Miyazawa Tokuo, Itabashi Kazuo, Tamura Masanori, Suzuki Hideaki, Ikenoue Tsuyomu
Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.
Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan.
Acta Paediatr. 2020 Jun;109(6):1154-1161. doi: 10.1111/apa.14961. Epub 2019 Sep 9.
This study aimed to identify the clinical features of infants who were healthy at birth, but developed sudden unexpected collapse and were then diagnosed with cerebral palsy before 5 years of age.
We retrospectively analysed 1182 records from the no-fault Japan Obstetric Compensation System for Cerebral Palsy database up to 2016. This identified 45 subjects (3.8%) who were subsequently diagnosed with severe cerebral palsy due to sudden unexpected postnatal collapse (SUPC). They were all healthy at birth, based on the criteria of five-minute Apgar scores of seven or more, with normal umbilical cord blood gases and no need for neonatal resuscitation within five minutes of birth.
The median birth weight of the 45 subjects (26 males) was 2770 g (range 2006-3695 g). Of these, 10 developed SUPC during early skin-to-skin contact (SSC). Medical personnel were not present in all 10 cases: nine were being breastfed at the time and eight of the mothers did not notice their infant's abnormal condition until medical staff alerted them.
This national study of children with cerebral palsy who appeared healthy at birth found that unsupervised breastfeeding was a common factor in cases of SUPC during early SSC.
本研究旨在确定出生时健康，但出现意外猝死，随后在5岁前被诊断为脑瘫的婴儿的临床特征。
我们回顾性分析了截至2016年日本脑瘫无过错产科赔偿系统数据库中的1182份记录。这确定了45名受试者（3.8%），他们随后因出生后意外猝死（SUPC）被诊断为重度脑瘫。根据出生后5分钟阿氏评分7分或更高、脐血气正常且出生后5分钟内无需新生儿复苏的标准，他们出生时均健康。
45名受试者（26名男性）的中位出生体重为2770克（范围2006 - 3695克）。其中，10名在早期皮肤接触（SSC）期间发生了SUPC。这10例中均无医护人员在场：9例当时正在进行母乳喂养，8名母亲直到医护人员提醒才注意到婴儿的异常情况。
这项针对出生时看似健康的脑瘫患儿的全国性研究发现，在早期SSC期间，无人监管的母乳喂养是SUPC病例中的一个常见因素。
