Aetiology of severe handicapping conditions in early childhood.

The hypothesis that the incidence of major childhood handicap could be significantly reduced by an increase in the availability of intensive care facilities for newborn babies has been considered in an examination of possible aetiological factors in 128 young children with mental and/or neurological handicaps referred to the Armitstead Child Development Centre, Dundee, 1973-77. Thirty-three children suffered from primary mental retardation; adverse perinatal factors were possibly implicated in one case. Low birth weight was considered to be the primary aetiological factor in 23 of 73 children with cerebral palsy +/- mental retardation and in 13 with other adverse perinatal factors. Moderate or severe neonatal complications were reported for 37% but in 27% complications were likely to have resulted from existing brain damage or abnormality. Available evidence suggested that early embryonic origin of handicap was most likely in three-quarters of cases of primary mental retardation, and in one-third of cases of cerebral palsy. Severity of handicap in children with cerebral palsy was significantly increased in those whose handicaps had a prenatal origin. Of this selected group of handicapped children (cerebral palsy being over-represented), adverse perinatal factors may have caused or exacerbated existing brain damage in, at most, one-third.