Histological chorioamnionitis is associated with cerebral palsy in preterm neonates

The histologic fetal inflammatory response and neonatal outcomes: systematic review and meta-analysis

OBJECTIVE

This study aimed to investigate the prognostic role of concomitant histological fetal inflammatory response with chorioamnionitis on neonatal outcomes through a systematic review and meta-analysis of existing literature.

DATA SOURCES

The primary search was conducted on October 17, 2021, and it was updated on May 26, 2023, across 4 separate databases (MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, and Scopus) without using any filters.

STUDY ELIGIBILITY CRITERIA

Observational studies reporting obstetrical and neonatal outcomes of infant-mother dyads with histological chorioamnionitis and histological fetal inflammatory response vs infant-mother dyads with histological chorioamnionitis alone were eligible. Studies that enrolled only preterm neonates, studies on neonates born before 37 weeks of gestation, or studies on neonates with very low birthweight (birthweight <1500 g) were included. The protocol was registered with the International Prospective Register of Systematic Reviews (registration number: CRD42021283448).

METHODS

The records were selected by title, abstract, and full text, and disagreements were resolved by consensus. Random-effect model-based pooled odds ratios with corresponding 95% confidence intervals were calculated for dichotomous outcomes.

RESULTS

Overall, 50 studies were identified. A quantitative analysis of 14 outcomes was performed. Subgroup analysis using the mean gestational age of the studies was performed, and a cutoff of 28 weeks of gestation was implemented. Among neonates with lower gestational ages, early-onset sepsis (pooled odds ratio, 2.23; 95% confidence interval, 1.76-2.84) and bronchopulmonary dysplasia (pooled odds ratio, 1.30; 95% confidence interval, 1.02-1.66) were associated with histological fetal inflammatory response. Our analysis showed that preterm neonates with a concomitant histological fetal inflammatory response are more likely to develop intraventricular hemorrhage (pooled odds ratio, 1.54; 95% confidence interval, 1.18-2.02) and retinopathy of prematurity (pooled odds ratio, 1.37; 95% confidence interval, 1.03-1.82). The odds of clinical chorioamnionitis were almost 3-fold higher among infant-mother dyads with histological fetal inflammatory response than among infant-mother dyads with histological chorioamnionitis alone (pooled odds ratio, 2.99; 95% confidence interval, 1.96-4.55).

CONCLUSION

This study investigated multiple neonatal outcomes and found association in the case of 4 major morbidities: early-onset sepsis, bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity.

Using Middle Cerebral Artery Doppler Ultrasound to Predict Clinical Chorioamnionitis After Preterm Prelabor Rupture of Membranes

BACKGROUND

In neonates, blood flow to the brain as measured by peak systolic velocity (PSV) in the middle cerebral artery (MCA) is altered in pregnancies affected by chorioamnionitis.

OBJECTIVE

We aim to determine whether PSV and other measures of flow in the MCA in the fetus are altered prior to the development of clinical chorioamnionitis following preterm prelabor rupture of membranes (PPROM).

METHODS

 This was a prospective observational study. Fifty patients from one institution were recruited after being diagnosed with PPROM between 23 weeks zero days and 33 weeks six days gestation. We performed measurements of the PSV in the fetal MCA on a weekly basis following PPROM and used the value taken closest to the time of delivery for our statistical analysis. The primary outcome assessed was clinical chorioamnionitis, and the exposure of interest was MCA PSV. Additional independent variables of interest were other Doppler measures of the MCA. Secondary outcomes included histological chorioamnionitis and other measures of neonatal health, including sepsis, days in the neonatal intensive care unit (NICU), and death.

RESULTS

Of the 50 patients recruited to our study, eight (16%) developed clinical chorioamnionitis, similar to previously reported values in the general population. The PSV in the MCA was not significantly associated with the development of clinical chorioamnionitis. However, an elevated MCA pulsatility index (PI), a measure of resistance to flow, was associated with a higher probability of developing clinical chorioamnionitis.

CONCLUSION

 There does not appear to be a difference in the PSV of the MCA of fetuses in pregnancies following PPROM with impending chorioamnionitis. However, elevated PI in the MCA could be a marker of impending chorioamnionitis in PPROM. Larger studies are needed to confirm these findings.

Placental Findings in Infants Gestational Age < 34 Weeks and Impact on Short-Term Outcomes

AIM

To analyse placental changes in infants' gestational age < 34 weeks and its correlation to short-term respiratory outcomes or death until hospital discharge.

