PubMed · 6918007
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S Senn. 1982-03-31. Statistics for nurses. 1. Are your data correct?. https://pubmed.ncbi.nlm.nih.gov/6918007/
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CONTEXT: Exposure to maternal or placental infection is related to risk of preterm birth and, in premature infants, of brain lesions predictive of cerebral palsy (CP). Few studies have investigated whether maternal infection is associated with risk of CP in children of normal birth weight. OBJECTIVE: To investigate maternal infection during the admission for delivery as a possible risk factor for CP in infants born weighing 2500 g or more. DESIGN: Population-based case-control study. SETTING: All hospitals in 4 northern California counties, 1983 through 1985. PARTICIPANTS: A total of 46 children with disabling spastic CP who had no recognized prenatal brain lesions and 378 randomly selected control children weighing 2500 g or more at birth and surviving to age 3 years. MAIN OUTCOME MEASURES: Disabling spastic CP and signs of neonatal morbidity. RESULTS: Maternal fever exceeding 38 degrees C in labor was associated with increased risk of unexplained CP (odds ratio [OR], 9.3; 95% confidence interval [CI], 2.7-31.0), as was a clinical diagnosis of chorioamnionitis. One or more indicators of maternal infection were present in 2.9% of control children, 22% of children with CP (OR, 9.3; 95% CI, 3.7-23.0), and 37% of those with the spastic quadriplegic subtype of CP (OR, 19.0; 95% CI, 6.5-56.0). Newborns exposed to maternal infection, both cases and controls, had 5-minute Apgar scores below 6 more often than those unexposed. Among children with CP, those born to infected women were more often hypotensive, needed intubation, had neonatal seizures, and received a clinical diagnosis of hypoxic-ischemic encephalopathy. CONCLUSION: Intrauterine exposure to maternal infection was associated with a marked increase in risk of CP in infants of normal birth weight. Maternal infection was also linked with low Apgar scores, other evidence of hypotension [corrected] and need for resuscitation, and neonatal seizures-signs commonly attributed to birth asphyxia.
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In developing countries, birth asphyxia is frequently associated with hypoxic ischaemic encephalopathy. This has been attributed to inadequate obstetric care but poor nutrition may also be important. This study determines the association between magnesium stores and hypoxic ischaemic encephalopathy. The level of red blood cell magnesium was measured on 572 women in labour and on selected offspring in a teaching hospital in South Africa. Fifty five of the 572 women delivered infants with hypoxic ischaemic encephalopathy and had significantly lower red blood cell magnesium levels (1.40 mmol/l) than controls. In the latter the levels varied somewhat with the mode of delivery, vertex births 1.76 mmol/l, Caesarean sections 1.67 mmol/l and vacuum extractions 1.61 mmol/l. Infants with hypoxic ischaemic encephalopathy had a significantly lower red blood cell magnesium level (1.39 mmol/l) than normal infants (1.61 mmol/l). Fifty four of 55 babies were black and from poor social circumstances and nutritional deficiency may be relevant. Maternal height, age and the duration of labour did not influence the chance of hypoxic ischaemic encephalopathy and affected infants were more likely than normal ones to be meconium stained (50%), to have a low Apgar score (58%) and to need endotracheal intubation at birth (54%). An intervention study in early pregnancy may determine magnesium's role in hypoxic ischaemic encephalopathy associated with asphyxia.