The origins of cerebral palsy

Abstract

Papers this year have helped clarify risk groups and identify some areas (e.g. the management of thrombophilias and the potential of induced hypothermia) with the potential to be rapidly introduced into clinical practice. In this enigmatic and multifactorial condition, however, progress remains slow. New tools such as magnetic resonance imaging are providing valuable insights into the lesions that result in cerebral palsy but the pathways to injury remain unclear. The future of cerebral palsy research lies in understanding the complex interactions of multiple factors on the road to cerebral palsy or in looking for final common pathways such as inflammation which may be amenable to manipulation.

Cell Type-specific Expression and Function of Toll-like Receptors 2 and 4 in Human Placenta: Implications in Fetal Infection

“…Also of note, cerebral palsy (CP) and related neurological disorders are associated with chorioamnionitis (CA) when it is accompanied by fetal inflammatory response syndrome (FIRS, a multisystemic microbial invasion of the fetus with the hallmark presentation of umbilical cord inflammation (i.e. funisitis) [9][10][11][12]. Recent studies implicate placental infection and inflammation at this site with severe neurological sequelae in the newborn [13,14].…”

“…Chorioamnionitis (CA), infection of placental tissues, is most often caused by ascending bacteria, mycoplasma or fungi, which result in a marked infiltration of neutrophils in maternal decidua and fetal membranes, with or without a neutrophilic response in the placenta and fetus [10]. CA is associated with preterm delivery, a major cause of neonatal mortality and morbidity [11]. Also of note, cerebral palsy (CP) and related neurological disorders are associated with chorioamnionitis (CA) when it is accompanied by fetal inflammatory response syndrome (FIRS, a multisystemic microbial invasion of the fetus with the hallmark presentation of umbilical cord inflammation (i.e.…”

Assessing the Risk of Cerebral Palsy in Children Born after Assisted Conception – The Role of Multiple Pregnancy and Preterm Delivery / Procena rizika od cerebralne paralize kod dece začete vantelesnim oplođenjem – uloga višestruke trudnoće i prevremenog rođenja

“…However, this study was focused on singleton births only, so the results and conclusion should be interpreted with caution due to exclusion of previously confirmed increased incidence of preterm and multiple births in IVF pregnancies (4,6,(16)(17)(18)(19)(20)(28)(29)(30)(31).…”

“…Although a decline in the incidence among infants born prematurely was found, the overall prevalence of CP is increasing. This can be explained by the rate of CP that is still stable among term infants, by the increasing survival of preterm and very low birth weight infants, and by the improved longevity in a general population (16,17). Most of the available findings suggest that there is a higher overall risk of CP in the population of children born after ART due to multiple births, preterm (<37 weeks of gestation) and very preterm (<32 weeks of gestation) delivery, low (<2500 g) or very low birth weight (<1500 g) (16)(17)(18)(19)(20).…”

“…This can be explained by the rate of CP that is still stable among term infants, by the increasing survival of preterm and very low birth weight infants, and by the improved longevity in a general population (16,17). Most of the available findings suggest that there is a higher overall risk of CP in the population of children born after ART due to multiple births, preterm (<37 weeks of gestation) and very preterm (<32 weeks of gestation) delivery, low (<2500 g) or very low birth weight (<1500 g) (16)(17)(18)(19)(20). Also, these risk factors are strongly associated with numerous long-term health consequences, admission to neonatal intensive care units and prolonged hospitalization (11,(21)(22)(23).…”