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Prospective evaluation of perinatal risk factors for cerebral palsy and delayed development in high risk infants
1Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
Insights
Neonatal sepsis is a significant risk factor for cerebral palsy (CP) and delayed development (DD) in high-risk infants. Careful monitoring and prevention of sepsis in newborns may reduce the incidence of CP and DD.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Neurology
Background:
- Cerebral palsy (CP) and delayed development (DD) are serious concerns in high-risk infants.
- Prematurity, intrauterine infection, and perinatal brain injury are known risk factors for CP.
Purpose of the Study:
- To examine perinatal predictors of CP and DD in high-risk infants.
- To identify specific antenatal, intrapartum, and neonatal factors associated with CP and DD.
Main Methods:
- Prospective evaluation of 184 high-risk infants, divided into two groups based on birth weight (<2,000g and ≥2,000g).
- Comparison of antenatal, intrapartum, and neonatal factors between infants with and without CP/DD.
- Univariate and multivariate analyses to determine significant risk factors.
Main Results:
- No significant antenatal or intrapartum factors were associated with CP/DD.
- In infants <2,000g, sepsis, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), ventriculomegaly (VM), and prolonged mechanical ventilation were significant postnatal risk factors.
- In infants ≥2,000g, sepsis and neonatal seizures were significant risk factors for CP/DD.
- Neonatal sepsis was a moderate risk factor for CP in infants ≥2,000g (OR 1.47; 95% CI 1.02-2.13).
Conclusions:
- Neonatal sepsis is a significant contributor to the development of CP and DD in high-risk infants.
- Close follow-up of high-risk infants with sepsis is recommended for early detection of CP and DD.
- Reducing neonatal sepsis may be a feasible strategy for preventing CP.
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.