Colver A F, Gibson M, Hey E N, Jarvis S N, Mackie P C, Richmond S
Northumbria Health Care Trust and University of Newcastle upon Tyne, Donald Court House, 13 Walker Terrace, Gateshead NE8 1EB, UK.
Arch Dis Child Fetal Neonatal Ed. 2000 Jul;83(1):F7-F12. doi: 10.1136/fn.83.1.f7.
To report epidemiological trends in cerebral palsy including analyses by severity.
Descriptive longitudinal study in north-east England. Every child with suspected cerebral palsy was examined by a developmental paediatrician to confirm the diagnosis. Severity of impact of disability was derived from a parent completed questionnaire already developed and validated for this purpose.
All children with cerebral palsy, not associated with any known postneonatal insult, born 1964-1993 to mothers resident at the time of birth in the study area.
Cerebral palsy rates by year, birth weight, and severity. Severity of 30% and above defines the more reliably ascertained cases; children who died before assessment at around 6 years of age are included in the most severe group (70% and above).
584 cases of cerebral palsy were ascertained, yielding a rate that rose from 1.68 per 1000 neonatal survivors during 1964-1968 to 2.45 during 1989-1993 (rise = 0.77; 95% confidence interval 0.2-1.3). For the more reliably ascertained cases there was a twofold increase in rate from 0.98 to 1.96 (rise = 0.98; 95% confidence interval 0.5-1.4). By birth weight, increases in rates were from 29.8 to 74.2 per 1000 neonatal survivors < 1500 g and from 3.9 to 11.5 for those 1500-2499 g. Newborns < 2500 g now contribute one half of all cases of cerebral palsy and just over half of the most severe cases, whereas in the first decade of this study they contributed one third of all cases and only one sixth of the most severe (chi(2) and chi(2) for trend p < 0.001).
The rate of cerebral palsy has risen in spite of falling perinatal and neonatal mortality rates, a rise that is even more pronounced when the mildest and least reliably ascertained are excluded. The effect of modern care seems to be that many babies < 2500 g who would have died in the perinatal period now survive with severe cerebral palsy. A global measure of severity should be included in registers of cerebral palsy to determine a minimum threshold for international comparisons of rates, and to monitor changes in the distribution of severity.
报告脑瘫的流行病学趋势，包括按严重程度进行分析。
在英格兰东北部进行的描述性纵向研究。每位疑似脑瘫的儿童均由发育儿科医生进行检查以确诊。残疾影响的严重程度源自一份已为此目的编制并验证的家长填写问卷。
1964年至1993年间出生于研究区域、其母亲在分娩时居住在此、且与任何已知的新生儿期后损伤无关的所有脑瘫儿童。
按年份、出生体重和严重程度划分的脑瘫发病率。严重程度达30%及以上定义为确诊更可靠的病例；在6岁左右评估前死亡的儿童被纳入最严重组（70%及以上）。
确诊584例脑瘫病例，发病率从1964 - 1968年每1000名新生儿幸存者中的1.68例升至1989 - 1993年的2.45例（上升0.77；95%置信区间0.2 - 1.3）。对于确诊更可靠的病例，发病率从0.98例翻倍至1.96例（上升0.98；95%置信区间0.5 - 1.4）。按出生体重划分，发病率的增幅为每1000名出生体重<1500g的新生儿幸存者从29.8例增至74.2例，出生体重在1500 - 2499g者从3.9例增至11.5例。出生体重<2500g的新生儿现在占所有脑瘫病例的一半，且占最严重病例的一半多一点，而在本研究的第一个十年中，他们占所有病例的三分之一，仅占最严重病例的六分之一（卡方检验及趋势卡方检验p<0.001）。
尽管围产期和新生儿死亡率下降，但脑瘫发病率仍有所上升，若排除最轻微和确诊最不可靠的病例，这种上升更为明显。现代医疗的影响似乎是，许多出生体重<2500g、原本会在围产期死亡的婴儿现在存活下来并患有严重脑瘫。脑瘫登记应纳入严重程度的总体衡量指标，以确定国际发病率比较的最低阈值，并监测严重程度分布的变化。
