Prematurity is strongly linked to an increased risk of cerebral palsy (CP), a group of permanent movement disorders caused by abnormal brain development or damage to the developing brain. This connection arises primarily because the brains of preterm infants are particularly vulnerable to injury during critical stages of development.
**Why Prematurity Increases Cerebral Palsy Risk**
Babies born prematurely—before 37 weeks of gestation—have brains that are still developing rapidly and are more susceptible to various types of injury. One key vulnerability is to **periventricular leukomalacia (PVL)**, a form of white matter brain injury characterized by the death of small areas of brain tissue around the ventricles (fluid-filled spaces). PVL is strongly associated with prematurity and is a major cause of CP in preterm infants. The immature brain’s white matter, especially the pre-oligodendrocytes (cells responsible for forming myelin), is highly sensitive to hypoxic-ischemic injury (lack of oxygen and blood flow), which can occur due to complications common in preterm birth such as intracranial hemorrhage, infection, or respiratory distress[4][7].
**Brain Development and Functional Connectivity**
Research using advanced imaging techniques like resting-state functional MRI has shown that preterm infants, even those without obvious clinical problems, have altered brain network development compared to full-term infants. Although some preterm infants may show normal resting-state networks by term-equivalent age, subtle differences in brain connectivity and structure can persist and contribute to neurodevelopmental impairments including CP[1]. These findings suggest that prematurity can disrupt the normal maturation of brain networks critical for motor control and cognition.
**Clinical Evidence of Prematurity and CP**
Studies consistently find that the majority of infants diagnosed with CP are born prematurely. For example, a recent characterization of infants diagnosed with CP showed that all diagnosed cases in a given period were premature births[6]. This aligns with the understanding that prematurity-related brain injuries are a leading cause of CP.
**Additional Risk Factors in Prematurity**
Premature infants often face complications such as intracranial hemorrhage (bleeding in the brain), sepsis (infection), and hypoglycemia (low blood sugar), all of which can further impair brain development and increase the risk of CP[2]. Despite improvements in neonatal care that have increased survival rates of preterm infants to about 90%, the incidence of CP remains higher in this group compared to term infants.
**Quality of Life and Outcomes**
Interestingly, some studies suggest that children with CP born prematurely may have different clinical courses and quality of life outcomes compared to those born at term. One study found that children with CP born preterm had better quality of life scores than those born at term, possibly reflecting differences in the severity or type of brain injury and subsequent clinical management[2]. However, quality of life is influenced by many factors including socioeconomic status, access to rehabilitation, and family support.
**Screening and Early Detection**
Given the high risk of CP in preterm infants, early detection and intervention are critical. Standardized screening protocols for high-risk infants, particularly those born prematurely, help identify CP early, allowing for timely therapies that can improve motor function and developmental outcomes[6].
**Summary of the Medical Evidence**
– Prematurity is a major risk factor for cerebral palsy due to the vulnerability of the immature brain to hypoxic-ischemic injury and whit
