A, Sheridan-Pereira M, Boylan P, Chalmers I.  The Dublin randomized control trial of intrapartum fetal monitoring . Am J Obstet Gynecol . 1985;;152:524-539.
54 +
Grant A.  The relationship between obstetrically preventable intrapartum asphyxia, abnormal neonatal neurologic signs and subsequent motor impairment in babies born at or after term . In: Kubli F, ed. Perinatal Events and Brain Damage in Surviving Children . Berlin, West Germany: Springer-Verlag; 1988;:149-159.
55 +
Dale A, Stanley FJ.  An epidemiologic study of cerebral palsy in Western Australia, 1956-1975, II: spastic cerebral palsy and perinatal factors . Dev Med Child Neurol . 1980;;22:13-25.
56 +
Hagberg B, Hagberg G, Olow I.  The changing panorama of cerebral palsy in Sweden . Acta Paediatr Scand . 1984;;73:433-440.
57 +
Jarvis SN, Holloway JS, Hey E.  Increase in cerebral palsy in normal birthweight babies . Arch Dis Child . 1985;;60:1113-1121.
58 +
Paneth N, Kiely J.  The frequency of cerebral palsy: a review of population studies in industrial nations since 1950 . In: Stanley F, Alberman E, eds. The Epidemiology of the Cerebral Palsies . Philadelphia, Pa: JB Lippincott; 1984;:46-56.
59 +
Pharoah POD, Cooke T, Rosenbloom I, Cooke RWI.  Trends in birth prevalence of cerebral palsy in normal birthweight babies . Arch Dis Child . 1987;;62:379-384.
60 +
Stanley FJ.  The changing face of cerebral palsy . Dev Med Child Neurol . 1987;;29:263-265.
61 +
Sexson WR, Sexson SB, Rawson JE, Brann AW.  The multisystem involvement of the asphyxiated newborn . Pediatr Res . 1976;;10:432.
62 +
Tack E, Perlman JM, Hause C, Griffen M, Martin T.  Systemic manifestations of perinatal asphyxia in the newborn . Pediatr Res . 1986;; 20:362A.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Freeman JM, Nelson KB.  Intrapartum asphyxia and cerebral palsy . Pediatrics . 1988;;82: 240-250.
2 +
American Academy of Pediatrics, Committee on Fetus and Newborn.  Use and abuse of the Apgar score . Pediatrics . 1986;;28:1148-1149.
3 +
Brann AW Jr.  Factors during neonatal life that influence brain disorders . In: Freeman J, ed. Prenatal and Perinatal Factors Associated With Brain Disorders . Bethesda, Md: US Dept Health and Human Services; 1985;:302-316.
4 +
Niswander K, Gordon M, Drage J.  The effect of intrauterine hypoxia on the child surviving to 4 years . Am J Obstet Gynecol . 1975;;121:892-899.
5 +
Lilienfeld A, Parkhurst E.  Study of the association of factors of pregnancy and parturition with the development of cerebral palsy: a preliminary report . Am J Epidemiol . 1951;;53:262-282.
6 +
Eastman N, Kohl S, Maisel J, Kavaler F.  The obstetrical background of 753 cases of cerebral palsy . Obstet Gynecol Surv . 1962;;17:459-500.
7 +
Chefetz M.  Etiology of cerebral palsy: role of reproductive insufficiency and the multiplicity of factors . Obstet Gynecol . 1965;;25:635-647.
8 +
Durkin M, Kaveggia E, Pendleton E, Neuhause G. Opitz JM.  Analysis of etiological factors in cerebral palsy with severe mental retardation: analysis of gestational, parturitional and neonatal data . Eur J Pediatr . 1976;;123:67-81.
9 +
Ruth VJ, Raivio KO.  Perinatal brain damage: predictive value of metabolic acidosis and the Apgar score . Br Med J . 1988;;297:24-27.
10 +
Blair E, Stanley FJ.  Intrapartum asphyxia: a rare cause of cerebral palsy . J Pediatr . 1988;; 112:515-519.
11 +
Paneth N, Stark RI.  Cerebral palsy and mental retardation in relation to indicators of perinatal asphyxia . Am J Obstet Gynecol . 1983;;147:960-966.
12 +
Finer NN, Robertson CM, Richards RT, Pinnell LE, Peters KL.  Hypoxic-ischemic encephalopathy in term infants: perinatal factors and outcome . JPediatr . 1981;;98:112-117.
13 +
Sarnat HB, Sarnat MS.  Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study . Arch Neurol . 1976;; 33:696-705.
14 +
Hagberg B, Hagberg G.  Prenatal and perinatal risk factors in a survey of 681 Swedish cases . In: Stanley F, Alberman A, eds. Epidemiology of the Cerebral Palsies: Clinics Develop Med, No. 87 . London, England: Heinemann Medical Books Ltd; 1984;:116-133.
