The Role of the Intrauterine and Perinatal Environment in Cerebral Palsy

Abstract

Author Disclosure Drs Paneth, Korzeniewski, and Hong did not disclose any relationships relevant to this article. After completing this article, readers should be able to: 1. Discuss the prevalence of cerebral palsy (CP) in school-aged children. 2. Describe the role of neuroimaging in CP. 3. Describe the impact of ventilatory practices in low-birthweight infants on the risk of CP. 4. Delineate the role of infection and fetal inflammation in pregnancy in the development of CP. The special importance of CP to clinicians whose practices encompass pregnancy and the perinatal or neonatal period is that no other neurodevelopmental disorder bears as close a causal relationship to the hazards of intrauterine and perinatal life. Although the strength of that relationship has been exaggerated at times, especially in relation to obstetric trauma and birth asphyxia, there can be no serious doubt that adverse events in pregnancy and the perinatal period do occasionally damage the fetal or neonatal brain. A distinctive feature of brain damage produced between early gestation and infancy is destruction of cerebral white matter or extrapyramidal tracts, thereby producing a clinical syndrome in which disturbance of motor control is a prominent and probably a necessary feature. Depending on the nature and extent of the insult, the motor disorder may be predominantly spastic, dyskinetic, or ataxic and may involve all four limbs (quadriplegia), one side (hemiplegia), or be most prominent in the legs (diplegia). CP severe enough to be recognized as a disability is found in about 1 in 500 school-age children in most developed countries, with little variation between countries or over the past 30 years. (1) Because CP often is accompanied by other neurodevelopmental disabilities, particularly seizure disorders, varying degrees of mental retardation, blindness, or deafness, affected children constitute the single largest group of children in the population who have major disabilities. (2) More …