ANTECEDENTS OF CEREBRAL PALSY IN VERY LOW–BIRTH WEIGHT INFANTS
Section snippets
Genetic Factors
Although many genetic syndromes are associated with CP, as a group they are rare and account for only a small proportion of cases.63 The most important genetic influences probably are those that predispose a woman to deliver prematurely.98 If, as discussed later, an inflammatory cytokine cascade is causally related to both preterm birth and CP,36 then genetic influences on the inflammatory response may constitute an inherited determinant of CP risk.32
Prepregnancy Factors
In studies restricted to preterm or VLBW
SUMMARY
Research from the last two decades provides directions for efforts to prevent CP in VLBW infants. The pathogenesis of CP seems to involve factors operating both during pregnancy and in the neonatal period. The most important prenatal factor appears to be intrauterine infection. Perinatal infection and other risk factors, such as the death of a co-twin, placental abruption, and cerebral ischemia, could trigger a cytokine cascade resulting in damage to the developing brain. The low frequency of
ACKNOWLEDGMENTS
The authors acknowledge the support and advice of Alan Leviton, MD. Dr. O'Shea acknowledges the support and advice of Robert Dillard, MD, and Kurt Klinepeter, MD.
References (151)
- et al.
Corticosteroid therapy for prevention of respiratory distress syndrome in severe preeclampsia
Am J Obstet Gynecol
(1999) - et al.
Intrapartum asphyxia: A rare cause of cerebral palsy
J Pediatr
(1988) - et al.
Intrauterine growth and spastic cerebral palsy
Am J Obstet Gynecol
(1990) The neurotoxicity of bilirubin
Clin Perinatol
(1990)- et al.
Double-blind developmental evaluation at 1-year corrected age of 597 premature infants with birth weights from 500 to 1350 grams enrolled in three placebo-controlled trials of prophylactic synthetic surfactant
J Pediatr
(1995) - et al.
Double-blind 1-year follow-up of 1540 infants with respiratory distress syndrome randomized to rescue treatment with two doses of synthetic surfactant or air in four clinical trials
J Pediatr
(1995) Antenatal corticosteroid therapy: A meta-analysis of the randomized trials, 1972 to 1994
Am J Obstet Gynecol
(1995)- et al.
Cerebral palsy in four northern California counties, births 1983 through 1985
J Pediatr
(1993) - et al.
Increased risk of spastic diplegia among very low birth weight children after preterm labor or prelabor rupture of membranes
J Pediatr
(1998) - et al.
Characteristic neuropathology of leukomalacia in extremely low birth weight infants
Pediatr Neurol
(1997)
Effectiveness of antenatal steroids in obstetric subgroups
Obstet Gynecol
Survival and follow-up of infants born at 23 to 26 weeks of gestational age: Effects of surfactant therapy
J Pediatr
Acid-base status at birth and subsequent neurosensory impairment in surviving 500 to 1000 gm infants
Am J Obstet Gynecol
Endotoxin leucoencephalopathy in the telecephalon of the newborn kitten
J Neurol Sci
Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intraamniotic infection
Infect Dis Clin North Am
The fetal inflammatory response syndrome
Am J Obstet Gynecol
Cerebral blood flow and energy metabolism in the newborn
Clin Perinatol
Prenatal and perinatal factors and cerebral palsy in very low birth weight infants
J Pediatr
Effect of corticosteroid on brain growth in fetal sheep
Obstet Gynecol
White matter disorders of prematurity: Association with intraventricular hemorrhage and ventriculomegaly
J Pediatr
Antenatal corticosteroids and cranial ultrasound abnormalities
Am J Obstet Gynecol
White matter damage in preterm newborns—an epidemiologic perspective
Early Hum Dev
Hypothyroxinemia of prematurity and the risk of cerebral white matter damage
J Pediatr
Preventive effects of dexamethasone on hypoxic-ischemic brain damage in the neonatal rat
Brain Dev
Case-control study of antenatal and intrapartum risk factors for cerebral palsy in very preterm singleton babies
Lancet
Maternal endotoxemia, fetal anomalies, and central nervous system damage: A rat model of a human problem
Am J Obstet Gynecol
Does transient hypothyroxinemia cause abnormal neurodevelopment in premature infants?
