ORIGINAL ARTICLES
August 2014
14.
15.
16. 17.
18. Higgins RD, Raju T, Edwards AD, Azzopardi DV, Bose CL, Clark RH, et al. Hypothermia and other treatment options for neonatal encephalopathy: an executive summary of the Eunice Kennedy Shriver NICHD workshop. J Pediatr 2011;159: 851-8.e1. 19. DuPont TL, Chalak LF, Morriss MC, Burchfield PJ, Christie L, Sanchez PJ. Short-term outcomes of newborns with perinatal acidemia who are not eligible for systemic hypothermia therapy. J Pediatr 2013; 162:35-41. 20. Bain LC, Dudley RA, Gould JB, Lee HC. Factors associated with failure to screen newborns for retinopathy of prematurity. J Pediatr 2012;161: 819-23. 21. Lee HC, Lyndon A, Blumenfeld YJ, Dudley RA, Gould JB. Antenatal steroid administration for premature neonates in California. Obstet Gynecol 2011;117:603-9.
routine clinical practice: how cooling is managed in the UK outside a clinical trial. Arch Dis Child Fetal Neonatal Ed 2009;94:F260-4. Azzopardi D, Strohm B, Linsell L, Hobson A, Juszczak E, Kurinczuk JJ, et al. Implementation and conduct of therapeutic hypothermia for perinatal asphyxial encephalopathy in the UK–analysis of national data. PLoS ONE 2012;7:e38504. Gould JB. The role of regional collaboratives: the California Perinatal Quality Care Collaborative model. Clin Perinatol 2010;37: 71-86. CPQCC Network Database Manual of Definitions for Infants Born in 2013. http://cpqcc.org/data/cpqcc_downloads. Accessed February 22, 2014. Higgins RD, Raju TN, Perlman J, Azzopardi DV, Blackmon LR, Clark RH, et al. Hypothermia and perinatal asphyxia: executive summary of the National Institute of Child Health and Human Development workshop. J Pediatr 2006;148:170-5.
50 Years Ago in THE JOURNAL OF PEDIATRICS An Etiologic and Diagnostic Study of Cerebral Palsy Malamud N, Itabashi HH, Castor J, Messinger HB. J Pediatr 1964;65:270-93
ifty years ago in The Journal, Malamud et al reported their initial clinicopathologic investigation to elucidate the etiology of cerebral palsy. At the Sonoma State Hospital from 1955 to 1960, the authors screened 4843 severely “mentally retarded” and “handicapped” patients to distinguish 1184 with cerebral palsy, and then studied 68 cases at autopsy. Striking is how little we have advanced our understanding of the origins of cerebral palsy, yet how much the care of these individuals has changed. The authors described children whose cerebral palsy was the sequela of a brain malformation or kernicterus, but also devised other gross groupings of “perinatal trauma” and “postnatal disorders,” debated heatedly at the time and no longer considered valid. They attempted to pair clinical factors to these groupings, but found little (eg, prolonged second stage of labor or the need for a maternal transfusion both linked to “perinatal trauma”). We know now that birth trauma is infrequently the cause of cerebral palsy.1 Otherwise, our understanding of etiology has improved minimally. We do not know what causes the majority of cases of cerebral palsy. At the same time, our stewardship of patients with cerebral palsy has changed. Warehouses of patients with cerebral palsy and intellectual disability no longer exist. One-half of the patients at the Sonoma State Hospital were seen or followed at the University of California, San Francisco. As a medical student there, when in 1986 the State Hospital transitioned to Sonoma Developmental Center as many children were de-institutionalized, I recall faculty describing the great halls of children and young adults. Photos and videos had been taken and circulated, and studies like this performed years earlier, with no consideration of patient consent. Children had been involuntarily sterilized and the subjects of many invasive tests. This particular cerebral palsy study came under media scrutiny in the early 2000s.2 Today we have humanized children with disabilities. We can only hope that over the next 50 years we will understand better the pathogenesis of their cerebral palsy and improve their lives further with therapeutic interventions or prevention.
F
Paul Graham Fisher, MD Departments of Neurology, Pediatrics, and Human Biology Stanford University Lucile Packard Children’s Hospital Palo Alto, California
References
http://dx.doi.org/10.1016/j.jpeds.2014.02.059
1. Nelson KD. Can we prevent cerebral palsy? N Engl J Med 2003;349:1765-9. 2. Mabrey V. “On Experiments Done On Institutionalized Children.” Available at http://www.cbsnews.com/news/a-dark-chapter-in-medicalhistory-09-02-2005/. Accessed March 25, 2014.
Hypothermia Therapy for Neonatal Hypoxic Ischemic Encephalopathy in the State of California
273
August 2014
14.
