Priorities for research

QUESTIONS IDENTIFIED BY:

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Intervention researchers and clinicians

Aetiology and prevention researchers

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High priority questions for Aetiology and prevention researchers identified questions

The intervention and aetiology/prevention survey had a slightly lower degree of stability. The aetiology/prevention survey had a number of questions with the full range of possible answers, suggesting low convergence.

 

 

Infection and Inflammation

• What is the association between altered fetal inflammatory response in CP mothers and infants and CP?
• Are cytokines markers of infection or ischaemia?
• What are the infectious agents involved in pregnancy that are strongly linked to CP?
• Does earlier recognition of maternal infection lead to reduced incdidence of HIE?
• Does cytokine elevation correlate with severity of injury?
• What are the molecular and cellular mechanisms that explain the epidemiologically observed association between chorioamnioitis and greater risk of CP?
• How can TORCH infections be reduced?
• How can chorioamnionitis in pregnancy be identified, treated and prevented? Who is most at risk?
• Does intra-uterine infection and fetal inflammatory response affect the fetal brain?
• Do viral and bacterial exposure/infection interact with genetic factors or know major risk factors IUGR, prematurity, multiple birth, ante partum haemorrhage on a pathway to CP?
• What are cytokines roles in brain development, pregnancy and inflammatory homeostatis?

Focus on Timing: Preterm, Term and Postnatal

• Do pathways to pre-term birth differ in the ways they predispose to brain injury?
• To what extent can CP be prevented in developing countries through the improved management of childhood illness?
• What are the predictors and risk factors of CP in term infants (from socio economic to neonatal health)?
• How can severe encephalopathy be reduced to moderate and moderate be reduced to mild?
• Is both infection and acidosis required in term infants to cause CP?
• What are the most effective public health initiatives to reduce post natal CP?
• What therapeutic drugs reduce the severity, if not stop the destruction of oligodendrocytes in PVL?
• What are the causes of neonatal encephalopathy?

Haematology

• How do disorders of coagulation (fetal and maternal) affect the fetal brain?
• What postnatal medications best reduce the risk of severe IVH?
• What are the underlying mechanisms of prenatal hypoxia/inflammation that result in brain damage?
• How can perinatal stroke be prevented?

Research tools

• Do we have the tools (registers) to identify if we start to prevent CP? How can we best combine data bases to increase accurate surveillance?
• Can a gold standard classification system of CP based on underlying pathology be developed and agreed on?
• How can the timing of lesions be most accurately identified?
• What strategy can be used to drive forward aetiological research by combining epidemiology with genetics, basic science and other disciplines to identify causal pathways?
  

Neuro-regeneration

• Do neuroprotective interventions change severity and functional outcomes?
• What are the mechanisms of neuro-regeneration?
• How can we maximise neuro-developmental outcome for babies born with perinatal hypoxic-ischaemic injury secondary to intrapartum asphyxia?

Genetics

• What are the maternal and fetal immune, clotting, and immune response genetic factors predisposing to CP?
• Do genetic factors play a role in neonatal encephalopathy?
• What role do thrombophilic risk factors have in the pathogenesis of CP?