Hypoxic/Ischemic and Infectious Events Have Cumulative Effects on the Risk of Cerebral Palsy in Very-Low-Birth-Weight Preterm Infants

Abstract

Background: Hypoxia/ischemia and inflammation are two major mechanisms for cerebral palsy (CP) in preterm infants. Objective: To investigate whether hypoxia/ischemia- and infection-related events in the perinatal and neonatal periods had cumulative effects on CP risk in very-low-birth-weight (VLBW) premature infants. Methods: From 1995 to 2005, 5,807 VLBW preterm infants admitted to Taiwan hospitals were enrolled.The cumulative effects of hypoxic/ischemic and infectious events during the perinatal and neonatal periods on CP risk at corrected age 24 months were analyzed. Results: Of the 4,355 infants with 24-month follow-up, 457 (10.5%) had CP. The CP group had significantly higher incidences of hypoxia/ischemia-related events in the perinatal and neonatal periods, and sepsis in the neonatal period than the normal group. Three hypoxic/ischemic events, including birth cardiopulmonary resuscitation (OR 2.25; 95% CI 1.81-2.82), patent ductus arteriosus (PDA) ligation (2.94; 1.35-5.75) and chronic lung disease (3.14; 2.61-3.85) had the most significant contribution to CP. Relative to CP risk for infants with neither the three hypoxic/ischemic events nor sepsis, the CP odds increased 1.98-, 2.26- and 2.15-fold for infants with birth cardiopulmonary resuscitation, PDA ligation and chronic lung disease, respectively; while the combination with sepsis further increased the odds to 3.18-, 3.83- and 3.25-fold, respectively. Using the three hypoxic/ischemic events plus sepsis, CP rates were 10.0, 16.7, 26.7, 40.0 and 54.7% for infants with none, one, two, three and four events, respectively. Conclusions: Hypoxic/ischemic and infectious events across the perinatal and neonatal periods exerted cumulative effects on CP risk in VLBW premature infants.

Impact of Xenon on CLIC4 and Bcl-2 Expression in Lipopolysaccharide and Hypoxia-Ischemia-Induced Periventricular White Matter Damage

“…HI and infection/inflammation are the 2 major risk factors for WMD in VLBW preterm infants [1, 16, 17]. However, clinical and experimental evidence suggests that systemic infection or inflammation is not enough to induce obvious central nervous system lesions.…”

“…Ma et al [3] previously demonstrated that Xe upregulated the prosurvival proteins Bcl-2 and brain-derived neurotrophic factor (BDNF) to ameliorate brain injury in asphyxiated rats. Bcl-2 and Bcl-XL prevent apoptosis by regulating the mitochondrial membrane potential, and thereby blocking cytochrome c release into the cytosol [17]. Therefore, it is plausible to state that Xe mediates its neuroprotective effects via upregulating the level of the antiapoptotic gene Bcl-2.…”

Isolated Cystic Periventricular Leukomalacia Differs from Cystic Periventricular Leukomalacia with Intraventricular Hemorrhage in Prevalence, Risk Factors and Outcomes in Preterm Infants

“…After obtaining parental consent, the infants were recruited for perinatal conditions and neonatal complications. Follow-up examinations were performed at a corrected age of 24 months [14]. On follow-up, pediatricians performed neuromotor examinations, while psychologists administered the Bayley Scales of Infant Development II [15].…”

“…Infants without cPVL and IVH served as the reference group. At the 24-month follow-up, CP was diagnosed on the basis of abilities and limitations in gross motor function using an algorithm-based classification [14]. Developmental delay was defined as the mental development index <70 by the Bayley Scales.…”

Identifying Risk Factors Shared by Bronchopulmonary Dysplasia, Severe Retinopathy, and Cystic Periventricular Leukomalacia in Very Preterm Infants for Targeted Intervention

“…Case files included sociodemographic backgrounds, perinatal conditions, and neonatal complications [6, 7]. Parent consent was obtained, and the Taiwan Joint Institutional Review Board approved this study.…”