Infection, inflammation, and neurologic injury in the preterm neonate

In the United States, there are 100,000 children under the age of 18 years living with cerebral palsy. Prematurity is one of the most important risk factors for cerebral palsy. Babies that weigh less than 1500 g at birth account for 1% to 2% of all live births; however, they account for 50% of cases of cerebral palsy. In this article we review the definition and epidemiology of cerebral palsy, discuss a mechanistic framework of cerebral palsy causation in the preterm neonate, and address the etiologic role of antenatal infection and inflammation in neonatal neurologic injury. The traditional view of cerebral palsy is that it is a consequence of intrapartum or labor-related events. Recently, evidence has accumulated suggesting that more than 75% of cases of cerebral palsy are related to processes occurring in the antenatal period remote from delivery. Intrauterine infection and inflammation are mechanistically associated with preterm birth, intraventricular hemorrhage, periventricular leukomalacia, and cerebral palsy.