Prematurity is a significant factor associated with the development of cerebral palsy (CP), a group of permanent movement and posture disorders caused by non-progressive disturbances in the developing fetal or infant brain. The relationship between prematurity and cerebral palsy is complex and involves multiple biological mechanisms, including inflammation, brain injury, and disruptions in neurodevelopment.
**Prematurity and Increased Risk of Cerebral Palsy**
Babies born prematurely, especially those born extremely preterm (before 28 weeks of gestation), have a substantially higher risk of developing cerebral palsy compared to full-term infants. This increased risk is largely due to the vulnerability of the immature brain to injury during critical periods of development. The brain of a preterm infant is still undergoing rapid growth and differentiation, making it more susceptible to damage from various insults such as inflammation, hypoxia (lack of oxygen), and hemorrhage.
**Role of Inflammation and Placental Pathology**
One of the key contributors to brain injury in preterm infants is inflammation, often originating from the placenta and fetal environment. Histologic chorioamnionitis, an inflammation of the fetal membranes due to infection, is frequently observed in preterm births and is strongly linked to adverse neurodevelopmental outcomes, including cerebral palsy. This inflammatory condition triggers a cascade of immune responses that can cross the placental barrier, leading to fetal neuroinflammation and subsequent brain injury.
Research indicates that the placenta acts as a critical hub for immune signaling, and inflammatory responses here can disrupt the fetal brain’s structural and functional development. Such disruptions may manifest as cerebral palsy or other neurodevelopmental disorders later in life. For example, funisitis, an inflammation of the umbilical cord often associated with chorioamnionitis, has been shown to increase the risk of death or cerebral palsy in extremely preterm infants[1][2][4].
**Mechanisms of Brain Injury in Prematurity**
The immature brain of a preterm infant is particularly vulnerable to several types of injury that can lead to cerebral palsy:
– **Periventricular Leukomalacia (PVL):** This is a form of white matter brain injury characterized by the death of small areas of brain tissue around the ventricles. PVL is strongly associated with prematurity and is a common pathological finding in children with cerebral palsy.
– **Intraventricular Hemorrhage (IVH):** Bleeding into the brain’s ventricular system is more common in preterm infants due to fragile blood vessels. Severe IVH can cause brain damage leading to motor impairments.
– **Hypoxic-Ischemic Injury:** Preterm infants often experience episodes of reduced oxygen supply, which can cause widespread brain injury.
These injuries disrupt the normal development of motor pathways and brain structures responsible for movement and coordination, resulting in the clinical features of cerebral palsy[1][4].
**Additional Risk Factors Linked to Prematurity**
Besides inflammation and direct brain injury, other factors related to prematurity contribute to the risk of cerebral palsy:
– **Birth Trauma and Asphyxia:** Emergency deliveries and complications during birth, which are more common in preterm infants, can lead to oxygen deprivation and brain injury, increasing CP risk[3].
– **Neonatal Intensive Care Unit (NICU) Stays:** Prolonged NICU stays often reflect severe prematurity and associated complications, which correlate wit
