The association between clinical chorioamnionitis and increased risk of cerebral palsy (CP) in term and near-term infants was determined in 109 children with CP not due to postnatal brain injury or developmental abnormalities compared to 218 controls, in a study at University of California, San Francisco, and Kaiser Permanente Division of Research, Oakland, CA. CP was a hemiparesis in 40% and quadriparesis in 38%. Neuroimaging had been obtained in 83%; focal infarct, white matter abnormalities, hypoxic-ischemic injury, and atrophy were the most common findings. Chorioamnionitis or endometritis had been diagnosed clinically in 14% of cases compared to 4% of controls (OR 3.8, CI 1.5-10.1; p=0.001). Independent risk factors for CP in addition to chorioamnionitis included maternal fever, prolonged rupture of membranes, intrauterine growth restriction, maternal black ethnicity, maternal age older than 25 years, and nulliparity. Other factors strongly associated with CP were a 5-minute Apgar score <7, birth asphyxia, and neonatal seizures. The population-attributable fraction of chorioamnionitis for CP is 11%, and for spastic quadriplegic CP, 27%. [1]
COMMENT. Clinical chorioamnionitis is independently associated with a 4-fold increased risk of CP in term infants. Chorioamnionitis may initiate or exacerbate brain injury from hypoxia-ischemia by leading to an elevation of inflammatory cytokines in the fetus. Prevention of perinatal inflammatory disorders may lower the incidence of CP in term infants.