Harm: Clinical Scenario
You see a child at age 3 with congenital disabling spastic cerebral palsy (CP). The cause of the CP remains a mystery, and the anxious parents are seeking your expert opinion. The little girl was born full-term with normal birth weight and cord blood pH. Her 5-minute Apgar Score was 5. Her mother had fever during labour, but there was no evidence of infection in the newborn infant. You recently attended a conference at which intrauterine infection was reported as a major risk factor for CP in premature infants. You wonder whether this is also true for term newborns.
You formulate the question, "In children who were born full-term with normal birth weight, is maternal infection a possible cause of congenital cerebral palsy?"
You perform a PubMed search using the MeSH terms "cerebral palsy" and "maternal infection". Of the 6 articles identified, only one deals with infants of normal birth weight. You review the abstract in PubMed and decide to copy the entire article JAMA 1997; 278:207-11.
Read the article and decide:
- Is the evidence from this randomised trial valid?
- If valid, is this evidence important?
- If valid and important, can you apply this evidence in caring for your patient?