Hypoxic/ischemic and infectious events have cumulative effects on the risk of cerebral palsy in very-low-birth-weight preterm infants

Neonatology. 2014;106(3):209-15. doi: 10.1159/000362782. Epub 2014 Jul 5.


Background: Hypoxia/ischemia and inflammation are two major mechanisms for cerebral palsy (CP) in preterm infants.

Objective: To investigate whether hypoxia/ischemia- and infection-related events in the perinatal and neonatal periods had cumulative effects on CP risk in very-low-birth-weight (VLBW) premature infants.

Methods: From 1995 to 2005, 5,807 VLBW preterm infants admitted to Taiwan hospitals were enrolled. The cumulative effects of hypoxic/ischemic and infectious events during the perinatal and neonatal periods on CP risk at corrected age 24 months were analyzed.

Results: Of the 4,355 infants with 24-month follow-up, 457 (10.5%) had CP. The CP group had significantly higher incidences of hypoxia/ischemia-related events in the perinatal and neonatal periods, and sepsis in the neonatal period than the normal group. Three hypoxic/ischemic events, including birth cardiopulmonary resuscitation (OR 2.25; 95% CI 1.81-2.82), patent ductus arteriosus (PDA) ligation (2.94; 1.35-5.75) and chronic lung disease (3.14; 2.61-3.85) had the most significant contribution to CP. Relative to CP risk for infants with neither the three hypoxic/ischemic events nor sepsis, the CP odds increased 1.98-, 2.26- and 2.15-fold for infants with birth cardiopulmonary resuscitation, PDA ligation and chronic lung disease, respectively; while the combination with sepsis further increased the odds to 3.18-, 3.83- and 3.25-fold, respectively. Using the three hypoxic/ischemic events plus sepsis, CP rates were 10.0, 16.7, 26.7, 40.0 and 54.7% for infants with none, one, two, three and four events, respectively.

Conclusions: Hypoxic/ischemic and infectious events across the perinatal and neonatal periods exerted cumulative effects on CP risk in VLBW premature infants.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cerebral Palsy / congenital
  • Cerebral Palsy / epidemiology
  • Cerebral Palsy / etiology*
  • Ductus Arteriosus, Patent / complications
  • Ductus Arteriosus, Patent / epidemiology
  • Female
  • Gestational Age
  • Humans
  • Hypoxia / complications*
  • Hypoxia / congenital
  • Hypoxia / epidemiology
  • Infant, Newborn
  • Infant, Premature*
  • Infant, Premature, Diseases / epidemiology
  • Infant, Premature, Diseases / etiology
  • Infant, Very Low Birth Weight*
  • Infections / complications*
  • Infections / congenital
  • Infections / epidemiology
  • Ischemia / complications*
  • Ischemia / congenital
  • Ischemia / epidemiology
  • Lung Injury / complications
  • Lung Injury / epidemiology
  • Male
  • Risk Factors