MATERIAL AND METHODS

Information regarding all in-house born preterm infants born before 34 weeks gestation and born from January 2009 until December 2014 were collected and included among others, placental pathology and relevant data on demographics and outcomes of infants.

RESULTS

Placental abnormalities was found in 157/253 (65.05%) cases. Acute placental inflammation was found to be the most common in both groups of premature neonates, followed by maternal vascular underperfusion. Maternal vascular underperfusion was significantly more common in GA ≤ 27 weeks compared to infants GA 28-33 weeks (35.2% vs. 13.7%; p = 0.018). Similarly, chronic placental inflammation was more common in infants GA ≤ 27 weeks compared to infants GA 28-33 weeks (14.3% vs. 3.3%; p = 0.014). Infants with placental pathology had a lower median birth weight (1460g vs. 1754g; p = 0.001, and were of shorter median GA at birth (31 vs. 32; p = 0.001). Infants with any placental disease had higher rates of death until hospital discharge (10.2% vs. 3.1%; p = 0.039) and higher rates of any stage of bronchopulmonary dysplasia (41.4% vs. 26.0%; p = 0.013). There were no significant differences in mechanical ventilation rates, duration of mechanical ventilation and duration of supplemental oxygen therapy.

CONCLUSION

Identifiable placental abnormalities were found in most infants born < 34 weeks gestation. Placental pathology is associated with increased rates of bronchopulmonary dysplasia and death until hospital discharge.

Histopathology of the fetal inflammatory response to intra-amniotic pathogens

Obstetric endorsement of the utility of placental histologic examination remains infrequent, especially from obstetricians who do not have a placental pathologist as part of their own local clinical care team. Placental pathologic examinations are viewed as useless if they do not provide answers to urgent clinical questions. Increasingly, however, it is appreciated that while placental analysis should be considered with regard to its longer term value; results can assess lifelong risks of a wide range of diseases that have been tied to prenatal exposures (e.g., [1]), including distinguishing sex-specific differences in those risks. (e.g., [2]) This review will focus solely on acute fetal (?) inflammation, more specifically, the fetal neutrophil responses in umbilical cord, chorionic plate vessels and to some degree, the fetal system as a whole. This histologic fetal inflammatory response is often the most readily accessible aspect of "FIR" piece of FIRS (the fetal inflammatory response syndrome). Some researchers have defined FIRS by a combination of both cytokine (especially IL-6) levels and the histopathologic FIR (Musilova et al., 2018) [3]. As we and others have noted, many histology based FIR cases, even those associated with neurodevelopmental outcomes such as cerebral palsy, are clinically silent.(e.g., [4]) Current clinical diagnostic criteria may have high specificity as they are very good at identifying non-FIR cases. However, that high specificity is coupled with very low specificity, identifying only 10% of FIR (Doty et al., 2018 Jul) [5]. Our aim is to provide a conceptual framework for the readers of the journal to better understand how to answer the following questions: What is a neutrophil and how is it important in FIR? What is the differential diagnosis for histologic FIR? How long has there been FIR? What secondary processes may have been recruited (and when) to contribute to the final pathology and pathophysiology of the given pregnancy?

Cumulative Antenatal Risk and Kindergarten Readiness in Preterm-Born Preschoolers

A suboptimal intrauterine environment is thought to increase the probability of deviation from the typical neurodevelopmental trajectory, potentially contributing to the etiology of learning disorders. Yet the cumulative influence of individual antenatal risk factors on emergent learning skills has not been sufficiently examined. We sought to determine whether antenatal complications, in aggregate, are a source of variability in preschoolers’ kindergarten readiness, and whether specific classes of antenatal risk play a prominent role. We recruited 160 preschoolers (85 girls; ages 3–4 years), born ≤33⁶/₇ weeks’ gestation, and reviewed their hospitalization records. Kindergarten readiness skills were assessed with standardized intellectual, oral-language, prewriting, and prenumeracy tasks. Cumulative antenatal risk was operationalized as the sum of complications identified out of nine common risks. These were also grouped into four classes in follow-up analyses: complications associated with intra-amniotic infection, placental insufficiency, endocrine dysfunction, and uteroplacental bleeding. Linear mixed model analyses, adjusting for sociodemographic and medical background characteristics (socioeconomic status, sex, gestational age, and sum of perinatal complications) revealed an inverse relationship between the sum of antenatal complications and performance in three domains: intelligence, language, and prenumeracy (p = 0.003, 0.002, 0.005, respectively). Each of the four classes of antenatal risk accounted for little variance, yet together they explained 10.5%, 9.8%, and 8.4% of the variance in the cognitive, literacy, and numeracy readiness domains, respectively. We conclude that an increase in the co-occurrence of antenatal complications is moderately linked to poorer kindergarten readiness skills even after statistical adjustment for perinatal risk.

