Neurology: A case-control study of risk factors for periventricular white matter injury at term in children with cerebral palsy

Periventricular white matter injury (PVWMI) is a well-known form of acquired brain injury in preterm infants, peaking
between 23-32 weeks' gestation.
It is a white matter damage spectrum
consisting of diffuse reactive gliosis, microglial activation, and the most severe focal periventricular necrosis.
The main pathogenic factors of PVWMI in preterm infants include cerebral ischemia superimposed on developmental local vascular fragility and systemic infection/inflammation, whether maternal, fetal, or neonatal, occurring in the context of maturation-dependent susceptibility hypoxic injury of oligodendrocyte lineages, and thus exhibiting a careful nonlinear relationship
.
A study published in Neurology sought to identify possible risk factors
associated with imaging findings of cerebral palsy (CP) and periventricular white matter injury (PVWMI).

This is a case-control study limited to term infants with cerebral palsy and cases taken from the Canadian Registry of Cerebral Palsy (CCPR) and the Alberta
Pregnancy Outcomes and Nutrition (APRON) study.
The diagnosis
of PVWMI is carried out according to the expert classification of the MRI report.
Risk factor variables are pre-selected; These variables include pregnancy complications, antenatal toxin exposure, perinatal infection, sex, small-for-gestational age, and perinatal adversity (i.
e.
, neonatal encephalopathy based on intrapartum hypoxia-ischaemia).

We used multivariate analysis to calculate odds ratios (OR) and their 95% confidence intervals (CI).

A total of 160 cases (7.
06% of the registered sample) were compared
with 1950 controls.
Of the PVWMI participants born at term, 59.
4% were male, and 13.
5% were born
to mothers of very high maternal age.
Multivariate analysis of weight control showed that PVWMI was associated
with pregnancy complications (OR=3.
35; 95%CI=2.
23~4.
94), prenatal toxin exposure (OR=2.
45; 95%CI=1.
67~3.
55), perinatal infection (OR=3.
61; 95%CI=1.
96~6.
29), and perinatal adversity (OR=2.
03; 95%CI=1.
42~2.
94).
Men born at term were no more likely to suffer from PVWMI than women (OR=1.
37; 95%CI=0.
98~1.
93).

Multivariate regression analysis showed that PVWMI was independently associated
with pregnancy complications (OR=3.
75; 95%CI 2.
46~5.
62), prenatal toxin exposure (OR=2.
80; 95%CI 1.
88~4.
12), perinatal infection (OR=4.
62; 95%CI 2.
46~8.
42), and perinatal adverse reactions (OR=2.
49; 95%CI=1.
71~3.
69).

Risk factors such as pregnancy complications, prenatal toxin exposure, perinatal infection, and perinatal adversity are associated with PVWMI in term infants, suggesting that different interactions between antenatal and perinatal factors may contribute to this unrecognized CP phenotype
.

Source: Marefi A, Husein N, Dunbar M, et al.
Risk Factors for Term-Born Periventricular White Matter Injury in Children With Cerebral Palsy: A Case-Control Study [published online ahead of print, 2022 Aug 30].
Neurology.
2022; 10.
1212/WNL.
0000000000201274.
doi:10.
1212/WNL.
0000000000201274