Why is there a modifying effect of gestational age on risk factors for cerebral palsy?

Abstract

Objective: To investigate risk factors for cerebral palsy in relation to gestational age. Design: Three case-control studies within a geographically defined cohort. Setting: The former Oxfordshire Health Authority. Participants: A total of 235 singleton children with cerebral palsy not of postnatal origin, born between 1984 and 1993, identified from the Oxford Register of Early Childhood Impairment; 646 controls matched for gestation in three bands: (32 weeks; 33-36 weeks; >37 weeks. Results: Markers of intrapartum hypoxia and infection were associated with an increased risk of cerebral palsy in term and preterm infants. The odds ratio (OR) for hypoxia was 12.2 (95% confidence interval 1.2 to 119) at (32 weeks and 146 (7.4 to 3651) at >37 weeks. Corresponding ORs for neonatal sepsis were 3.1 (1.8 to 5.4) and 10.6 (2.1 to 51.9). In contrast, pre-eclampsia carried an increased risk of cerebral palsy at >37 weeks (OR 5.1 (2.2 to 12.0)) but a decreased risk at (32 weeks (OR 0.4 (0.2 to 1.0)). However, all infants (32 weeks with maternal pre-eclampsia were delivered electively, and their risk of cerebral palsy was no lower than that of other electively delivered (32 week infants (OR 0.9 (0.3 to 2.7)). Nearly 60% of (32 week controls were delivered after spontaneous preterm labour, itself an abnormal event. Conclusion: Inflammatory processes, including pre-eclampsia, are important in the aetiology of cerebral palsy. The apparent reduced risk of cerebral palsy associated with pre-eclampsia in very preterm infants is driven by the characteristics of the gestation matched control group. Use of the term ''protective'' in this context should be abandoned.

Définition de l’asphyxie intrapartum et conséquences sur le devenir

“…Toutefois, l'impact de l'hypoxie intrapartum sur le risque de paralysie cérébrale est beaucoup moins élevé chez le grand prématuré que chez le nouveauné à terme [52]. Cela ne doit pas être interprété comme une moindre vulnérabilité à l'hypoxie du cerveau immature.…”

Association of Maternal Hypertension and Chorioamnionitis With Preterm Outcomes

“…Although it is unlikely that a prenatal infection is directly responsible for the increased relative risk for NEC found in chorioamnionitis, innate immunity upregulation in the gut toward bacterial antigens plays a key role in the pathogenesis of NEC. 38 One limitation of our study, which is common to all studies looking at conditions associated with very preterm delivery, is the lack of a proper "control" group of normal infants, 17,36 because preterm birth is always the result of a pathologic process. Consequently, we can only compare the risks after hypertension with those after chorioamnionitis.…”

“…Although the association between chorioamnionitis and early sepsis was expected, 36 the association with NEC is more problematic. The pathogenesis of NEC is multifactorial, and both infectious and vascular factors are involved.…”

Influência da dançaterapia na mobilidade funcional de crianças com paralisia cerebral hemiparética espástica

“…A etiologia da PC é multifatorial e geralmente não é estabelecida, devido a dificuldade de precisar a causa e o momento exato da lesão (Greenwood, Yudkin, Sellers, Impey, & Doyle, 2005). No entanto, a etiologia compreende aspectos pré-natais (malformações do sistema nervoso central, infecções congênitas e quadros de hipóxia), peri-natais (anóxia peri-natal) e pós-natais (meningites, infecções, lesões traumáticas e tumorais) (Blair & Watson, 2006;Cans et al, 2007;Garne, Dolk, Krägeloh-Mann, Holst-Ravn, & Cans, 2008).…”