This coverage is not sanctioned by, nor a part of, the American Congress of Obstetricians and Gynecologists.

From Medscape Medical News

Preterm Birth, Complications Related to Cerebral Palsy Reduced
Alice Goodman
Authors and Disclosures

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May 3, 2011 (Washington, DC) — New approaches to preventing preterm birth and related complications were discussed by Roberto J. Romero, MD, here at the American Congress of Obstetricians and Gynecologists (ACOG) 59th Annual Clinical Meeting. In particular, Dr. Romero highlighted studies of cutting-edge technology that may lead to an approach for the prevention of cerebral palsy.

“Preterm birth is one of the most challenging problems,” he said, and the frequency of preterm birth in the United States has remained unchanged over the past 2 decades, remaining at 12% overall and 20% in underserved populations. “Worldwide, 30 million preterm babies are born annually, with both short- and long-term complications,” Dr. Romero told listeners at the Anna Maria D’Amico lecture. Dr. Romero is affiliated with the Perinatal Research Branch of the National Institutes of Health and is a professor at Wayne State University in Detroit, Michigan.

Preterm birth is a syndrome with multiple etiologies, Dr. Romero emphasized. No single test can predict all preterm births, and no singular treatment or prevention strategy will eradicate preterm birth. That being said, 2 factors are strongly associated with preterm birth: Short cervix (a cervix <15 mm in length) increases the risk for preterm birth by 50%, and progesterone deficiency is implicated in both preterm birth and short cervix. These 2 factors overlap and are amenable to treatment.

A study reported on last month by Medscape Medical News describes in detail the results of the PREGNANT trial, showing a significant 45% reduction in preterm birth (before 33 weeks’ gestation) with the use of vaginal progesterone vs placebo (P = .02).

In that large, multicenter, randomized, placebo-controlled trial, 465 women with a singleton pregnancy and a short cervix on sonography (10 – 20 mm) were randomly assigned at 19 to 23 weeks of gestation to treatment with daily, self-administered vaginal progesterone or placebo. The rates of preterm birth at less than 28 weeks’ gestation and 35 weeks’ gestation were also significantly reduced with vaginal progesterone gel vs placebo, with a relative risk reduction of 50% (P = .04) and a relative risk reduction of 38% (P = .02), respectively.

Vaginal progesterone was also associated with a significantly reduced risk for respiratory distress syndrome (P = .03), any neonatal morbidity or mortality event (P = .04), and low birth weight (P = .01). No difference in adverse events was observed when vaginal progesterone was compared with placebo.

Dr. Romero commented on the implications of PREGNANT: “It is now possible to screen and assess risk delivery using cervical ultrasound [to measure cervical length,] and a simple intervention [ie, vaginal progesterone gel] can make a big difference.”

He noted that before the results of PREGNANT were released online, a pharmacoeconomic analysis found that using ultrasound to measure cervical length could reduce the costs associated with preterm birth by $12 million, provided each scan cost $184 or less. For vaginal progesterone, the same analysis found that the number-needed-to-treat (NNT) to prevent 1 preterm birth was 14, and the NNT to prevent 1 case of respiratory distress syndrome was 22.

“These numbers compare favorably with other obstetrical interventions commonly used to prevent preeclampsia and respiratory distress syndrome,” Dr. Romero stated.

“Vaginal progesterone gel will absolutely be used in clinical practice in women with short cervix. This treatment is of benefit for one of our biggest challenges in obstetrics — the high rate of premature delivery,” stated ACOG’s Scientific Program Committee Chair Raul Artal, MD, professor and chairman of the Department of Obstetrics, Gynecology, and Women’s Health at St. Louis University in Missouri.

Dr. Romero focused the remainder of his talk on potential approaches to prevent cerebral palsy, which is associated with both preterm delivery and fetal infection.

Three large, randomized trials showed equivocal evidence for prevention of cerebral palsy using magnesium sulfate for neuroprotection. A meta-analysis of these 3 trials found that use of magnesium sulfate in patients at risk for preterm birth reduced the risk for cerebral palsy by 31%. The NNT was 52, and the cost to prevent 1 case of cerebral palsy was $10,000. This suggests that magnesium sulfate can protect against some cases of cerebral palsy, Dr. Romero said.

Another approach is aimed at the complications of infection, as in utero infection accounts for about 20% of cases of cerebral palsy, he continued. “Compelling evidence suggests that bacterial infections can activate the microglia and astrocytes [2 key cells implicated in cerebral palsy], injuring the myelin. Infection leads to periventricular leukomalacia, which leads to cerebral palsy. The presence of funisitis at birth suggests that the neonate was exposed to infection in utero, and this can be useful in the medicolegal setting [in proving that infection — not malpractice — caused cerebral palsy],” Dr. Romero said.

Cutting-edge technology is being studied in animals to prevent cerebral palsy. This approach uses dendrimers, which are tree-like plastics that can attach drug and target ligands and be viewed by imaging. In neonatal animals, intravenous dendrimers containing N-acetylcysteine (an anti-inflammatory) were found to target neural inflammation in the microglia and astrocytes, he explained.

Animals with endotoxin-induced neuroinflammation were divided into 2 groups. One group was injected on day 1 of life with dendrimers that release N-acetylcysteine, and the other group was untreated. The group receiving the dendrimer injections had improved motor coordination compared with their untreated counterparts, although their motor coordination was not as good as that of control animals.

“The use of nanotechnology to combat intrauterine infections is experimental at present. Although these results are exciting, this approach needs to be studied in humans to see if it translates to the clinical setting,” Dr. Artal commented.

