Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.
JAMA Pediatr. 2013 Jun;167(6):544-8. doi: 10.1001/jamapediatrics.2013.1379.
For the past 100 years, medicine in industrialized nations has become increasingly focused on specific medical interventions designed to improve the health of individual patients. Substantial evidence suggests that broader improvements in public health, nutrition, and economic well-being are more salient than medical or surgical interventions for the remarkable decrease in infant and child deaths since 1900. Less is known about the impact of specific medical interventions on morbidity such as intellectual disability (ID).
To explore the impact of medical interventions in early childhood on increasing the prevalence of later ID, as reported in the literature from 1950 through 2000.
We reviewed the medical literature and other data from 1950 through 2000 to construct estimates of the condition-specific prevalence of ID over time. We further explored the existing literature to document historically relevant influences on condition-specific prevalence, including the introduction of effective interventions, the timing of these introductions, and the likelihood of their widespread use.
Twentieth century United States and Western Europe.
Populations of children who received a life-saving intervention within the first 5 years of life and were evaluated for ID after 5 years of age.
Case-specific prevalence of ID from 1950 through 2000.
Low birth weight is associated with approximately 10% to 15% of the total prevalence of ID. No other new medical therapies introduced during this period were associated with a clinically significant increase in ID prevalence.
Previous research has shown that specific medical interventions, such as newborn screening for congenital thyroid deficiency and phenylketonuria, have decreased the prevalence of ID approximately 16% in the United States since 1950. These results suggest that other medical interventions, particularly the advent of intensive care technologies, have also increased the prevalence of ID.
在过去的 100 年里，工业化国家的医学越来越专注于特定的医疗干预措施，旨在改善个体患者的健康。大量证据表明，自 1900 年以来，公共卫生、营养和经济福祉的广泛改善对于婴儿和儿童死亡率的显著下降比医疗或手术干预更为重要。对于特定医疗干预措施对发病率（如智力障碍[ID]）的影响了解较少。
探讨 1950 年至 2000 年文献报道的儿童早期医疗干预对智力障碍发病率增加的影响。
我们回顾了 1950 年至 2000 年的医学文献和其他数据，以构建特定疾病随时间推移的 ID 患病率的估计值。我们进一步探索了现有文献，以记录对特定疾病的患病率有历史影响的因素，包括有效干预措施的引入、这些干预措施的引入时间以及它们广泛使用的可能性。
20 世纪的美国和西欧。
在生命的头 5 年内接受救命干预并在 5 岁后接受智力障碍评估的儿童人群。
1950 年至 2000 年特定疾病的 ID 患病率。
低出生体重与大约 10%至 15%的 ID 总患病率相关。在此期间引入的其他新医疗疗法与 ID 患病率的临床显著增加无关。
先前的研究表明，自 1950 年以来，美国特定的医疗干预措施，如新生儿先天性甲状腺功能减退症和苯丙酮尿症筛查，使 ID 患病率降低了约 16%。这些结果表明，其他医疗干预措施，特别是重症监护技术的出现，也增加了 ID 的患病率。
