Infection in the Newborn as a Cause of Cerebral Palsy, 12/2004

It is becoming increasingly recognized that either maternal or fetal infection is a major element in the cause of Cerebral Palsy. This process may also affect the premature newborn as demonstrated by a recent study performed by Stoll and her colleagues at the NIH National Institute of Child Health and Human Development.1

The authors identified 6093 children born between 1993 and 2001 included in the data base of the Institute. These children weighed less than 1000 gm (a bit over 2 pounds), survived, and were available for study when they were between 18 and 22 months corrected gestational age. Children who had shunts placed in the ventricles of their brains to drain fluid or had major malformations of the brain were excluded. 

Nearly two of three children in their study acquired some type of infection during their newborn period. Over 40% of those with some sort of infection developed brain injury resulting in cerebral palsy, cognitive impairments, or both. For cerebral palsy alone, 16% of children who acquired any kind of infection in the post natal period developed cerebral palsy while only 8% of those without infection developed cerebral palsy. Children with infection in their blood (sepsis), infection associated bowel disease, and meningitis were especially at risk. The forms of Cerebral Palsy were not specified in this study. 

Comment:
This study is most interesting taken in the context of the present attention to the role of maternal and placental infection and inflammation on the occurrence of Cerebral Palsy. It shows that newborn children with acquired infections, not caused by infection of the mother or of the placenta, are also prone to develop Cerebral Palsy and cognitive defects. It is worth noting that the infection need not affect the brain directly. The chemicals (cytokines) released by the infant to fight infection may be the source of the injury. Adult neurologists may see an analogy between the white matter injury seen in these infants and those seen in multiple sclerosis where it is believed that the inflammatory process begins outside of the brain and is then carried into it in a number of possible ways.

1Stoll, B.J., et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA, Nov 17 2004; 292 (19):2357-2401

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