Division of Neonatology, Department of Pediatrics, Chi Mei Medical Center, Tainan 71004, Taiwan.
Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan.
Int J Environ Res Public Health. 2021 Aug 26;18(17):8984. doi: 10.3390/ijerph18178984.
The aim of this long-term longitudinal study in Taiwan was to estimate and compare the prevalence of cerebral palsy (CP) and to identify the age of CP diagnosis of term-born and preterm children with different birthweights. Records of 1494 extremely low birth weight (ELBW, <1000 g), 3961 very low birth weight (VLBW, 1000-1499 g), 19,612 low birth weight (LBW, 1500-2499 g) preterm, and 100,268 matched term-born children were retrieved from Taiwan's National Health Insurance Research Database. According to a 12-year retrospective data review, the results showed the highest prevalence of CP in preterm ELBW children (147.3 cases per 1000 neonatal survivors), followed by preterm VLBW (97.2 cases), preterm LBW (27.7 cases), with the lowest prevalence in term-born children (2.5 cases). Regardless of the birthweight group, 90% of preterm children with CP were diagnosed by 4 years of age, but it was 7 years before 90% of term-born children with CP were diagnosed. After removing the children whose CP was caused by brain infections, injuries, or cerebrovascular accidents after 4 months of age, there were similar mean ages at the initial CP diagnosis (1.58-1.64 years of age) across birthweight groups born prematurely, but initial diagnosis occurred at an older age (2.41 years of age) in term-born children. The results indicate that birthweight is reversely correlated with the prevalence of CP in preterm children. Although the three preterm birthweight groups received different types of developmental follow-up programs after birth, it did not influence their age at the initial diagnosis of CP. Furthermore, we suggest that follow-up for at least 4 years after birth for preterm children, and 7 years for term-born children, is optimal for estimating CP prevalence. In order to identify and provide early intervention for term-born children with CP earlier, it is suggested that parents routinely fill out a self-reported motor developmental screening questionnaire and pediatricians conduct a motor developmental examination on term-born children at each time of scheduled vaccination injections.
本项在台湾进行的长期纵向研究旨在评估和比较脑瘫（CP）的流行率，并确定不同出生体重的足月和早产儿 CP 诊断的年龄。从台湾全民健康保险研究数据库中检索到 1494 例极低出生体重儿（ELBW，<1000g）、3961 例极低出生体重儿（VLBW，1000-1499g）、19612 例低出生体重儿（LBW，1500-2499g）早产儿和 100268 例匹配的足月出生儿的记录。根据一项为期 12 年的回顾性数据分析，结果显示早产儿 ELBW 患儿的 CP 患病率最高（每 1000 例新生儿幸存者中有 147.3 例），其次是早产儿 VLBW（97.2 例）、早产儿 LBW（27.7 例），而足月出生儿的 CP 患病率最低（2.5 例）。无论出生体重组如何，90%的 CP 早产儿在 4 岁之前得到诊断，但 90%的 CP 足月出生儿要在 7 岁之前才能得到诊断。去除 4 个月后因脑感染、损伤或脑血管意外导致 CP 的患儿后，早产儿各出生体重组的首次 CP 诊断的平均年龄（1.58-1.64 岁）相似，但足月出生儿的首次诊断年龄较大（2.41 岁）。结果表明，出生体重与早产儿 CP 的患病率呈负相关。尽管三组早产儿在出生后接受了不同类型的发育随访方案，但这并未影响他们首次 CP 诊断的年龄。此外，我们建议，对于早产儿，出生后至少随访 4 年，对于足月出生儿，随访 7 年，是估计 CP 患病率的最佳方案。为了更早地发现和为足月出生的 CP 患儿提供早期干预，建议家长定期填写自我报告的运动发育筛查问卷，儿医在每次计划接种疫苗时对足月出生儿进行运动发育检查。
