Tag Archives: cerebral palsy

Multiple Births

About one pregnancy in 30 results in multiple births, two or more children born at once. Almost all of these are twins. The frequency falls off dramatically as the numbers of births goes up with triplets rarer than twins, quadruplets rarer than triplets, and five or more births almost unheard of and nearly always as a result of medical intervention of some kind. Higher order live births are rare, more often some or all of the fetuses miscarry or are stillborn. In 2013, only 66 sets of quintuplets or higher were born in the United States, and there were more than 32 times as many twin births as all higher order births combined. In all, there are about 130,000 sets of twins born every year.

Common reasons for multiple births are older mothers—twinning is more common in mothers over 30—and fertility treatments, which often involve multiple ovulation or the creation of multiple embryos as a hedge against a greater risk of losing them. Fertility drugs, which encourage ovulation, often lead to multiple mature ova in one cycle. Twinning runs in families. A woman who is a twin is likely to have twins herself. Twins can be either monozygotic, developing from a single zygote that splits, or dizygotic, in which two ova are fertilized and two entirely separate zygotes develop. Triplets are sometimes monozygotic; triplets usually, and higher order births almost always, are either strictly polyzygotic or a combination of the two.

Multiple births are prone to complication. Because multiples are so hard on the gestational environment, it is quite common—moreso as the order increases—for one or more of the fetuses not to survive. The most births ever recorded is a woman who delivered octuplets after undergoing fertility treatments, but it is very rare for all eight fetuses to survive in such a pregnancy. Although more than 90 percent of single pregnancies are carried to term, more than half of twins and 91 percent of triplets are preterm, another factor affecting survival. Because of this, multiples tend to have low birth weight and are more prone than singletons to cerebral palsy.

Cerebral Palsy And Heredity

Damage to areas within the largest part of the brain—the cerebrum—typically before or during birth is called "cerebral palsy." This term refers not to one specific condition but is a name for a broad category of motor deficiencies that result in physical disability. The damage may result from inflammation, infection, or low birth weight or birth defects. Over half of all children with cerebral palsy have been found to have birth defects or low birth weight. Babies born with cerebral palsy may be floppy or stiff. Children with these conditions often exhibit language problems, not necessarily due to cognitive deficits—though such deficits are not uncommon—but as a result of respiratory problems or difficulties with facial muscle control.

The causes of cerebral palsy are not clear. Contrary to what was once believed, babies born with the umbilical cord wrapped around the neck, which actually happens in as many as a third of all pregnancies, are not at significantly higher risk for cerebral palsy. Rather, women who have infectious diseases such as rubella, chickenpox, or toxoplasmosis during pregnancy are more likely to have children with birth defects such as cerebral palsy. Multiple birth are associated with low birth weight, and particularly if there has been a miscarriage, one or more of the infants are at heightened risk for a form of cerebral palsy.

Researchers have also found a family connection in cerebral palsy. Siblings, children, and first cousins of children who are born with cerebral palsy are themselves at higher than normal risk of thee conditions. One study found that, while children who are twins are already three times as likely as single births to have some form of cerebral palsy, when one twin develops one, the other is 15 times more likely to do so as well. The same study showed younger siblings of children with cerebral palsy showed a sixfold increase in risk, roughly the same as children of parents with cerebral palsy.

The good news is that by adolescence, with proper treatment, children with cerebral palsy have quality of life roughly comparable to that of children who are not affected. In a survey, teenagers with cerebral palsy self-assessed as doing as well as—or better than in some areas—their peers.

Living With Cerebral Palsy

Cerebral palsy is a term referring to any of a number of types of brain damage affecting the cerebellum, the largest part of the brain. Often, the damage is due to inflammation, caused by infection or related to low birth weight or birth defects. Over half of all children with cerebral palsy were found to have birth defects or low birth weight. Doctors once believed that cerebral palsy often resulted from obstructions preventing oxygen from reaching the baby’s brain during or immediately after birth, for example, the umbilical cord being wrapped around the baby’s neck. While this does occur, it is usually harmless, and rarely leads to cerebral palsy.

While causes of many cases of cerebral palsy have been found, it is not always clear why these things happen. Women who have rubella, chickenpox, toxoplasmosis, or certain other infectious diseases during pregnancy are more likely to have children with birth defects. Children born as multiples are likely to have low birth weight, and, especially in cases in which one of the children miscarried, are prone to cerebral palsy. Recent studies have also found a family link. The children, siblings, and even first cousins of people with cerebral palsy are particularly at risk for having the condition themselves.

There is no cure for cerebral palsy, but there are interventions that can help minimize the deficit and improve the child’s capabilities. These interventions are most effective the sooner they are given, when the brain tissue is less specialized; they generally involve training a healthy portion of the brain to take over or augment a function of the damaged part. That is why doctors try to make a diagnosis sooner rather than later, by tracking children known to be at risk of developing the disease, by looking for delays in reaching developmental milestones in the first year, an by looking for symptoms of cerebral palsy such as poor muscle tone and abnormal movements.

Researchers have now found a better way to treat the movement problems that cerebral palsy can cause. They have devised a rubric for classifying patients based on the nature of the deficit, determining that different types of movement issue benefit from different types of treatment. This will make it easier for treatments to be used that are tailored for the person’s needs.

