Cerebral palsy and placental infection: a case-cohort study

Abstract

BackgroundThe association between cerebral palsy in very preterm infants and clinical, histopathologic and microbiological indicators of chorioamnionitis, including the identification of specific micro-organisms in the placenta, was evaluated in a case-cohort study.MethodsChildren with a diagnosis of cerebral palsy at five years of age were identified from amongst participants in a long-term follow-up program of preterm infants. The comparison group was a subcohort of infants randomly selected from all infants enrolled in the program. The placentas were examined histopathologically for chorioamnionitis and funisitis, and the chorioamnionic interface was aseptically swabbed and comprehensively cultured for aerobic and anaerobic bacteria, yeast and genital mycoplasmas. Associations between obstetric and demographic variables, indicators of chorioamnionitis and cerebral palsy status were examined by univariate analysis.ResultsEighty-two infants with cerebral palsy were compared with the subcohort of 207 infants. Threatened preterm labor was nearly twice as common among the cases as in the subcohort (p < 0.01). Recorded clinical choroamnionitis was similar in the two groups and there was no difference in histopathologic evidence of infection between the two groups. E. coli was cultured from the placenta in 6/30 (20%) of cases as compared with 4/85 (5%) of subcohort (p = 0.01). Group B Streptococcus was more frequent among the cases, but the difference was not statistically significant.ConclusionsThe association between E. coli in the chorioamnion and cerebral palsy in preterm infants identified in this study requires confirmation in larger multicenter studies which include microbiological study of placentas.

Lipopolysaccharide increases alveolar type II cell number in fetal mouse lungs through Toll-like receptor 4 and NF-κB

“…We have used E. coli LPS in our model of chorioamnionitis as a potent stimulator of the innate immune system, as gramnegative bacteria may comprise a significant percentage of intrauterine infections (27). In addition, the signaling pathways activated by LPS through TLR4 have been well studied.…”

Prevalence and pathogenesis of congenital anomalies in cerebral palsy

“…Intrauterine infection has been implicated as a pathogenic mechanism for CP 15 – 17. However, correlation between markers of intrauterine infection and CP should not be inferred as being causal.…”

Chorioamnionitis and brain damage in the preterm newborn

“…Escherichia coli in the chorioamnion and cerebral palsy in the preterm infant [41]. This study requires confirmation in larger multicenter studies.…”