Schendel Diana E, Schuchat Anne, Thorsen Poul
Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Ment Retard Dev Disabil Res Rev. 2002;8(1):39-45. doi: 10.1002/mrdd.10011.
Cerebral palsy is the most common neuromotor developmental disability of childhood, affecting as many as 8,000 to 12,000 children born in the U.S. each year (corresponding to a prevalence rate of between 2 and 3 per 1000 children). Recent improvements in neonatal care have not resulted in a decline in the overall prevalence of cerebral palsy and, in fact, greater numbers of very preterm/very low birth weight infants are surviving with cerebral palsy and other developmental problems. Infection in pregnancy may be an important cause of the disorder. In preterm infants, there appears to be about a 2-fold increased risk for cerebral palsy from chorioamnionitis, and in term infants the estimated increased risk is about 4-fold. Provisionally, chorioamnionitis might account for 12% of spastic cerebral palsy in term infants and 28% of cerebral palsy in preterm infants. Studies of biochemical markers of fetal inflammation typically associated with infection also suggest that an inflammatory response may be an important independent etiologic factor. If a substantial proportion of cerebral palsy is attributable to acute amnionitis infection and/or neonatal sepsis, cerebral palsy should have decreased in the United States after administration of intrapartum antibiotics became widespread in response to publication of public health consensus guidelines for Group B streptococcus in 1996. However, failure to detect declines could have a number of explanations and these explanations illustrate the many public health challenges related to intrauterine infection and cerebral palsy. Given the gaps in our current knowledge about intrauterine infection and cerebral palsy, public health recommendations for timely and specific prevention activities are limited at this time.
脑瘫是儿童期最常见的神经运动发育障碍，每年影响多达8000至12000名在美国出生的儿童（相当于每1000名儿童中有2至3名的患病率）。新生儿护理方面的近期改善并未导致脑瘫总体患病率下降，事实上，更多的极早产/极低出生体重儿存活下来，但伴有脑瘫和其他发育问题。孕期感染可能是该疾病的一个重要原因。在早产儿中，绒毛膜羊膜炎导致脑瘫的风险似乎增加了约2倍，而在足月儿中，估计增加的风险约为4倍。初步来看，绒毛膜羊膜炎可能占足月儿痉挛性脑瘫的12%，占早产儿脑瘫的28%。对通常与感染相关的胎儿炎症生化标志物的研究也表明，炎症反应可能是一个重要的独立病因因素。如果相当一部分脑瘫可归因于急性羊膜炎感染和/或新生儿败血症，那么在美国1996年针对B族链球菌发布公共卫生共识指南后，随着产时抗生素的广泛使用，脑瘫患病率应该会下降。然而，未能检测到下降可能有多种解释，这些解释说明了与宫内感染和脑瘫相关的众多公共卫生挑战。鉴于我们目前对宫内感染和脑瘫的认识存在差距，目前关于及时和具体预防措施的公共卫生建议有限。
