Preterm birth is strongly linked to an increased risk of cerebral palsy (CP), a group of permanent movement and posture disorders caused by non-progressive disturbances in the developing brain. This connection arises primarily because the brains of preterm infants are especially vulnerable to injury during critical periods of development, leading to neurological impairments such as CP.
**Why Preterm Birth Increases Cerebral Palsy Risk**
Preterm birth, defined as delivery before 37 weeks of gestation, exposes the infant’s brain to a range of insults that can disrupt normal development. The earlier the birth, the higher the risk. Extremely preterm infants (born before 28 weeks) face the greatest vulnerability due to the immaturity of their brain structures and blood vessels.
One key mechanism involves injury to the brain’s white matter, particularly a condition called periventricular leukomalacia (PVL). PVL is characterized by the death of small areas of brain tissue around the ventricles, which are fluid-filled spaces in the brain. This white matter damage disrupts the pathways that control movement and coordination, often resulting in CP[1][3].
**Role of Intraventricular Hemorrhage and White Matter Injury**
Intraventricular hemorrhage (IVH), bleeding into the brain’s ventricular system, is a common complication in preterm infants. Severe IVH can cause damage to the surrounding white matter, leading to immediate neurological problems and long-term developmental disabilities including CP[1]. The risk of IVH and subsequent white matter injury is higher in preterm infants due to fragile blood vessels and unstable blood flow regulation in the immature brain.
**Inflammation and the Placental-Fetal Brain Axis**
Another important factor linking preterm birth to CP is inflammation. The placenta plays a critical role in fetal brain development and immune regulation. Inflammatory responses triggered by infections or other prenatal exposures can alter the placental environment, leading to fetal neuroinflammation. This inflammation can cause structural and functional brain disruptions that increase the risk of CP and other neurodevelopmental disorders[2].
**Hemoglobin Levels and Brain Injury**
Recent research has shown that low hemoglobin levels and red blood cell counts in the first week after birth are associated with a higher risk of PVL and related brain injuries in preterm infants. These blood parameters may influence oxygen delivery to the brain, affecting its vulnerability to injury and subsequent development of CP[4].
**Neurodevelopmental Outcomes Beyond Motor Impairment**
Preterm infants who develop CP often face additional challenges such as cognitive impairments, behavioral difficulties, and sensory processing problems. For example, swallowing difficulties and oral sensory processing issues are more common in children born preterm, reflecting the broad impact of early brain injury beyond motor function alone[5].
**Early Detection and Intervention**
Because preterm infants are at high risk for CP, early detection is crucial. Standardized screening protocols in neonatal intensive care units (NICUs) help identify infants with early signs of CP, allowing timely intervention. Studies show that a significant proportion of infants diagnosed with CP in recent years were born prematurely, underscoring the importance of monitoring this population closely[6].
**Summary of Key Points**
– Preterm birth significantly increases the risk of cerebral palsy due to the vulnerability of the immature brain to injury.
– White matter injury, especially periventricular leukomalacia, is a primary brain lesion linked to CP in preterm infants.
– Intraventricular hemorrhage contributes to white matter damage and neurological impairment.
– Placental inflammation and fetal neuroinflammation play a critical role in brain injury leading to CP.
– Low hemoglobin levels in early life correlate with higher risk of brain injury in preterm infants.
– Preterm birth-related brain injury affects multiple neurodevelopmental domains beyond motor control.
– Early detection and intervention improve outcomes for preterm infants at risk of CP.
This extensive understanding of the relationship between preterm birth an