Cerebral Palsy Risk

Researchers are zeroing in on a more precise and detailed understanding of the risk factors for cerebral palsy, a category of motor deficiency conditions that result in physical disability. There are a number of related conditions grouped under the term "cerebral palsy," with a variety of causes, but they all involve damage to areas within the largest part of the brain, the cerebrum.

The common wisdom about cerebral palsy is that this damage is a result of asphyxial birth events, such as nuchal cord—a fairly common condition in which a baby is born with the umbilical cord wrapped around the neck—or other things that interfere with oxygen reaching the brain during or immediately after birth. New research, however, shows that nuchal cord is harmless more often than not, and other problems are more important in cerebral palsy than previously realized.

Those other problems are primarily inflammation due to infection, low birth weight, and birth defects. Low weight and birth defects were found in over half of all children with cerebral palsy, and the dyskenesia, or problems coordinating muscle movements, present in some types of cerebral palsy was associated only with those factors, and not with asphyxiation during birth at all. Low birth weight is common with premature births, and birth defects are common in babies born to mothers who had rubella, chickenpox, toxoplasmosis, or certain other infectious diseases while they were pregnant. Children born in multiple births, particularly when there is a miscarriage, are also particularly prone to cerebral palsy.

There are support groups available in many communities and online for people with cerebral palsy and for parents of children with cerebral palsy. However, people with cerebral palsy can do more than simply cope with the condition. There’s no cure, but ongoing treatment can often help people with strength and movement, through a combination of training, medication, and surgery in some cases. Physical and occupational therapy can also be useful, though they can only do so much. The goal with treatment for cerebral palsy is not to eliminate every trace of the condition but to make it possible for people to carry out the routine tasks of daily life.

Cord Blood

The umbilical cord is the connection between a fetus and its mother’s body that provides it with nourishment and enables it to grow and develop. Once the fetus develops a circulatory system, it links to the umbilical cord. The placental blood retained in the umbilical cord once a baby is born contains stem cells from the baby, cells with all the baby’s DNA but which are not adapted to function in any particular organ or type of tissue. These cells are very important; their versatility means they have a number of potential therapeutic applications. Stem cells can in some cases be extracted from bone marrow, but it’s a more involved process. That’s why, more and more, new parents are electing to have the umbilical cord blood collected and preserved for possible future use.

This preservation must be done immediately after birth, which is why parents must make the decision before labor begins. The blood is collected from the placenta and umbilical cord, the same tissue that had been used to nurture the baby during pregnancy. The collection is painless to both mother and child, as the cells are extracted from tissue no longer attached to either as they are unneeded after birth. Once collected, the blood is stored in the same way as—but separate from—other banked blood, and can be used to provide treatment for the baby and the family.

There are public and private banks. Some parents may prefer the public option, because not only are no fees charged for public cord blood collection and storage, the stem cells can be used to benefit others directly and indirectly. Researchers are using cord blood stem cells to learn more about hereditary and acquired diseases, how they spread, and how they can be treated. Moreover, certain serious diseases, such as leukemia and metabolic conditions, can be treated with cord blood from unrelated donors. While publicly banked cord blood cannot be guaranteed to be available to the donor specifically, the more parents there are who choose public banking, the more there is available for everyone.

However, if it is highly likely that the child will need cord blood stem cell therapy, private banking may be the better option. The parents of a two-an-a-half-year-old boy with cerebral palsy had privately banked his cord blood when he was born. When the boy went into cardiac arrest, it caused significant brain damage and left him in a persistent vegetative state. However, after treatment with cord blood stem cells, he was able to speak and move on his own.

Cord Blood Banking

There’s an often overlooked way for expectant parents to protect the health of the new baby and his or her relatives. Cord blood is a rich source of unique stem cells that can be collected without invasive procedures or ethical concerns and used in medical treatments for the child, siblings and others if the need arises.

Umbilical cord blood is typically discarded as medical waste, but new parents can ask that it be banked. Private cord blood banking saves the stem cells for the exclusive use of the child and family. Cord blood can also be donated to free public banking facilities that can use it to benefit many people.

The procedure involves no risk at all to the mother or to the baby. It takes about five minutes and is completely painless. Blood is collected after the umbilical cord has been cut, so there is no pain, discomfort, or harm.

Regenerative medicine, in which an individual’s own stem cells are used to repair damaged or diseased tissues and organs, is among the most promising areas of medical research. Though only about half a percent of infants develop conditions currently treatable with cord blood cells, scientists are expanding the potential uses of these cells every day. Clinical trials are now under way to evaluate the benefits of using a child’s cord blood stem cells in the treatment of type 1 diabetes, hearing loss, cerebral palsy and other brain injuries.

Cord blood stem cells have already been used for over 20 years to help reduce transplant rejection and instead of bone marrow in the treatment of leukemia and other cancers and blood, immune and metabolic disorders.

Ideally, you’ll never need the banked blood—your baby will hopefully have a long and healthy life. However, knowing cord blood stem cells are available if they are needed can provide parents like you with security and peace of mind. The cells may also be effective in treating some conditions that might affect a parent or sibling.

It’s important to decide whether you want to bank—and inform labor personnel of your decision—sooner rather than later. Cord blood can only be collected in the first fifteen minutes after the birth, so you should be sure the doctor or birth attendant knows if you’re doing it as soon as possible.