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Published on: November 20, 2015
Cerebral palsy in preterm infants: a population-based case-control study of antenatal and intrapartal risk factors
B Jacobsson1, G Hagberg, B Hagberg
1Perinatal Center, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden. bo.jacobsson@obgyn.gu.se
Insights
Infection and low Apgar scores are linked to spastic cerebral palsy (CP) in preterm infants. Specific factors like abruptio placentae and fever impact risk differently based on prematurity and CP type.
Area of Science:
- Perinatal Medicine
- Neonatology
- Neurology
Background:
- Foetomaternal infection is a known risk factor for spastic cerebral palsy (CP) in term infants.
- The association between infection and CP is less clear in preterm infants.
- Understanding infection-related risk factors is crucial for preventing CP in vulnerable preterm populations.
Purpose of the Study:
- To investigate infection-related risk factors for spastic CP specifically in preterm infants.
- To differentiate risk factors based on gestational age (very preterm vs. moderately preterm) and CP subtype (hemiplegic vs. diplegic).
Main Methods:
- Population-based case-control study of preterm infants with spastic CP (very preterm <32 wk, n=91; moderately preterm 32-36 wk, n=57) and matched controls (n=296).
- Retrieved 154 maternal, antenatal, and intrapartal variables from obstetric records.
- Statistical analysis to identify significant risk factors for CP.
Main Results:
- Histological chorioamnionitis/pyelonephritis, prolonged membrane rupture-to-birth interval, short admission-delivery interval (<4h), and low Apgar scores (<7 at 1, 5, 10 min) were significant risk factors for CP in the overall preterm group.
- Abruptio placentae and low Apgar scores were significant for moderately preterm and hemiplegic CP.
- Fever before delivery was a risk factor for very preterm and spastic diplegic CP.
- Antenatal antibiotic exposure was linked to spastic diplegic CP.
Conclusions:
- Antenatal infections had a marginal impact on CP risk.
- Low Apgar scores and abruptio placentae were key risk factors, particularly in moderately preterm infants with hemiplegic CP.
- Specific risk factors varied by gestational age and CP classification, highlighting the complexity of CP etiology in preterm infants.
Unlabelled:
Previous studies have indicated that foetomaternal infection increases the risk of spastic cerebral palsy (CP) in term infants, whereas this association appears to be less evident in preterm infants. The aim of this study was to analyse infection-related risk factors for spastic CP in preterm infants. A population-based series of preterm infants with spastic CP, 91 very preterm (<32 wk) and 57 moderately preterm (32-36 wk), born in 1983-90, were included and matched with a control group (n = 296). In total, 154 maternal, antenatal and intrapartal variables were retrieved from obstetric records. In the entire group, histological chorioamnionitis/pyelonephritis, long interval between rupture of membranes and birth, admission-delivery interval <4 h and Apgar scores of <7 at 1 min just significantly increased the risk of CP, and Apgar scores of <7 at 5 and 10 min were strongly associated with an increased risk. Abruptio placentae, Apgar scores <7 at 1 min and pathological non-stress test (reason for delivery) were significant risk factors of CP only in the moderately preterm and hemiplegic groups, whereas fever before delivery was a significant risk factor in the very preterm and spastic diplegic groups. Antibiotics during pregnancy was associated with CP only in the spastic diplegic CP group.
Conclusion:
Antenatal infections marginally increased the risk of CP. Low Apgar score and abruptio placentae were associated with CP, especially in moderately preterm infants with hemiplegic CP.
