主页 > 医学新闻 >
【medical-news】极低出生体重婴儿的脑瘫发病率下
Caroline Cassels
January 4, 2007 — The prevalence of cerebral palsy (CP) among very-low-birth-weight (VLBW) infants — those born weighing less than 1500 g — is declining, a new study suggests.
In the largest study of its kind to date, researchers at Liverpool University, in the United Kingdom, pooled data from 16 European CP registries and found a significant fall in the prevalence of CP in VLBW infants, from 60.6 per 1000 live births in 1980 to 39.5 per 1000 live births in 1996. Furthermore, this decline was attributed to a reduction in the bilateral subtype of CP.
"One of the big questions is whether the improved perinatal mortality of low-birth-weight babies comes at the expense of a greater risk of cerebral palsy. However, we have demonstrated a significant fall in the rates of cerebral palsy in these children, which suggests they now have a better chance of survival without severe neurological impairment," the study's principal investigator, Mary Jane Platt, MD, told Medscape.
The study is published in the January 6 issue of the Lancet.
Strength In Numbers
Collectively known as the Surveillance of Cerebral Palsy in Europe (SCPE), the network of CP registries was established in 1998 and has standardized definitions of CP as well as agreed definitions and descriptions of affected children.
While previous, smaller studies have suggested that CP may be declining in VLBW children, this study is the first with the statistical power to accurately detect prevalence trends.
"Although the numbers of very-low-birth-weight infants are increasing, there still aren't large numbers of these children, so it is difficult to look at CP trends in this population. The opportunity derived from 16 groups working together provided us with a large enough pool of [VLBW] children to determine whether there were any trends in terms of the prevalence of cerebral palsy over an extended period of time," said Dr. Platt
The study included children from 16 centers in 9 European countries born between 1980 and 1996 with known birth weight. To ensure accurate clinical assessment, affected children were at least 4 years old at the time of inclusion in the SCPE database.
Demographic characteristics of the mother and the sex, weight, and gestational age at birth of the child were recorded. In addition, information about whether the child was from a multiple pregnancy and the neurological subtype of CP, as well as measurements of each child's function, including IQ, ability to walk, vision, and hearing, were gathered.
Appropriate Care
A total of 7884 children with CP were born during the study period. Of these, 2103 had a birth weight of less than 1500 g or had a gestational age of less than 32 weeks at the time of birth and constituted the study population.
The investigators found that in all centers the proportion of VLBW children among live births increased. This increase was most pronounced in Sweden and the United Kingdom, where it increased from 0.5% in 1980 to almost 1% in 1996.
There was a significant fall in the prevalence of CP among VLBW babies over the study period. However, in children with birth weights of less than 1000 g, there was no significant change in the prevalence over the 17-year study period.
Furthermore, the authors report, rates of unilateral spastic CP were similar in children with birth weights of less than 1000 g and those between 1000 and 1499 g.
While the study was not designed to elucidate why CP rates are dropping in VLBW infants, Dr. Platt said the study results suggest that these children are receiving appropriate care.
"It is very difficult to attribute this decline to anything specific. For instance, we don't know what the rate of cerebral palsy is among children who are ventilated vs the rate in those who are not. However, the fact that the study shows rates of CP are declining gives us confidence that the care these babies are receiving is appropriate," said Dr. Platt.
Preventing Preterm Birth
In an accompanying editorial, Maureen Hack, MD, and Deanne Wilson Costello, MD, from Case Western Reserve University, in Cleveland, Ohio, write that while the decrease in CP revealed by the study is "encouraging," there is still a long way to go.
"Cerebral palsy is associated with major disabilities: in the SCPE study, 35.2% of the children with bilateral spastic cerebral palsy were unable to walk and 23.5% of children had severe mental retardation. Furthermore, both the SCPE study and data from the [United States] have recorded an increase in the number of live births of very low birth weight, which might lead to an increase in the number of children with cerebral palsy. Therefore, every effort needs to be invested in the prevention of preterm birth and its associated brain injury," they write.
Lancet. 2007;369:7-8, 43-50.
http://www.medscape.com/viewarticle/550303
阅读本文的人还阅读：
作者:admin@医学,生命科学 2011-03-26 17:14
医学,生命科学网