title: Chorioamnionitis and cerebral palsy: lessons from a patient registry.
abstract: OBJECTIVE
  The fetal neuroinflammatory response has been linked to the development of brain injury in newborns and subsequent neurologic impairment. We aimed to explore the maternal and child factors associated with histologic chorioamnionitis in cerebral palsy.
  
  
  METHODS
  We conducted an observational study on a cohort of children with cerebral palsy who were identified from the Quebec Cerebral Palsy Registry. Placental pathology was reported prospectively. Maternal and child factors associated with histological chorioamnionitis were explored.
  
  
  RESULTS
  Placental reports were available in 455 of 534 (85%) children with cerebral palsy, and of these 12% had histological signs of chorioamnionitis on reports. These children were more likely to have large placentas over 90th percentile for gestational age (53.7% versus 30.7%, p = 0.001) and were born significantly more prematurely (<32 weeks in 51.9% vs 24.1%, p = 0.007) than children without chorioamnionitis. A clinical sign of perinatal infection was reported in 61.1% of children with chorioamnionitis, however each clinical sign was seen in a minority of these children. Children with chorioamnionitis were more likely to have spastic diplegic cerebral palsy subtype (37% vs 19.2%, p = 0.003) and periventricular white matter injury on neuroimaging (52.9% vs 35.8%, p = 0.004). However no differences in neuroimaging or subtypes were seen when stratified by prematurity.
  
  
  CONCLUSIONS
  Histological chorioamnionitis was a frequent pathological finding in children with cerebral palsy born prematurely, with larger placentas relative to gestation and birth weight. Future case control studies are needed to shed light on the role of inflammatory placental findings in pregnancy outcomes.
authors.affiliation: Department of Neurology & Neurosurgery, McGill University, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: Shevell
authors.affiliation: Department of Pediatrics, McGill University, Canada.
authors.forename: Pia
authors.initials: P
authors.lastname: Wintermark
authors.affiliation: Department of Neurology & Neurosurgery, McGill University, Canada.
authors.forename: Ruba
authors.initials: R
authors.lastname: Benini
authors.affiliation: Department of Neurology & Neurosurgery, McGill University, Canada; Department of Pediatrics, McGill University, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Shevell
authors.affiliation: Department of Neurology & Neurosurgery, McGill University, Canada; Department of Pediatrics, McGill University, Canada. Electronic address: Maryam.oskoui@mcgill.ca.
authors.forename: Maryam
authors.initials: M
authors.lastname: Oskoui
mesh_terms: D000328:Adult; D001724:Birth Weight / Q000502:physiology; D002547:Cerebral Palsy / Q000453:epidemiology* / Q000473:pathology; D002821:Chorioamnionitis / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Cerebral palsy; Chorioamnionitis; Periventricular white matter injury; Placenta