Cerebral Palsy: Potential Neurological Complications
Preterm infants, particularly those with birth weights less than 1500g
and/or gestational ages of less than 32 weeks, are at risk for delays
or deficits in neurodevelopment. Aberrant neuromotor function observed
in the first year of life may resolve with maturation (transient dystonias)
or evolve into frank cerebral palsy. Cerebral palsy is most strongly associated
with white matter injury occurring in very preterm infants who have sustained
periventricular leukomalacia (PVL) and/or Grade IV intraventricular hemorrhage.
Preterm infants with PVL constitute approximately 35-40% of children with
cerebral palsy (Nickel, 2000). Children who do not develop cerebral palsy
still may experience motor impairments which may not become evident until
they become school age.
Neuromotor disturbances represent the most common hidden disability occurring
in children of preterm birth. Additional risk factors for neuromotor dysfunction
include: frequent episodes of apnea and bradycardia during the neonatal
period; severe bronchopulmonary dsyplasia; and male gender. The former
two factors may induce hypoxia of the brain tissues. Neurodevelopmental
dysfunction is also positively associated with lower cognitive outcome.
It is important for the clinician to be alert for signs/symptoms of neurosensory
or neuromotor dysfunction, as timely intervention may improve outcome.
Bracewell, M., & Marlow, N. (2002). Patterns of motor
disability in very preterm children. Mental Retardation and Developmental
Disabilities Research Reviews, 8(4), 241-248.
Colvin, M., McGuire, W., and Fowlie, P.W. (2004). Neurodevelopmental
outcomes after preterm birth. British Medical Journal, 329, 1390-1393.
Janvier, A., Khairy, M., Kokkotis, A., Cormier, C., Messmer,
D., & Barrington, K. (2004). Apnea is associated with neurodevelopmental
impairment in very low birth weight infants. Journal of Perinatology,
24(12), 763-768.
Nickel, R.E. (2000). Cerebral palsy. In R.E. Nickel &
L.W. Desch (Eds.), The physician's guide to caring for children with
disabilities and chronic conditions, (pp. 143). Baltimore, MD: Paul
H. Brookes Publishing.
Perlman, J.M. (2001). Neurobehavioral
deficits in premature graduates of intensive care: Potential medical and
neonatal environmental risk factors. Pediatrics, 108(6), 1339-1346.