Cerebral Palsy: Potential Neurological Complications

Preterm infants, particularly those with birth weights less than 1500g and/or gestational ages of less than 32 weeks, are at risk for delays or deficits in neurodevelopment. Aberrant neuromotor function observed in the first year of life may resolve with maturation (transient dystonias) or evolve into frank cerebral palsy. Cerebral palsy is most strongly associated with white matter injury occurring in very preterm infants who have sustained periventricular leukomalacia (PVL) and/or Grade IV intraventricular hemorrhage. Preterm infants with PVL constitute approximately 35-40% of children with cerebral palsy (Nickel, 2000). Children who do not develop cerebral palsy still may experience motor impairments which may not become evident until they become school age.

Neuromotor disturbances represent the most common hidden disability occurring in children of preterm birth. Additional risk factors for neuromotor dysfunction include: frequent episodes of apnea and bradycardia during the neonatal period; severe bronchopulmonary dsyplasia; and male gender. The former two factors may induce hypoxia of the brain tissues. Neurodevelopmental dysfunction is also positively associated with lower cognitive outcome. It is important for the clinician to be alert for signs/symptoms of neurosensory or neuromotor dysfunction, as timely intervention may improve outcome.

Bracewell, M., & Marlow, N. (2002). Patterns of motor disability in very preterm children. Mental Retardation and Developmental Disabilities Research Reviews, 8(4), 241-248.

Colvin, M., McGuire, W., and Fowlie, P.W. (2004). Neurodevelopmental outcomes after preterm birth. British Medical Journal, 329, 1390-1393.

Janvier, A., Khairy, M., Kokkotis, A., Cormier, C., Messmer, D., & Barrington, K. (2004). Apnea is associated with neurodevelopmental impairment in very low birth weight infants. Journal of Perinatology, 24(12), 763-768.

Nickel, R.E. (2000). Cerebral palsy. In R.E. Nickel & L.W. Desch (Eds.), The physician's guide to caring for children with disabilities and chronic conditions, (pp. 143). Baltimore, MD: Paul H. Brookes Publishing.

Perlman, J.M. (2001). Neurobehavioral deficits in premature graduates of intensive care: Potential medical and neonatal environmental risk factors. Pediatrics, 108(6), 1339-1346.