Maternal Infection and Cerebral Palsy in Infants of Normal Birth Weight
ABSTRACT & COMMENTARY
Synopsis: Normal birth weight infants who developed cerebral palsy often had perinatal infections.
Source: Grether JK, Nelson KB. Maternal infection and cerebral palsy in infants of normal birth weight. JAMA 1997;278:207-211.
Grether and nelson from the california Birth Defects monitoring Program and the National Institute of Neurological Disorders and Stroke reviewed the records of infants from four San Francisco Bay counties with moderate or severe cerebral palsy (CP) diagnosed in the first three years of life.
In this study population of 155,636 infants born between 1983 and 1986 who had survived for at least three years, they found 192 with moderate or severe congenital CP. Ninety-seven (0.67/1000) were singletons born weighing more than 2500 g. Children with CP without spasticity were excluded. Also excluded were 36 children with conditions that might have produced CP outside of the intrapartum period (brain malformations, prenatal destructive brain lesions, neonatal infections, etc.). This left 46 infants who were singletons and weighed 2500 g or more at birth for analysis. As matched controls, they studied 378 children who had similar case criteria except for not having CP.
Pregnancy records were reviewed for evidence of maternal intrapartum infection including fever higher than 38°C during labor, a clinical or histologic diagnosis of chorioamnionitis, foul amniotic fluid, maternal sepsis, or urinary tract infection. Grether and Nelson did not include bacteriologic studies, WBC in mothers or infants, or the use of antibiotics.
Maternal fever and chorioamnionitis were associated with a markedly increased risk of CP, and one or more indicators of maternal infection were found in 22% of CP children, compared to only 2.9% of controls. Newborns born of mothers with indications of intrapartum infections, both CP and controls, had Apgar scores of less than 5 more often than infants not so exposed. In infants with CP born to infected mothers, low Apgar scores, hypotension, need for intubation, and neonatal seizures were more common than in infants with CP whose mothers were not infected.
COMMENT BY RICHARD EHRENKRANZ, MD
Although low birth weight, premature infants are at greater risk of developing CP than infants of normal birth weight, more than 50% of cases of CP occur in infants of normal birth weight, who constitute more than 90% of all births. The etiology of many cases of CP is unknown, and the hypothesis that neonatal asphyxia is a cause of many cases has not been sustained.
On the basis of their careful study, Grether and Nelson conclude that intrapartum exposure to maternal infection is associated with a marked increase in the risk of CP in infants of normal birth weight. This extends earlier observations that maternal or placental infections increase the risk of CP in premature, low birth weight infants.1 This interesting study further delineates one possible etiology of CP. It is especially important because it is possible that increased vigilance for maternal intrapartum infections, combined with early therapeutic interventions, could prevent some of these disasters. However, the cause or causes of many cases of CP, particularly those occurring unexpectedly in term infants, remain obscure.
Reference
1. Murphy DJ, et al. Case-control study of antenatal and intrapartum risk factors for cerebral palsy in very preterm singleton babies. Lancet 1995;346:1449-1454.
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