Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Republic of Korea.
PLoS One. 2019 Jun 14;14(6):e0218320. doi: 10.1371/journal.pone.0218320. eCollection 2019.
The objective of this study was to identify growth parameters that can affect mortality of cerebral palsy (CP).
This was a birth cohort study based on the National Health Screening Program for Infants and Children database along with the National Health Insurance Service, which were linked using a personal identifier number. The birth cohort consisted of 2 191 956 subjects, representing 93.5% of live births from 2007-2011, with maximal 10-year follow-up (range, 5-10 years) until October 2016. Subjects with CP were identified. Growth parameters in terms of birth weight, underweight (weight-for-age below the 3rd percentile), rate of body weight gain were collected, along with all-cause mortality after the age of 1 year.
Prevalence of CP was 2.0 per 1000 live births (95% CI, 1.94-2.06). All-cause mortality after the age of 1 year was 0.09 deaths/1000 person-years (95% CI, 0.08-0.09) in the general population (GP) and 2.85 deaths/1000 person-years (95% CI, 2.32-3.50) in subjects with CP during the follow-up. Therefore, the incidence rate ratio for all-cause mortality was 32.15 (95% CI, 25.72-39.76) in subjects with CP compared to GP. Presence of underweight was significantly associated with higher mortality in both subjects with CP and GP, where the adjusted hazard ratio of death was 2.60 (95% CI, 1.93-3.50) at the age of 18-24 months, 3.12 at 30-36 months, 4.37 at 42-48 months, 5.12 at 54-60 months, and 4.17 at 66-71 months. Birth weight did not affect mortality in both subjects with CP and GP after the age of 1 year (p > 0.05).
While subjects with CP shows higher mortality, underweight is an important growth parameter that affects all-cause mortality of both subjects with CP and GP. This study urges increased awareness that subjects with CP who are underweight require special care.
本研究旨在确定影响脑瘫（CP）死亡率的生长参数。
这是一项基于国家婴儿和儿童健康筛查计划数据库以及国家健康保险服务的出生队列研究，使用个人识别号码将两者联系起来。该出生队列包括 2191956 名受试者，代表 2007-2011 年活产儿的 93.5%，随访时间最长为 10 年（范围为 5-10 年），截至 2016 年 10 月。确定了脑瘫患者。收集了出生体重、体重不足（体重-年龄低于第 3 百分位）和体重增加率等生长参数，以及 1 岁后所有原因的死亡率。
1 岁后所有原因的死亡率为 0.09 例/1000 人年（95%可信区间，0.08-0.09），普通人群（GP）为 0.09 例/1000 人年（95%可信区间，0.08-0.09），脑瘫患者为 2.85 例/1000 人年（95%可信区间，2.32-3.50）。因此，脑瘫患者的全因死亡率的发病率比为 32.15（95%可信区间，25.72-39.76）与 GP 相比。体重不足在脑瘫患者和 GP 中均与死亡率升高显著相关，调整后的死亡风险比为 18-24 个月时 2.60（95%可信区间，1.93-3.50），30-36 个月时 3.12，42-48 个月时 4.37，54-60 个月时 5.12，66-71 个月时 4.17。1 岁后，脑瘫患者的出生体重与全因死亡率无关（p>0.05）。
虽然脑瘫患者的死亡率较高，但体重不足是影响脑瘫患者和 GP 全因死亡率的重要生长参数。本研究提醒人们注意，体重不足的脑瘫患者需要特别护理。