15.
16. 17.
18. Higgins RD, Raju T, Edwards AD, Azzopardi DV, Bose CL, Clark RH, et al. Hypothermia and other treatment options for neonatal encephalopathy: an executive summary of the Eunice Kennedy Shriver NICHD workshop. J Pediatr 2011;159: 851-8.e1. 19. DuPont TL, Chalak LF, Morriss MC, Burchfield PJ, Christie L, Sanchez PJ. Short-term outcomes of newborns with perinatal acidemia who are not eligible for systemic hypothermia therapy. J Pediatr 2013; 162:35-41. 20. Bain LC, Dudley RA, Gould JB, Lee HC. Factors associated with failure to screen newborns for retinopathy of prematurity. J Pediatr 2012;161: 819-23. 21. Lee HC, Lyndon A, Blumenfeld YJ, Dudley RA, Gould JB. Antenatal steroid administration for premature neonates in California. Obstet Gynecol 2011;117:603-9.
routine clinical practice: how cooling is managed in the UK outside a clinical trial. Arch Dis Child Fetal Neonatal Ed 2009;94:F260-4. Azzopardi D, Strohm B, Linsell L, Hobson A, Juszczak E, Kurinczuk JJ, et al. Implementation and conduct of therapeutic hypothermia for perinatal asphyxial encephalopathy in the UK–analysis of national data. PLoS ONE 2012;7:e38504. Gould JB. The role of regional collaboratives: the California Perinatal Quality Care Collaborative model. Clin Perinatol 2010;37: 71-86. CPQCC Network Database Manual of Definitions for Infants Born in 2013. http://cpqcc.org/data/cpqcc_downloads. Accessed February 22, 2014. Higgins RD, Raju TN, Perlman J, Azzopardi DV, Blackmon LR, Clark RH, et al. Hypothermia and perinatal asphyxia: executive summary of the National Institute of Child Health and Human Development workshop. J Pediatr 2006;148:170-5.
50 Years Ago in THE JOURNAL OF PEDIATRICS An Etiologic and Diagnostic Study of Cerebral Palsy Malamud N, Itabashi HH, Castor J, Messinger HB. J Pediatr 1964;65:270-93
ifty years ago in The Journal, Malamud et al reported their initial clinicopathologic investigation to elucidate the etiology of cerebral palsy. At the Sonoma State Hospital from 1955 to 1960, the authors screened 4843 severely “mentally retarded” and “handicapped” patients to distinguish 1184 with cerebral palsy, and then studied 68 cases at autopsy. Striking is how little we have advanced our understanding of the origins of cerebral palsy, yet how much the care of these individuals has changed. The authors described children whose cerebral palsy was the sequela of a brain malformation or kernicterus, but also devised other gross groupings of “perinatal trauma” and “postnatal disorders,” debated heatedly at the time and no longer considered valid. They attempted to pair clinical factors to these groupings, but found little (eg, prolonged second stage of labor or the need for a maternal transfusion both linked to “perinatal trauma”). We know now that birth trauma is infrequently the cause of cerebral palsy.1 Otherwise, our understanding of etiology has improved minimally. We do not know what causes the majority of cases of cerebral palsy. At the same time, our stewardship of patients with cerebral palsy has changed. Warehouses of patients with cerebral palsy and intellectual disability no longer exist. One-half of the patients at the Sonoma State Hospital were seen or followed at the University of California, San Francisco. As a medical student there, when in 1986 the State Hospital transitioned to Sonoma Developmental Center as many children were de-institutionalized, I recall faculty describing the great halls of children and young adults. Photos and videos had been taken and circulated, and studies like this performed years earlier, with no consideration of patient consent. Children had been involuntarily sterilized and the subjects of many invasive tests. This particular cerebral palsy study came under media scrutiny in the early 2000s.2 Today we have humanized children with disabilities. We can only hope that over the next 50 years we will understand better the pathogenesis of their cerebral palsy and improve their lives further with therapeutic interventions or prevention.
F
Paul Graham Fisher, MD Departments of Neurology, Pediatrics, and Human Biology Stanford University Lucile Packard Children’s Hospital Palo Alto, California
References
http://dx.doi.org/10.1016/j.jpeds.2014.02.059
1. Nelson KD. Can we prevent cerebral palsy? N Engl J Med 2003;349:1765-9. 2. Mabrey V. “On Experiments Done On Institutionalized Children.” Available at http://www.cbsnews.com/news/a-dark-chapter-in-medicalhistory-09-02-2005/. Accessed March 25, 2014.
Hypothermia Therapy for Neonatal Hypoxic Ischemic Encephalopathy in the State of California
273
