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Chorioamnionitis and Cerebral Palsy in Term and Near-Term Infants
Yvonne W. Wu, MD, MPH;
Gabriel J. Escobar, MD;
Judith K. Grether, PhD;
Lisa A. Croen, PhD;
John D. Greene, MA;
Thomas B. Newman, MD, MPH
JAMA. 2003;290:2677-2684.
Context Half of all cases of cerebral palsy (CP) occur in term infants, for whom risk factors have not been clearly defined. Recent studies suggest a possible role of chorioamnionitis.
Objective To determine whether clinical chorioamnionitis increases the risk of CP in term and near-term infants.
Design, Setting, and Patients Case-control study nested within a cohort of 231 582 singleton infants born at 36 or more weeks' gestation between January 1, 1991, and December 31, 1998, in the Kaiser Permanente Medical Care Program, a managed care organization providing care for more than 3 million residents of northern California. Case patients were identified from electronic records and confirmed by chart review by a child neurologist, and comprised all children with moderate to severe spastic or dyskinetic CP not due to postnatal brain injury or developmental abnormalities (n = 109). Controls (n = 218) were randomly selected from the study population.
Main Outcome Measure Association between clinical chorioamnionitis and increased risk of CP in term and near-term infants.
Results Most CP cases had hemiparesis (40%) or quadriparesis (38%); 87% had been diagnosed by a neurologist and 83% had undergone neuroimaging. Chorioamnionitis, considered present if a treating physician made a diagnosis of chorioamnionitis or endometritis clinically, was noted in 14% of cases and 4% of controls (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.5-10.1; P = .001). Independent risk factors identified in multiple logistic regression included chorioamnionitis (OR, 4.1; 95% CI, 1.6-10.1), intrauterine growth restriction (OR, 4.0; 95% CI, 1.3-12.0), maternal black ethnicity (OR, 3.6; 95% CI, 1.4-9.3), maternal age older than 25 years (OR, 2.6; 95% CI, 1.3-5.2), and nulliparity (OR, 1.8; 95% CI, 1.0-3.0). The population-attributable fraction of chorioamnionitis for CP is 11%.
Conclusion Our data suggest that chorioamnionitis is an independent risk factor for CP among term and near-term infants.
Author Affiliations: Departments of Neurology (Dr Wu), Pediatrics (Drs Wu and Newman), and Epidemiology and Biostatistics (Dr Newman), University of California, San Francisco; Kaiser Permanente Division of Research, Oakland, Calif (Drs Escobar and Croen and Mr Greene); and California Department of Health Services, Sacramento (Dr Grether).
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