Prospective evaluation of perinatal risk factors for cerebral palsy and delayed development in high risk infants

Abstract

Prematurity, intrauterine infection and perinatal brain injury have been reported to be significant risk factors of cerebral palsy (CP). We examined the perinatal predictors of cerebral palsy and delayed development (DD) in 184 high risk infants. Thirty-five infants were diagnosed as cerebral palsy and delayed development at 12 months corrected age. Antenatal, intrapartum, and neonatal factors were prospectively evaluated in 2 groups of high risk infants compared with controls; Group A (n = 79), infants weighing less than 2,000 g; Group B (n = 43), infants weighing 2,000 g or more. In univariate analysis, there were no significant antenatal and intrapartum factors associated with cerebral palsy and delayed development in either group. We found that significant postnatal risk factors of CP in group A included sepsis (p = 0.008), BPD (bronchopulmonary dysplasia) (p = 0.028), IVH (intraventricular hemorrhage) (p = 0.042), ventriculomegaly (VM) (p = 0.001) and a longer duration of mechanical ventilation (p = 0.001); while in group B, sepsis (p = 0.047) and neonatal seizure (p = 0.027) were significant risk factors. In multivariate analysis, sepsis in group B was a moderate risk factor of CP (OR (odds ratio) 1.47; 95% CI (confidence interval) 1.02-2.13). In conclusion, neonatal sepsis may contribute to the development of cerebral palsy and delayed development. We suggest that high risk infants who have sepsis should be carefully followed for cerebral palsy and delayed development. The prevention of cerebral palsy may be feasible by decreasing neonatal risk factors such as sepsis during the neonatal period.

Neurogenic bladder: etiology and assessment

“…It is caused by perinatal infection or a period of anoxia (or hypoxia) affecting the tissues of the central nervous system [56] (Table 4). It appears in babies who are less than 2 kg at birth, have had intraventricular hemorrhage, experienced a neonatal seizure or received mechanical ventilation for a prolonged period of time in the postnatal period [57]. The incidence of cerebral palsy is increasing, as more severely premature infants are surviving and going home.…”

Cerebral palsy in preterm infants: a population‐based case‐control study of antenatal and intrapartal risk factors

“…Although perinatal and neonatal risk factors for CP appear to dominate in the preterm group, further investigation into antenatal and intrapartal risk factors is interesting, as they can act as antecedents to the brain damage resulting in CP. In previous analyses of antenatal risk factors for CP in preterm infants no single risk factor has been consistent across all or even most studies (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Recent studies suggest that foetoplacental uterine infection/in ammation is important in the initiation of preterm labour and for the development of central nervous system injury and CP (16,17).…”

“…The very preterm group (<32 wk) and the moderately preterm group (32-36 wk) were analysed separately, as infection is considered to be a more common cause of very preterm birth (22). Furthermore, the moderately preterm group has usually not been investigated in previous studies (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), despite its comprising 44% of preterm CP and 18% of all CP (1,2).…”

Systematic review of chorioamnionitis and cerebral palsy

“…We previously identified 17 studies that evaluated the association between clinical chorioamnionitis and cerebral palsy [Nelson and Ellenberg, 1985b;Cooke, 1990;Grether et al, 1996;Allan et al, 1997;Gray, et al, 1997;O'Shea et al, 1998;Wilson-Costello et al, 1998;Kim et al, 1999;Grether and Nelson, 2000;Jacobsson et al, 2000;Yoon et al, 2000] or cPVL [Perlman, et al, 1996;Roland et al, 1996;Wiswell et al, 1996;Zupan et al, 1996;Spinillo et al, 1998;Baud et al, 1999] in preterm infants, with relative risks ranging from 0.95 to 7.3. Two of these studies were replaced by new reports [Gray et al, 2000;Yoon et al, 2000] published in the year 2000, which provided updated information on a group of patients that had been previously reported.…”