Cerebral palsy: Steps to prevent brain damage in babies

By Sade Oguntola

Some measures can be taken before and during pregnancy, as well as after childbirth, to reduce the risk of developmental conditions such as cerebral palsy. Research shows that regular intake of folic acid during pregnancy can significantly lower the risk of premature birth by as much as 70 per cent.

In addition, a growing body of evidence supports the use of magnesium sulfate, an inexpensive but effective injection, in preventing cerebral palsy among premature babies.

Researchers at the University of Bristol led a programme, known as the “Prevention of Cerebral Palsy in Preterm Labour (PReCePT)” project, to increase the use of this treatment. Findings from the initiative were published in the Archives of Disease in Childhood.

Babies born before 34 weeks of pregnancy are classified as premature. The final weeks of pregnancy are critical for the development of vital organs such as the brain, lungs, and liver. As a result, premature infants face a higher risk of long-term health challenges compared to full-term babies. These may include chronic illnesses, asthma, feeding difficulties, and an increased risk of sudden infant death syndrome (SIDS).

Cerebral palsy is a condition caused by abnormal brain development or damage to the developing brain, affecting a child’s ability to control movement and posture. This damage can occur before birth, during delivery, shortly after birth, or within the early years of life while the brain is still developing.

In the past, lack of oxygen during childbirth was believed to be the main cause of cerebral palsy. However, researchers now understand that this accounts for only a small proportion of cases.

Current evidence shows that administering magnesium sulphate to women at risk of preterm birth can protect babies from brain injury and reduce the risk of cerebral palsy by about one-third. Despite this, the treatment has not always been routinely given to all eligible women in many countries.

The PReCePT programme was first developed in the West of England in 2014 by the West of England Academic Health Science Network (AHSN) in collaboration with University Hospitals Bristol and Weston NHS Foundation Trust.

It was later piloted in five NHS trusts and evaluated by the NIHR Applied Research Collaboration West. Following its success, the programme was expanded nationwide across England through the AHSN Network.

Researchers estimated that in its first year alone, the programme could generate lifetime savings of approximately £3 million for society. This figure accounts for the cost of implementing the programme, treating cerebral palsy over a lifetime, and the health benefits gained from preventing new cases.

Commenting on the findings, Professor Chris Aimakhu, a consultant obstetrician and gynaecologist at University College Hospital (UCH), Ibadan, explained that magnesium sulphate works by helping to halt premature labour.

“When a woman goes into labour too early, magnesium sulphate helps stop the contractions,” he said. “It does not directly affect the baby’s brain. Its role is to prevent early delivery, which in turn reduces the risk associated with prematurity.”

Professor Aimakhu noted that premature labour can occur for various reasons, including fibroids during pregnancy, infections such as malaria, or urinary tract infections.

“Once contractions begin, if they are not stopped, they can lead to the opening of the cervix and early delivery,” he added.

However, he cautioned that magnesium sulphate is not suitable for all pregnant women.

“At UCH, Ibadan, we use it, but patients must be carefully selected,” he said. “The drug can have side effects, such as reduced urine output, and toxicity may cause respiratory depression or even arrest.”

Several factors increase a child’s risk of developing cerebral palsy. These include low birth weight, infections such as chickenpox or rubella during pregnancy, severe jaundice in newborns, complications involving the umbilical cord during birth, and certain maternal medical conditions like thyroid disorders, intellectual disability, or seizures.

Multiple pregnancies, such as twins or triplets, also carry a higher risk, particularly if one baby dies before or shortly after birth. This increased risk is partly linked to the higher likelihood of premature birth and low birth weight in multiple pregnancies.

Ensuring a healthy pregnancy is key to preventing developmental problems, including cerebral palsy. Recommended steps include maintaining good health before conception, receiving vaccinations against diseases like rubella and chickenpox, and attending early and regular prenatal care appointments.

Women who are at risk of preterm delivery are encouraged to discuss preventive options with their healthcare providers. Studies confirm that administering magnesium sulphate before an anticipated early preterm birth significantly reduces the risk of cerebral palsy among surviving infants.