Dr. Romero and Dr. Artal have disclosed no relevant financial relationships.

American Congress of Obstetricians and Gynecologists (ACOG) 59th Annual Clinical Meeting. Presented May 1, 2011.

These announcements were the result of 2008 workshop on the topic at PPB, and the summary published in the Journal of Pediatrics (Hay et al J Pediatr. 2009;155:612-7). Please encourage extramural scientists interested in this topic to consider submission of applications in response to these announcements.

Although not RFAs (see below the picket fence for the implications of this statement), through these announcements NICHD is letting the community know of our keen interest in stimulating research in this under-studied field.

1.     Studies in Neonatal Hypoglycemia (R01) <http://grants.nih.gov/grants/guide/pa-files/PA-11-053.html> (PA-11-053) Eunice Kennedy Shriver National Institute of Child Health and Human Development Application Receipt Date(s): Multiple dates, see announcement.

2.     Studies in Neonatal Hypoglycemia (R03) <http://grants.nih.gov/grants/guide/pa-files/PA-11-054.html> (PA-11-054) Eunice Kennedy Shriver National Institute of Child Health and Human Development  Application Receipt Date(s): Multiple dates, see announcement.

3.     Studies in Neonatal Hypoglycemia (R21) <http://grants.nih.gov/grants/guide/pa-files/PA-11-055.html> (PA-11-055) Eunice Kennedy Shriver National Institute of Child Health and Human Development  Application Receipt Date(s): Multiple dates, see announcement.

John W. Kluge in 2007

John W. Kluge, former foundation president and chair of the board of directors, passed away on Tuesday, September 7 at his family home in Charlottesville , VA at the age of 95. Mr. Kluge was champion for cerebral palsy and related brain disorders research. CPIRF President James C. Stearns noted “John Kluge served CPIRF for many years as a board member, including as its President. He gave tirelessly of his time and was generous in his financial contributions. His memory will live on through the many programs he supported which benefitted the lives of children and adults with cerebral palsy and other disabilities.” CPIRF wishes to express our sincerest condolences and sympathies to the Kluge family and many friends.

Ms. Jacqueline (Jackie) Carmosino

Jackie is based with CEO Glenn R. Tringali in our new office at 186 Princeton Hightstown Road, Building 4, 2nd Floor; Princeton Junction, NJ 08550 which opened on June 1, 2010. The Princeton Junction location will be the CPIRF headquarters and eventually the sole operating office once we complete the transitional process of closing our Washington, DC office on or before September, 2010. (NOTE: Donor contributions and billing inquiries will continue to be processed through our Washington, DC office until such time.)

Most recently, Mr. Tringali was the Chief Development Officer at the Cancer Research Institute and from 2001-2008, previously served the autism community, first as CEO of the National Alliance for Autism Research prior to leading the organization’s successful merger with Autism Speaks in February, 2006 where he was named Executive Vice President.

CPIRF CEO – Glenn R. Tringali

“I am incredibly honored and excited to be joining the Cerebral Palsy International Research Foundation. The national and global research and education programs we are funding are critically important. With an estimated 1 million children and adults with CP in our country, the need for supporting our efforts has never been greater”.

CPIRF is the nation’s preeminent private organization dedicated to the prevention and treatment of Cerebral Palsy and related developmental disorders. In its fifty-five year history, CPIRF has provided more than $50 million to support research and educational activities in the biomedical and clinical sciences.

The American Academy of Audiology honored Dr. Stephen Fausti with the Jerger Career Award for his distinguished career in audiology research during their conference in San Diego on April 15. Dr. Fausti is the Director of the Portland VA Medical Center’s (VAMC) National Center for Auditory Rehabilitative Research (NCRAR) and a member of the Cerebral Palsy International Research Foundation Scientific Advisory Council. Please CLICK HERE to read more.

Please find below a link to the Today Show website that contains the CP segment aired this morning.

Click Here to watch the Today Show Segment!

Stay tuned for our posting of the video segment!

Her previous work found that black ethnicity is associated with a 40% increased risk of CP among term and near-term infants. In a follow up study, Wu et al confirmed her earlier finding of increased risk of CP among black infants, although the relative risk did not reach statistical significance as in the previous study. These findings are consistent with research conducted by the Centers for Disease Control. They found a higher prevalence of cerebral palsy in black 8-year old children as compared to other racial groups in three different geographical areas of the country: metropolitan Atlanta, Northern Alabama and Southeastern Wisconsin . The prevalence of CP was highest among 8 year old black children in all three regions and was 30% higher overall than the prevalence found in white non-Hispanic children.

Drs. Wu and Gilbert are going to use a database maintained by the Office of Statewide Health Planning and Development (OSHPD) of California. This database contains 10 years of birth certificate information from the whole state of California and is linked with another database maintained by the California Department of Developmental Services that contains all diagnoses of cerebral palsy in the same time period. She will test the following hypotheses: 1) Infants born to black mothers experience an increased risk of cerebral palsy that is only partially explained by increased rates of prematurity and other potential confounders; and 2) Infants born to mothers of Hispanic origin demonstrate a lower risk of cerebral palsy. Dr Wu hopes to complete her study by the end of next year.

The Developmental Medicine and Child Neurology  Supplement on “Adults with CP workshop”

Dr. Mindy Aisen gave a plenary talk at the 63rd AACPDM Annual Meeting on September 26th in Scottsdale, Arizona. Her talk was entitled ‘ Updating Research Priorities for Cerebral Palsy’.

Download her Power Point Presentation here.
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