Are Extremely Low Gestational Age Newborns Born to Obese Women at Increased Risk of Cerebral Palsy at 2 Years?

The authors hypothesized that the risk of cerebral palsy at 2 years in children born extremely preterm to overweight and obese women is increased relative to the risk among children born to neither overweight nor obese women. In a multicenter prospective cohort study, the authors created multinomial logistic regression models of the risk of diparetic, quadriparetic, and hemiparetic cerebral palsy that included the prepregnancy body mass index of mothers of 1014 children born extremely preterm, cerebral palsy diagnoses of children at 2 years, as well as information about potential confounders. Overweight and obese women were not at increased risk of giving birth to a child who had cerebral palsy. The risk ratios associated with overweight varied between 1.1 for quadriparesis (95% CI = 0.5, 2.1) to 2.0 for hemiparesis (95% CI = 0.4, 9.8). The risk ratios associated with obesity varied between 0.7 for diparesis (95% CI = 0.2, 2.5) to 2.5 for hemiparesis (95% CI = 0.4, 13).

Chorioamnionitis in the Development of Cerebral Palsy: A Meta-analysis and Systematic Review

CONTEXT

Chorioamnionitis (CA) has often been linked etiologically to cerebral palsy (CP).

OBJECTIVES

To differentiate association from risk of CA in the development of CP.

DATA SOURCES

PubMed, Cochrane Library, Embase, and bibliographies of original studies were searched by using the keywords (chorioamnionitis) AND ((cerebral palsy) OR brain).

STUDY SELECTION

Included studies had to have: (1) controls, (2) criteria for diagnoses, and (3) neurologic follow-up. Studies were categorized based on: (1) finding incidence of CP in a CA population, or risk of CP; and (2) incidence of CA in CP or association with CP.

DATA EXTRACTION

Two reviewers independently verified study inclusion and extracted data.

RESULTS

Seventeen studies (125 256 CA patients and 5 994 722 controls) reported CP in CA. There was significantly increased CP inpreterm histologic chorioamnionitis (HCA; risk ratio [RR] = 1.34, P < .01), but not in clinical CA (CCA). Twenty-two studies (2513 CP patients and 8135 controls) reported CA in CP. There was increased CCA (RR = 1.43, P < .01), but no increase in HCA in preterm CP. Increased HCA was found (RR = 4.26, P < .05), as well as CCA in term/near-term CP (RR = 3.06, P < .01).

CONCLUSIONS

The evidence for a causal or associative role of CA in CP is weak. Preterm HCA may be a risk factor for CP, whereas CCA is not. An association with term and preterm CP was found for CCA, but only with term CP for HCA.

Neonatal outcomes following preterm birth classified according to placental features

BACKGROUND

Preterm birth has staggering health implications, and yet the causes of most cases are still unknown. Placental features have been understudied as an etiology for preterm birth, and the association between placental pathologic lesions and neonatal outcomes are incompletely understood.

OBJECTIVE

We sought to characterize births according to placental pathology and relate these to adverse neonatal outcomes.

STUDY DESIGN

We studied 20,091 births (15,710 term and 4381 preterm) with placental evaluations. Births were classified according to the presence or absence of placental lesions consistent with malperfusion (vasculopathy, infarct, advanced villous maturation, perivillous fibrin, fibrin deposition) and intrauterine inflammation/infection (chorioamnionitis, funisitis, vasculitis). Outcomes were gestational week of delivery, birthweight z-score, neonatal respiratory distress syndrome, and intraventricular hemorrhage.

RESULTS

Among all preterm births, evidence of placental malperfusion was identified more often than inflammation/infection (50.6% vs 27.3%, P < .0001). Placental malperfusion was associated with reduced fetal growth (adjusted birthweight z-score, -0.83, P < .0001) and lesions of inflammation/infection were associated with earlier delivery (adjusted difference -2.08 weeks, P < .0001) than those with no lesions. When both placental lesions were present, earlier delivery (adjusted difference -2.28 weeks, P < .0001) and reduced fetal growth (adjusted birthweight z-score difference, -0.24, P = .001) were observed more often than when neither lesion was present. Findings were similar when restricted to cases of spontaneous preterm birth. Intraventricular hemorrhage was higher in preterm births with malperfusion lesions than cases with no lesions (7.6% vs 3.4%; odds ratio, 1.98; confidence interval, 1.18-3.32), accounting for gestational age and other covariates.