15 +
Nelson KB, Ellenberg JH.  Antecedents of cerebral palsy . N Engl J Med . 1986;;315:81-86.
16 +
Stanley FJ.  Perinatal risk factors in the cerebral palsies . Clin Dev Med . 1984;;87:98-104.
17 +
Robertson CM, Finer NN.  Term infants with hypoxic-ischemic encephalopathy: outcome at 3.5 years . Dev Med Child Neurol . 1985;;27:473-484.
18 +
Voorhies TM, Lipper EG, Lee BCP, Vannucci RC, Auld PAM.  Occlusive vascular disease in asphyxiated newborn infants . J Pediatr . 1984;;105:92-96.
19 +
Finer NN, Robertson CM, Peters KL.  Factors affecting outcome in hypoxic-ischemic encephalopathy in term infants . AJDC . 1983;;137:21-25.
20 +
Sykes GS, Molloy PM, Johnson P, et al.  Do Apgar scores indicate asphyxia? Lancet . 1982;; 1:494-496.
21 +
Lumley J.  Does continuous intrapartum fetal monitoring predict long-term neurological disorders? Paediatr Perinat Epidemiol . 1988;;2:299-307.
22 +
Niswander K, Henson G, Elbourne D, et al.  Adverse outcome of pregnancy and the quality of obstetric care . Lancet . 1984;;2:827-831.
23 +
Niswander KR, Gordon M. The Women and Their Pregnancies . Philadelphia, Pa: WB Saunders Co; 1972;.
24 +
Naeye RL, Tafari N. Risk Factors in Pregnancy and Diseases of the Fetus and Newborn . Baltimore, Md: Williams & Wilkins; 1983;.
25 +
Naeye RL.  When and how does antenatal brain damage occur?  In: Iffy L, ed. Second Perinatal Practice and Malpractice Symposium . New York, NY: Healthmark Committee; 1986;:125.
26 +
Broman S.  The collaborative perinatal project: an overview . In: Mednick SA, Harway M, Finello KM, eds. Handbook of Longitudinal Research . New York, NY: Praeger Publishers; 1984;;2:185-215.
27 +
The Collaborative Study on Cerebral Palsy, Mental Retardation and Other Neurological and Sensory Disorders of Infancy and Childhood Manual . Bethesda, Md: US Dept of Health, Education and Welfare; 1966;.
28 +
Nelson KB, Ellenberg JH.  Obstetric complications as risk factors for cerebral palsy or seizure disorders . JAMA . 1984;;251:1843-1848.
29 +
Nelson KB, Ellenberg JH.  Antecedents of cerebral palsy, I: univariate analysis of risks . AJDC . 1985;;139:1031-1038.
30 +
Mannino FL, Trauner DA.  Strokes in neonates . J Pediatr . 1983;;102:605-610.
31 +
Hensleigh PA, Fainstat T, Spencer R.  Perinatal events and cerebral palsy . Am J Obstet Gynecol . 1986;;154:978-981.
32 +
Lupton BA, Hill A, Roland EH, Whitefield MF, Flodmark O.  Brain swelling in the asphyxiated term newborn: pathogenesis and outcome . Pediatrics . 1988;;82:139-146.
33 +
Naeye RL.  Causes of perinatal mortality excess in prolonged gestations . Am J Epidemiol . 1978;;108:429-433.
34 +
Gallery EDM, Hunyor SN, Gyory AZ.  Plasma volume contraction: a significant factor in both pregnancy-associated hypertension and chronic hypertension in pregnancy . Q J Med . 1979;;48:593-602.
35 +
Goodlin RC, Dobry CA, Anderson JC, Woods RE, Quaife M.  Clinical signs of normal plasma volume expansion during pregnancy . Am J Obstet Gynecol . 1983;;145:1001-1009.
36 +
Grunberger W, Leodolter S, Parashalk O.  Maternal hypotension: fetal outcome in treated and untreated cases . Gynecol Obstet Invest . 1979;;10: 32-38.
37 +
Morris N, Osborn SB, Wright HP.  Effective circulation of the uterine wall in late pregnancy . Lancet . 1955;;1:323-324.
38 +
Naeye RL.  How and when does antenatal hypoxia damage fetal brains?  In: Kubli F, Patel N, Schmidt W, Linderkamp O, eds. Perinatal Events and Brain Damage in Surviving Children . New York, NY: Springer-Verlag NY Inc; 1988;:83-91.
39 +
Blidner IN, McClermont S, Anderson GD, Sinclair JC.  Size-at-birth standards for an urban Canadian population . Can Med Assoc J . 1984;; 130:133-140.
40 +
Hastings RP, ed. SUGI Supplemental Library User's Guide . 5th ed. Cary, NC: SAS Institute; 1986;.