Clin Perinatol
Describing the cerebral palsies: Methods of classifying and counting
Antecedents of cerebral palsy in a multicenter trial of indomethacin for intraventricular hemorrhage
Arch Pediatr Adolesc Med
Prenatal magnesium sulfate exposure and risk of cerebral palsy
JAMA
Impact of intrauterine growth restriction on neurodevelopmental and growth outcomes in very low birth weight infants
Acta Paediatr
Very low birth weight: A problematic cohort for epidemiologic studies of very small or immature neonates
Am J Epidemiol
Dexamethasone prevents hypoxic-ischemic brain damage in the neonatal rat
Pediatr Res
Nuclear Factor-kB-A pivotal transcription factor in chronic inflammatory disease
N Engl J Med
A novel role for thyroid hormone, glucocorticoids and retinoic acid in timing oligodendrocyte development
Development
Amniotic fluid concentrations of interleukin-1 beta, interleukin-6 and TNF-alpha in chorioamnionitis before 32 weeks of gestation: histologic associations and neonatal outcome
Br J Obstet Gynecol
Are neonatal brain lesions due to intrauterine infection related to mode of delivery?
Br J Obstet Gynaecol
Predictive value of umbilical artery pH in preterm infants
Arch Dis Child
Postnatal white matter necrosis in preterm infants
J Perinatol
Effects of dexamethasone on IL-1beta, IL-6, and TNF-alpha production by mononuclear cells of newborns and adults
Biol Neonate
A research definition for “birth asphyxia”?
Dev Med Child Neurol
Etiologic factors associated with the development of periventricular leukomalacia
Acta Paediatr Scand
Cytokine release from microglia: Differential inhibition by pentoxifylline and dexamethasone
J Infect Dis
A comparison of the protective effect of dexamethasone to other potential prophylactic agents in a neonatal rat model of cerebral hypoxia-ischemia
J Neurosurg
Preeclampsia and cerebral palsy: Are they related?
Dev Med Child Neurol
Cerebral palsy in very low birthweight infants
Arch Dis Child
Trends in incidence of cranial ultrasound lesions and cerebral palsy in very low birthweight infants 1982–93
Arch Dis Child Fetal Neonatal Ed
Australian collaborative trial of antenatal thyrotropin-releasing hormone: Adverse effects at 12-month follow-up
Pediatrics
Blood pressure, heart rate, and skin temperature in preterm infants: Association with periventricular hemorrhage
Arch Dis Child
Modification of the infection-associated risks of preterm birth and white matter damage in the preterm newborn by polymorphisms in the tumor necrosis factor-locus?
Pathogenesis
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Neurodevelopmental Follow-up of Preterm Infants: What Is New?
2019, Pediatric Clinics of North AmericaCitation Excerpt :A key component of neurodevelopmental impairment is cerebral palsy (CP).6 During the early years of neonatology, a primary focus of follow-up studies was on identification of rates of CP.7–9 CP is often associated with other long-term sequelae, including cognitive, sensory, and language impairments; seizure disorders; and growth abnormalities.
Chorioamnionitis and cerebral palsy: Lessons from a patient registry
2014, European Journal of Paediatric NeurologyCitation Excerpt :The prevalence of CP is inversely proportional to gestational age (GA), with a 60-fold higher risk of CP in children born at less than 28 weeks gestation compared to term infants.5 Not surprisingly, low birth weight has also been found to be strongly associated with CP, with a 70-fold increased risk of CP in extremely low birth weight infants (i.e. <1500 g) compared to normal birth weight infants.6 Chorioamnionitis and intrauterine exposure to maternal infection are risk factors for premature birth.7,8
Incidence and risk factors for cerebral palsy in infants with perinatal problems: A 15-year review
2007, Early Human DevelopmentWhy aren't identical twins linguistically identical? Genetic, prenatal and postnatal factors
2006, CognitionCitation Excerpt :Diminished fetal blood flow is a major risk factor for prenatal brain injuries. Consistent with this, recent studies have shown that placental abruption is associated with neuropsychiatric disorders (Jablensky, Morgan, Zubrick, Bower, & Yellachich, 2005) and neurodevelopmental disorders such as cerebral palsy (O’Shea & Dammann, 2000). Premature rupture of membranes (PROM) refers to the condition in which the amniotic sac ruptures prior to delivery.
Neonatal antecedents for cerebral palsy in extremely preterm babies and interaction with maternal factors
2005, Early Human Development
The authors thank the North Carolina Department of Environment, Health, and Natural Resources and the Brenner Children's Hospital (Dr. O'Shea) and the United Cerebral Palsy Research and Educational Foundation (EH-003-98) (Dr. Dammann).
Address reprint requests to T. Michael O'Shea, MD, MPH Department of Pediatrics Wake Forest University School of Medicine Medical Center Boulevard Winston-Salem, NC 27157