Advances in Understanding Cerebral Palsy Syndromes After Prematurity Lubov Romantseva, MD,* Michael E. Msall, MD* Author Disclosure Drs Romantseva and Msall did not disclose any financial relationships relevant to this article. Objectives After completing this article, readers should be able to: 1. List neonatal morbidities that have been associated with the development of cerebral palsy (CP). 2. Describe the ultrasonographic findings that are suggestive of CP. 3. Compare and contrast the use of ultrasonography and magnetic resonance imaging in detecting lesions associated with CP. 4. Review strategies to adapt the infant neurologic examination to detection of CP. 5. Explain how the International Classification of Functioning can be used to examine risk and resiliency factors with respect to outcome. 6. Describe the severity of most cases of CP. Introduction During the past 25 years, major advances in maternal-fetal medicine, neonatology, and translational developmental biology have resulted in survival rates exceeding 90% among infants born at weights between 1,000 and 1,499 g, 80% for infants born at weights between 751 and 999 g, and 60% for infants born weighing 500 to 750 g. (1) These birthweight categories approximately reflect appropriate weights for 28 to 32 weeks’, 26 to 27 weeks’, and 23 to 25 weeks’ gestation, respectively. Although survival has improved among these very and extremely preterm infants, prevention of adverse neurodevelopmen- tal outcomes in early childhood among such high-risk survivors as well as other neonatal cohorts receiving new technologies remains a major challenge. (2) The most common early recognized neurodevelopmental impairment is cerebral palsy (CP), and the overall prevalence of this disorder has not decreased over the past 25 years. However, with recent discoveries in brain structure and function, immunology, nutrition, early childhood learning, and developmental plasticity, the future holds promise. The purpose of this review is to describe risk factors for CP in preterm infants, focusing predominantly on extremely low-birthweight (ELBW) and very low-birthweight infants, but also highlighting gaps in the current knowledge of outcomes among moderately low-birthweight infants. Recent data from multicenter studies emphasize the complex pathways to the CP syndromes in infants born very and extremely preterm. We use as a framework the International Classification of Functioning (ICF) model, which describes a child’s health and well-being via four components: 1) body structures, 2) body functions, 3) activities, and 4) participation. (3) We illustrate the ICF model for children who have diplegic, hemiplegic, triplegic, and quadriplegic CP after prematurity. We also illustrate the value of early motor milestones, sequential neurodevelopmental evaluation at key ages, and a classification system at age 2 years to optimize habilitative strategies in the preschool years. It is critically important to understand causal pathways, the spectrum of developmental functioning, and family supports to devise prevention strategies for future vulnerable populations of preterm infants receiving new technologies. Current epidemiology evidence suggests that approximately 1 in 3 children who have CP were born at either 28 to 31 weeks or 32 to 36 weeks gestational age. (4)(5)(6)(7)(8)(9) In the United States, with its currently scarce CP resources, groups considered at low-risk for neonatal follow-up surveillance contribute a large number of cases of CP. From a population impact, understanding pathways of the CP syndromes in *University of Chicago Pritzker School of Medicine, Comer Children’s and LaRabida Children’s Hospitals, Section of Developmental and Behavioral Pediatrics, Kennedy Center, and Institute of Molecular Pediatrics, Chicago Ill. Article development NeoReviews Vol.7 No.11 November 2006 e575 by guest on December 7, 2015 http://neoreviews.aappublications.org/ Downloaded from