Cerebral Palsy and the Relationship to Prematurity

Abstract

Cerebral palsy (CP) is the most common cause of childhood-onset, lifelong physical disability in most countries around the world. Prematurity is the leading identifiable risk factor of cerebral palsy and is defined as birth occurring prior to 37 weeks’ gestation. Premature infants are at a much higher risk for developing CP than full-term infants, and the risk increases as gestational age and birthweight decreases. Despite technological advances in neonatal care over the past several decades, cerebral palsy remains a major neurologic sequela among extremely low birth weight survivors, affecting 9–17% of survivors. Antenatal and perinatal factors that influence the risk of CP include gestational age at delivery, birth weight, presence of multiple gestation, and chorioamnionitis. Following delivery, there are a number of risk factors that contribute to a premature infant’s development of CP. These include intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, presence of a patent ductus arteriosus, necrotizing enterocolitis, hyperbilirubinemia, hypocarbia, neonatal sepsis, hypoxia, and apnea. Interventions to reduce the risk of CP include antenatal glucocorticoid administration, magnesium sulfate for neuroprotection, and delayed cord clamping at delivery.