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Published on: November 20, 2015
The panorama of cerebral palsy after very and extremely preterm birth: evidence and challenges
1University of Chicago, Pritzker School of Medicine, Kennedy Mental Retardation Center, Comer Children's and LaRabida Children's Hospitals, IL 60637, USA. mmsall@peds.bsd.uchicago.edu
Insights
Advances in neonatal care improve survival for very preterm infants, but neurodevelopmental motor impairment, including cerebral palsy, remains a challenge. Understanding these pathways is key to improving long-term outcomes.
Area of Science:
- Neonatology
- Maternal-Fetal Medicine
- Neurodevelopmental Pediatrics
Background:
- Significant progress in neonatal care has increased survival rates for extremely preterm infants (born <28 weeks gestation).
- Despite improved survival, neurodevelopmental motor impairments, particularly cerebral palsy, persist as major challenges for these vulnerable infants.
Purpose of the Study:
- To review advancements in understanding the pathways leading to cerebral palsy in preterm children.
- To analyze the impact of specific comorbidities on neurodevelopmental outcomes.
- To guide management strategies for improving central nervous system function and quality of life.
Main Methods:
- Literature review and analysis of major advances in maternal-fetal medicine and neonatology.
- Examination of the contributions of chronic lung disease, intraventricular hemorrhage, and retinopathy of prematurity.
- Assessment of the role of postnatal steroid administration.
Main Results:
- Preterm birth remains a significant risk factor for cerebral palsy and other neurodevelopmental motor impairments.
- Chronic lung disease, intraventricular hemorrhage, and retinopathy of prematurity are key contributors to adverse neurodevelopmental outcomes.
- Postnatal steroid use requires careful consideration due to potential long-term effects.
Conclusions:
- Continued research is essential to elucidate the complex pathways underlying cerebral palsy in preterm infants.
- Management should focus on mitigating comorbidities that threaten survival and protecting neurodevelopmental functions.
- Interventions aimed at improving motor skills, feeding, communication, and learning are crucial for enhancing the long-term well-being of preterm survivors.
Abstract:
During the past 2 decades, major advances in maternal-fetal medicine and neonatology have resulted in unprecedented survival of very preterm (<32 weeks) and extremely preterm (<28 weeks) babies. Despites these advances in prenatal care, neurodevelopmental motor impairment remains a substantial sequela. This article describes the major progress and challenges in understanding pathways of preterm children who go on to have one of the cerebral palsy syndromes. The contributions of chronic lung disease, intraventricular hemorrhage, retinopathy of prematurity, and postnatal steroids are analyzed. Management can then be directed to limiting the comorbidities that are associated with threats to survival and to improving protection of central nervous system functions that are involved in moving, manipulative skills, feeding, communication, and learning.
