Premature babies, especially those born before 32 weeks of gestation, face a significantly higher risk of developing cerebral palsy (CP), a group of permanent movement disorders caused by brain injury or abnormal brain development. One critical factor contributing to this increased risk is the use of mechanical ventilation and related respiratory support interventions, which, if not carefully managed, can lead to ventilation errors that may exacerbate brain injury in these vulnerable infants.
Prematurity itself is a major risk factor for cerebral palsy. Research shows that premature infants account for approximately 33% to 50% of all cerebral palsy cases, with the highest risk observed in babies born before 28 weeks of pregnancy. In fact, up to 15% of babies born between 24 and 27 weeks develop CP. This elevated risk is linked to the underdevelopment of vital organs, including the lungs and brain, making these infants more susceptible to complications such as hypoxic-ischemic encephalopathy (HIE), respiratory distress syndrome (RDS), and brain injuries that can lead to CP[1].
Respiratory distress syndrome is common in premature infants due to a deficiency or inactivation of pulmonary surfactant, a substance that helps keep the lungs inflated. This condition often necessitates respiratory support, including mechanical ventilation, to maintain adequate oxygenation and lung function. However, mechanical ventilation, while lifesaving, carries risks. Improper ventilation settings or prolonged ventilation can cause lung injury, inflammation, and fluctuations in blood oxygen and carbon dioxide levels, which may contribute to brain injury and increase the risk of cerebral palsy[2].
Ventilation errors can lead to episodes of hypoxia (low oxygen) or hyperoxia (excess oxygen), both of which are harmful to the developing brain. Additionally, fluctuations in carbon dioxide levels can affect cerebral blood flow, potentially causing periventricular leukomalacia (PVL), a type of white matter brain injury strongly associated with CP in preterm infants. PVL often occurs in babies born between 24 and 32 weeks gestation and is linked to impaired neurodevelopmental outcomes[5].
To mitigate these risks, neonatal care teams employ strategies such as careful monitoring of ventilator settings, use of less invasive ventilation techniques, and administration of surfactant therapy to improve lung function. Moreover, therapeutic hypothermia (brain cooling) has emerged as a standard treatment for neonates with moderate-to-severe hypoxic-ischemic encephalopathy, showing promise in reducing death and severe neurodevelopmental disability, including cerebral palsy, by protecting the brain from further injury after oxygen deprivation events[3].
Premature infants with low birth weight (less than 2,500 grams) often experience respiratory complications like bronchopulmonary dysplasia (BPD), which is associated with an increased risk of cerebral palsy and growth failure. The interplay between lung disease, ventilation management, and brain injury underscores the complexity of care required to minimize CP risk in these infants[2].
In pregnancies involving multiples, such as twins, the risk of preterm birth and associated complications rises, further increasing the likelihood of cerebral palsy due to factors like intrauterine growth restriction and prolonged labor, which can cause oxygen deprivation. Prompt and skilled medical intervention during and after birth is crucial to prevent brain injury in these high-risk infants[1].
Ongoing research and clinical advancements aim to improve outcomes for premature babies by refining ventilation techniques, enhancing neonatal resuscitatio