CONCLUSION

Placental pathology provides important insight into subtypes of preterm birth with adverse neonatal outcomes. Co-occurrence of malperfusion and inflammation/infection, especially among spontaneous preterm births, may be a novel pattern of placental injury linked to severe adverse outcomes.

Fetal inflammation associated with minimal acute morbidity in moderate/late preterm infants

OBJECTIVE

To determine whether exposure to acute chorioamnionitis and fetal inflammation caused short-term adverse outcomes.

DESIGN

This is a prospective observational study: subjects were mothers delivering at 32-36 weeks gestation and their preterm infants at a large urban tertiary level III perinatal unit (N=477 infants). Placentae and fetal membranes were scored for acute histological chorioamnionitis based on the Redline criteria. Fetal inflammation was characterised by histological diagnosis of funisitis (umbilical cord inflammation), increased cord blood cytokines measured by ELISA, and activation of the inflammatory cells infiltrating the placenta and fetal membranes measured by immunohistology. Maternal and infant data were collected.

RESULTS

Twenty-four per cent of 32-36-week infants were exposed to histological chorioamnionitis and 6.9% had funisitis. Immunostaining for leucocyte subsets showed selective infiltration of the placenta and fetal membranes with activated neutrophils and macrophages with chorioamnionitis. Interleukin (IL) 6, IL-8 and granulocyte colony-stimulating factor were selectively increased in the cord blood of preterm infants with funisitis. Compared with infants without chorioamnionitis, funisitis was associated with increased ventilation support during resuscitation (43.8% vs 15.4%) and more respiratory distress syndrome postnatally (27.3% vs 10.2%) in univariate analysis. However, these associations disappeared after adjusting for prematurity.

CONCLUSIONS

Despite fetal exposure to funisitis, increased cord blood cytokines and activated placental inflammatory cells, we could not demonstrate neonatal morbidity specifically attributable to fetal inflammation after adjusting for gestational age in moderate and late preterm infants.

Association of severe placental inflammation with death prior to discharge and cerebral palsy in preterm infants

OBJECTIVE

The objective of our study was to identify placental patterns associated with death before discharge or cerebral palsy in a large cohort of preterm infants with a high follow-up rate at 2 years of corrected age.

DESIGN

Population-based monocentric study.

SETTINGS

Monocentric study in the maternity unit of the University Hospital of Angers, France between 24⁺⁰ and 33⁺⁶  weeks of gestation, between January 2008 and December 2011.

POPULATION

All singleton infants born alive with a placental examination were eligible.

METHODS

Clinical data (obstetric and neonatal) were collected prospectively through the LIFT cohort. Placental data were collected retrospectively from medical records. The main outcome measure was death before discharge or cerebral palsy.

RESULTS

We did not find any significant association between severe inflammatory lesions on the placenta and death [odds ratio (OR) 1.49; 95% CI 0.55-4.01; P = 0.43] or cerebral palsy (OR 1.41; 95% CI 0.43-4.62; P = 0.57). This lack of significant association persisted even after adjustment (aOR 0.9; 95% CI 0.20-2.30; P = 0.54; aOR 0.98; 95% CI 0.27-3.58; P = 0.97).

CONCLUSION

Our results do not provide evidence for a significant association between severe inflammatory placental lesions and either death before discharge or cerebral palsy at 2 years of corrected age in preterm infants born at <34 weeks of gestational age. Further studies remain necessary to confirm this result.

TWEETABLE ABSTRACT

We found no significant association between inflammatory placental lesions and death or cerebral palsy.

