Platt Mary Jane, Cans Christine, Johnson Ann, Surman Geraldine, Topp Monica, Torrioli Maria Giulia, Krageloh-Mann Inge
Division of Public Health, Whelan Building, University of Liverpool, Liverpool L69 3GB, UK.
Lancet. 2007 Jan 6;369(9555):43-50. doi: 10.1016/S0140-6736(07)60030-0.
The risk of cerebral palsy, the commonest physical disability of children in western Europe, is higher in infants of very low birthweight (VLBW)--those born weighing less than 1500 g--and those from multiple pregnancies than in infants of normal birthweight. An increasing proportion of infants from both of these groups survive into childhood. This paper describes changes in the frequency and distribution of cerebral palsy by sex and neurological subtype in infants with a birthweight below 1000 g and 1000-1499 g in the period 1980-96.
A group of 16 European centres, Surveillance of Cerebral Palsy in Europe, agreed a standard definition of cerebral palsy and inclusion and exclusion criteria. Data for children with cerebral palsy born in the years 1980-96 were pooled. The data were analysed to describe the distribution and prevalence of cerebral palsy in VLBW infants. Prevalence trends were expressed as both per 1000 livebirths and per 1000 neonatal survivors.
There were 1575 VLBW infants born with cerebral palsy; 414 (26%) were of birthweight less than 1000 g and 317 (20%) were from multiple pregnancies. 1426 (94%) had spastic cerebral palsy, which was unilateral (hemiplegic) in 336 (24%). The birth prevalence fell from 60.6 (99%CI 37.8-91.4) per 1000 liveborn VLBW infants in 1980 to 39.5 (28.6-53.0) per 1000 VLBW infants in 1996. This decline was related to a reduction in the frequency of bilateral spastic cerebral palsy among infants of birthweight 1000-1499 g. The frequency of cerebral palsy was higher in male than female babies in the group of birthweight 1000-1499 g (61.0 [53.8-68..2] vs 49.5 [42.8-56.2] per 1000 livebirths; p=0.0025) but not in the group of birthweight below 1000 g.
These data from a large population base provide evidence that the prevalence of cerebral palsy in children of birthweight less than 1500 g has fallen, which has important implications for parents, health services, and society.
在西欧，脑瘫是儿童中最常见的身体残疾，极低出生体重（VLBW，即出生体重低于1500克）的婴儿以及多胞胎婴儿患脑瘫的风险高于正常出生体重的婴儿。这两类婴儿中越来越多的人存活至童年期。本文描述了1980 - 1996年间出生体重低于1000克和1000 - 1499克的婴儿中，脑瘫按性别和神经亚型划分的频率及分布变化。
欧洲脑瘫监测组织的16个欧洲中心商定了脑瘫的标准定义以及纳入和排除标准。汇总了1980 - 1996年出生的脑瘫儿童的数据。对这些数据进行分析，以描述极低出生体重婴儿中脑瘫的分布和患病率。患病率趋势以每1000例活产儿以及每1000例新生儿幸存者来表示。
共有1575例极低出生体重的脑瘫婴儿；其中414例（26%）出生体重低于1000克，317例（20%）为多胞胎。1426例（94%）患有痉挛性脑瘫，其中336例（24%）为单侧（偏瘫）痉挛性脑瘫。出生患病率从1980年每1000例极低出生体重活产儿中的60.6（99%可信区间37.8 - 91.4）降至1996年每1000例极低出生体重婴儿中的39.5（28.6 - 53.0）。这种下降与出生体重在1000 - 1499克的婴儿中双侧痉挛性脑瘫频率的降低有关。在出生体重1000 - 1499克的婴儿组中，男性婴儿的脑瘫频率高于女性婴儿（每1000例活产儿中分别为61.0 [53.8 - 68.2] 和49.5 [42.8 - 56.2]；p = 0.0025），但在出生体重低于1000克的婴儿组中并非如此。
这些来自大量人群的数据表明，出生体重低于1500克儿童的脑瘫患病率有所下降，这对家长、医疗服务机构和社会具有重要意义。