41 +
Bruzzi P, Green SB, Byar DP, Brinton LA, Schairer C.  Estimating the population attributable risk for multiple risk factors using case-control data . Am J Epidemiol . 1985;;122:904-914.
42 +
Benichou J, Gail MH. Variance calculations and confidence intervals for estimates of the attributable risk based on logistic models. Biometrika. In press.
43 +
Dijxhoorn MJ, Visser GHA, Fidler JJ, Touwen BCL, Huisjes HJ.  Apgar score, meconium and acidaemia at birth in relation to neonatal neurological morbidity in term infants . Br J Obstet Gynaecol . 1986;;93:217-222.
44 +
Dijxhoorn MJ, Visser GHA, Huisjes HJ, Fidler JJ, Touwen BCL.  The relationship between umbilical pH values and neonatal neurologic morbidity in full-term appropriate for dates infants . Early Hum Dev . 1985;;11:33-42.
45 +
Perkins RP.  Perspectives on perinatal brain damage . Obstet Gynecol . 1987;;69:807-819.
46 +
Svenningsen L, Eidal K.  Lack of correlation between umbilical arterial pH, retinal hemorrhages and Apgar scores in the newborn . Acta Obstet Gynecol Scand . 1987;;66:639-642.
47 +
Niswander KR.  Asphyxia in the fetus and cerebral palsy . Yearbook of Obstetrics and Gynecology . Chicago, Ill: Year Book Medical Publishers Inc; 1983;:107-125.
48 +
Fenichel G. Neonatal Neurology . New York, NY: Churchill Livingstone Inc; 1985;.
49 +
Myers RE.  Two patterns of perinatal brain damage and their conditions of occurrence . Am J Obstet Gynecol . 1972;;112:246-276.
50 +
Myers RE, Adamsons K.  Obstetric considerations of perinatal brain injury . In: Scarpelli EM, Cosmi EV, eds. Reviews in Perinatal Medicine . Baltimore, Md: University Park Press; 1981;;4:222-245.
51 +
Myers RE, Wagner KR, DeCourten GM.  Lactic acid accumulation in tissue as cause of brain injury and death in cardiogenic shock from asphyxia . In: Lauerser NH, Hockberg HM, eds. Perinatal Biochemical Monitoring . Baltimore, Md: Williams & Wilkins; 1981;:11.
52 +
Myers RE.  Experimental models of perinatal brain damage: relevance to human pathology . In: Gluck L, ed. Intrauterine Asphyxia and the Developing Fetal Brain . Chicago, Ill: Year Book Medical Publishers Inc; 1977;:37-97.
53 +
MacDonald D, Grant A, Sheridan-Pereira M, Boylan P, Chalmers I.  The Dublin randomized control trial of intrapartum fetal monitoring . Am J Obstet Gynecol . 1985;;152:524-539.
54 +
Grant A.  The relationship between obstetrically preventable intrapartum asphyxia, abnormal neonatal neurologic signs and subsequent motor impairment in babies born at or after term . In: Kubli F, ed. Perinatal Events and Brain Damage in Surviving Children . Berlin, West Germany: Springer-Verlag; 1988;:149-159.
55 +
Dale A, Stanley FJ.  An epidemiologic study of cerebral palsy in Western Australia, 1956-1975, II: spastic cerebral palsy and perinatal factors . Dev Med Child Neurol . 1980;;22:13-25.
56 +
Hagberg B, Hagberg G, Olow I.  The changing panorama of cerebral palsy in Sweden . Acta Paediatr Scand . 1984;;73:433-440.
57 +
Jarvis SN, Holloway JS, Hey E.  Increase in cerebral palsy in normal birthweight babies . Arch Dis Child . 1985;;60:1113-1121.
58 +
Paneth N, Kiely J.  The frequency of cerebral palsy: a review of population studies in industrial nations since 1950 . In: Stanley F, Alberman E, eds. The Epidemiology of the Cerebral Palsies . Philadelphia, Pa: JB Lippincott; 1984;:46-56.
59 +
Pharoah POD, Cooke T, Rosenbloom I, Cooke RWI.  Trends in birth prevalence of cerebral palsy in normal birthweight babies . Arch Dis Child . 1987;;62:379-384.
60 +
Stanley FJ.  The changing face of cerebral palsy . Dev Med Child Neurol . 1987;;29:263-265.
61 +
Sexson WR, Sexson SB, Rawson JE, Brann AW.  The multisystem involvement of the asphyxiated newborn . Pediatr Res . 1976;;10:432.
62 +
Tack E, Perlman JM, Hause C, Griffen M, Martin T.  Systemic manifestations of perinatal asphyxia in the newborn . Pediatr Res . 1986;; 20:362A.

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