Onset factors in cerebral palsy: A systematic review

Studies have noted several factors associated with the occurrence of Cerebral Palsy (CP), yet considerable uncertainty remains about modifiable factors related to disease onset. A systematic review was performed to identify existing systematic reviews and primary studies pertaining to targeted factors associated with the onset of CP. The following databases were searched: MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, Scopus, Web of Science, Cochrane Database of Systematic Reviews, CINHAL, ProQuest Dissertations & Theses, Huge Navigator, AARP Ageline. Variations of MeSH and keyword search terms were used. Critical appraisal was conducted on selected articles. Data extraction targeted reported factors, risk estimates, and 95% confidence intervals (CI). Findings identified two systematic reviews and three meta- analyses, as well as 83 studies of case control, cohort, and cross-sectional methodological designs. Selected studies indicated that lower gestational age was associated with the onset of CP. Medical diagnoses for the mother, in particular chorioamnionitis, was found to be positively associated with onset of CP. Preeclampsia was reported to be either inconclusive or positively associated with CP onset. Low birth weight predominantly indicated a positive association with the onset of CP, while male gender showed mixed findings. The combination of male gender with pre-term or low birth weight was also found to be positively associated with CP. Evidence was identified in the literature pertaining to specific factors relating to the onset of CP, in particular showing positive associations with lower gestational age and low birth weight.

Impact of duration of rupture of membranes on outcomes of premature infants

OBJECTIVE

The primary aim of the study was to determine how the risk of adverse outcomes was related to the duration of the latency period and gestational age at birth following preterm premature rupture of the fetal membranes (PPROM).

STUDY DESIGN

Retrospective review of infants discharged from 330 neonatal intensive care units. We defined four subgroups based on gestational age: 23 to 25, 26 to 28, 29 to 31 and 32 to 34 weeks. Each gestational age group was evaluated by duration of ROM: <24 h, 1 to 7 days, 8 to 14 days, 15 to 21 days, 21 to 28 days and >28 days and compared with a referent group (PPROM of >24 h but <7 days).

RESULT

In all, 239 808 non-anomalous infants 23 to 34 weeks' gestational age were identified; 37 233 (15.5%) had rupture of membranes (ROM) >24 h. Compared with a reference group (PPROM of >24 h but <7 days), the risk of mortality for PPROM of 8 to 14, 15 to 21 and 21 to 28 days varied depending on gestational age at birth. Only PPROM >28 days was consistently associated with increased mortality and decreased likelihood of survival without morbidity in all gestational age subgroups.

CONCLUSION

PPROM for >28 days is associated with an increased risk of death and morbidity.

Prenatal inflammation is associated with adverse neonatal outcomes

OBJECTIVE

The purpose of this study was to determine whether prenatal inflammation (as assessed by clinical chorioamnionitis, maternal temperature >38°C, or histologic chorioamnionitis) is associated with a composite adverse neonatal outcome.

STUDY DESIGN

We performed a prospective cohort study of women at 22 weeks to 33 weeks 6 days' gestation with symptoms of labor (April 2009 to March 2012). Relevant maternal and neonatal exposures and outcomes were recorded. Multivariable logistic regression was performed to determine the association between prenatal inflammation and neonatal outcomes that were controlled for potential confounders.

RESULTS

We analyzed 871 mother-infant pairs. The preterm birth rate was 42.0%. When we controlled for infant sex and modified the data by gestational age at delivery, prenatal inflammation remains a significant risk factor for adverse neonatal outcomes, despite advancing gestational age: clinical chorioamnionitis at 32 weeks' gestation (odds ratio [OR], 3.12; 95% confidence interval [CI], 1.02-9.52], at 36 weeks' gestation (OR, 8.88; 95% CI, 4.32-18.25), and at 40 weeks' gestation (OR, 25.30; 95% CI, 9.25-69.19); maternal temperature >38°C at 32 weeks' gestation (OR, 3.18; 95% CI, 0.66-15.42), at 36 weeks gestation (OR, 8.40; 95% CI, 3.60-19.61), and at 40 weeks gestation (OR, 22.19; 95% CI, 8.15-60.44); histologic chorioamnionitis at 32 weeks gestation (OR, 1.25; 95% CI, 0.64-2.46), at 36 weeks gestation (OR, 2.56; 95% CI, 1.54-4.23), and at 40 weeks gestation (OR, 5.23; 95% CI, 1.95-13.99).

CONCLUSION

The protective association with advancing gestational age is diminished when prenatal inflammation is present.

Chorioamnionitis and cerebral palsy: lessons from a patient registry

AIM

The fetal neuroinflammatory response has been linked to the development of brain injury in newborns and subsequent neurologic impairment. We aimed to explore the maternal and child factors associated with histologic chorioamnionitis in cerebral palsy.

METHODS

We conducted an observational study on a cohort of children with cerebral palsy who were identified from the Quebec Cerebral Palsy Registry. Placental pathology was reported prospectively. Maternal and child factors associated with histological chorioamnionitis were explored.

