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Centre for Evidence-
Based Medicine

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:

  1. Is the evidence from this randomised trial valid?
  2. If valid, is this evidence important?
  3. If valid and important, can you apply this evidence in caring for your patient?

Continue to completed worksheet