Antibiotic 'cerebral palsy link'

By Michelle Roberts Health reporter, BBC News

Antibiotics appeared to treble the risk of cerebral palsy
A study has linked a small number of cases of cerebral palsy to antibiotics given to women in premature labour.
The UK study found 35 cases of cerebral palsy in 769 children of women without early broken waters given antibiotics.
This compared with 12 cases among 735 children of women not given the drugs. Advice is being sent to the study's 4,148 mothers and a helpline set up.

Medical experts stressed pregnant women should not feel concerned about taking antibiotics to treat infections.

The Oracle study was the largest trial in the world into premature labour and was set up to investigate whether giving antibiotics - which might tackle an underlying symptomless infection - to women with signs of premature labour would improve outcomes for babies.

One in eight babies in the UK is born prematurely and prematurity is the leading cause of disability and of infant death in the first month after birth.

Premature labour
In 2001, ORACLE found the antibiotic erythromycin had immediate benefits for women in premature labour (before 37 weeks gestation) whose waters had broken. It delayed onset of labour and reduced the risk of infections and breathing problems in babies.

Erythromycin and the other antibiotic studied - co-amoxiclav - showed no benefit or harm for the women whose waters were still intact, however, and doctors were advised not to routinely prescribe them in such circumstances.
To study the longer-term outcomes, the Medical Research Council-funded scientists followed up the children seven years later.

Unexpectedly, both antibiotics appeared to increase the risk of functional impairment - such as difficulty walking or problems with day to day problem solving - and treble the chance of cerebral palsy in the children of the women whose waters had not broken.

Of the 769 children born to mothers without early broken waters and given both antibiotics, 35 had cerebral palsy, compared with 12 out of 735 whose mothers did not receive antibiotics in the same circumstances.
The reasons behind this link are unclear, particularly as there was no increased risk of cerebral palsy in women whose waters had broken.

Hostile environment
The researchers believe cerebral palsy is unlikely to be a direct effect of the antibiotic but rather due to factors involved in prolonging a pregnancy that might otherwise have delivered early.
Researcher Professor Peter Brocklehurst of Oxford University said: "We have a suspicion that infection is implicated in premature labour.

"Antibiotics may merely suppress levels of infection to stop preterm labour, but the baby remains in a hostile environment."
Infections during pregnancy or infancy are known to cause cerebral palsy.

In a letter to doctors and midwives advising them about the findings, Chief Medical Officer Sir Liam Donaldson says: "Pregnant women should not feel concerned about taking antibiotics to treat infections.

"It is important to note that these women had no evidence of infection and would not routinely be given antibiotics."
Where there is obvious infection, antibiotics can be life-saving for both mother and baby, the CMO says.

The Royal College of Obstetricians and Gynaecologists said: "These findings do not mean that antibiotics are unsafe for use in pregnancy. Pregnant women showing signs of infection should be treated promptly with antibiotics."
Cerebral palsy can cause physical impairments and mobility problems.

It results from the failure of a part of the brain to develop before birth or in early childhood or brain damage and affects one in 400 births.

Arthritis knee op 'does not work'

The surgery is not recommended in the UK
An operation offered to ease the symptoms of osteoarthritis makes no difference, say Canadian doctors.
Patients given knee arthroscopy showed no improvement beyond that provided by physiotherapy and painkillers.
Arthritis experts in the UK said some surgeons were still carrying out the operation, against national guidance.
They said New England Journal of Medicine study showed doctors still relying on the technique to treat osteoarthritis were misguided.

Thousands of people in the UK suffer from osteoarthritis in the knee, which can be painful and limit movement.
The operation involves inserting instruments through small incisions to try to flush out loose fragments of cartilage, and to smooth the surfaces of the joints, in the hope that this will relieve symptoms.
A group of 178 men and women, with an average age of 60, were enrolled in the trial at the University of Western Ontario.
All of them were given physiotherapy and painkilling drugs such as ibuprofen, but half of the volunteers were also given the "lavage and debridement" procedure.

When their symptoms were compared at various points afterwards, the group who had the operation were faring no better than those who had not received it.

Guidelines breached
Dr Brian Feagan, one of the researchers, said: "This is definitive evidence that arthroscopic surgery provides no additional therapeutic value when added to physical therapy and medication for patients with moderate osteoarthritis of the knee."
This type of surgery is still recommended for some other knee conditions, including more severe osteoarthritis where the knee is "locked" in position, but is not recommended for moderate osteoarthritis by the National Institute for Health and Clinical Excellence, which formulates UK guidelines.

A spokesman for the Arthritis Research Campaign said there was no longer any excuse for performing it in patients with less severe arthritis.

"Arthroscopic lavage and debridement is still commonly performed in the US but more rarely in the UK over the past ten years, and is no longer accepted as an effective treatment for osteoarthritis of the knee in this country.
"Surgeons still performing this operation need to ask themselves why they are doing it."