RESULTS

Placental reports were available in 455 of 534 (85%) children with cerebral palsy, and of these 12% had histological signs of chorioamnionitis on reports. These children were more likely to have large placentas over 90th percentile for gestational age (53.7% versus 30.7%, p = 0.001) and were born significantly more prematurely (<32 weeks in 51.9% vs 24.1%, p = 0.007) than children without chorioamnionitis. A clinical sign of perinatal infection was reported in 61.1% of children with chorioamnionitis, however each clinical sign was seen in a minority of these children. Children with chorioamnionitis were more likely to have spastic diplegic cerebral palsy subtype (37% vs 19.2%, p = 0.003) and periventricular white matter injury on neuroimaging (52.9% vs 35.8%, p = 0.004). However no differences in neuroimaging or subtypes were seen when stratified by prematurity.

DISCUSSION

Histological chorioamnionitis was a frequent pathological finding in children with cerebral palsy born prematurely, with larger placentas relative to gestation and birth weight. Future case control studies are needed to shed light on the role of inflammatory placental findings in pregnancy outcomes.

Chorioamnionitis in the pathogenesis of brain injury in preterm infants

Chorioamnionitis (or placental infection) is suspected to be a risk factor for brain injury in premature infants. The suggested association between chorioamnionitis and cystic periventricular leukomalacia and cerebral palsy is uncertain because of the variability of study designs and definitions of chorioamnionitis. Improvements in neonatal intensive care may have attenuated the impact of chorioamnionitis on brain health outcomes. Large multicenter studies using rigorous definitions of chorioamnionitis on placental pathologies and quantitative magnetic resonance techniques may offer the optimal way to clarify the complex role of chorioamnionitis in modifying brain health and long-term outcomes.

Perinatal inflammation results in decreased oligodendrocyte numbers in adulthood

AIMS

Maternal inflammation is a risk factor for preterm birth, and premature infants are often exposed to supplemental oxygen as a life-sustaining therapy. While more immature neonates are surviving, rates of neurodevelopmental impairment are not improving. We developed a novel mouse model with clinically relevant exposures to test the hypothesis that systemic maternal inflammation with transient neonatal hyperoxia exposure will induce a phenotype similar to diffuse periventricular leukomalacia (PVL) like that observed in premature human infants.

MAIN METHODS

Timed-pregnant C3H/HeN mice received intraperitoneal injections of lipopolysaccharide (LPS) or saline on embryonic day 16. Newborn pups were placed in room air (RA) or 85% oxygen (O2) for 14 days, followed by 14 days in RA recovery. Oligodendroglial and microglial populations were evaluated at 14 and 28 days.

KEY FINDINGS

Brain weight to body weight ratios were lower in mice exposed to LPS. Oligodendrocyte numbers were decreased significantly in the cerebral cortex and hippocampus in groups exposed to LPS or LPS/O2 at 14 days, and persisted in the cerebral cortex at 28 days for LPS/O2 mice. At day 14, cleaved caspase 3 was increased and numbers of microglia were elevated in the cerebral cortex and hippocampus of LPS/O2 animals.

SIGNIFICANCE

These data indicate that combining systemic maternal LPS and neonatal hyperoxic exposure impairs myelination, and suggests that this novel mouse model may represent a subtle, diffuse form of periventricular white matter injury that could provide a clinically relevant platform for further study of perinatal brain injury.

Intra-partum fever and cerebral palsy in Khartoum, Sudan

Background

Cerebral palsy (CP) is a major cause of childhood disability. There are various maternal and neonatal predictors associated with the development of CP, and they are variable across different populations. This case–control study was designed to investigate maternal and neonatal predictors of CP at Khartoum pediatric neurology clinics. Data (maternal sociodemographic characteristics and neonatal expected predictors) were collected from mothers of children with CP and healthy controls using questionnaires.

Results

One hundred and eleven cases of CP and 222 controls were included. Spastic CP was the most common type (69.4%). In logistic regression, maternal age, parity, birth weight, and sex were not associated with CP. However, maternal fever (OR = 8.4, CI = 2.3–30.5; P = 0.001), previous neonatal death (OR = 5.4, CI = 1.8–16.2; P = 0.003), and poor sucking (OR = 30.5, CI = 10.0–93.1; P < 0.001) were predictors of CP.

Conclusions

Fever during labor is a significant risk factor for developing CP in children. Further efforts are required for labor management to prevent CP in this setting.