Kirby R S, Brewster M A, Canino C U, Pavin M
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA.
J Dev Behav Pediatr. 1995 Oct;16(5):318-26.
The prevalence of developmental disabilities in early childhood is not well documented. An established birth defects registry extended surveillance to identify cases of developmental disorders in early childhood by adding all known sources of diagnosis and service to case-finding methods. Residents of a northwest Arkansas region born during 1985 to 1987 and diagnosed with either a birth defect or a developmental disorder by the 4th birthday comprised the studied cohort. Case records were linked with death certificates to examine the influence of mortality on prevalence ratios. Prevalence ratios estimated were 64.5/1000 resident live births (60.9/1000 among survivors to age 4 years) for either birth defect or developmental disorder, 33.4/1000 for developmental disorder, 37.0/1000 for birth defect, and 9.5/1000 for both developmental disorder and birth defect. Prevalence ratios of specific developmental disorders and the role of mortality in decreasing population prevalence are reported. The most common diagnostic categories in this age group were developmental delay, seizures, and failure to thrive. Overlap of birth defect categories with a diagnosed developmental disability was examined; 68.8% of children diagnosed with neural tube defects and 45.5% of those with chromosomal abnormalities who survived to age 4 years had clinically diagnosed developmental disorders. An anticipated high degree of overlap (77%) for other central nervous system defects was found. For other birth defect categories, developmental disorder diagnosis was present in 20 to 30% of the study group. Death before age 4 years occurred most often when the diagnosis was newborn seizures (17.1%) or "conditions of the brain" (13.6%); the mortality rate was 6 to 8% for epilepsy or seizure disorders, mental retardation, and vision loss. The large number of developmental diagnoses among this cohort indicates that surveillance of these disorders in early childhood, even with tentative diagnoses, is feasible. Data obtained indicate that many birth defects are associated with developmental disorders; potentially, this association can contribute to earlier identification of developmental disorders in childhood.
幼儿发育障碍的患病率尚无充分记录。一个已建立的出生缺陷登记处扩大了监测范围，通过在病例查找方法中增加所有已知的诊断和服务来源，来识别幼儿发育障碍病例。阿肯色州西北部地区1985年至1987年出生、在4岁生日前被诊断患有出生缺陷或发育障碍的居民构成了研究队列。病例记录与死亡证明相联系，以检查死亡率对患病率的影响。估计出生缺陷或发育障碍的患病率为64.5/1000活产居民（4岁幸存者中为60.9/1000），发育障碍为33.4/1000，出生缺陷为37.0/1000，发育障碍和出生缺陷均有的为9.5/1000。报告了特定发育障碍的患病率以及死亡率在降低人群患病率中的作用。该年龄组最常见的诊断类别是发育迟缓、癫痫发作和发育不良。研究了出生缺陷类别与已诊断发育障碍的重叠情况；存活至4岁的被诊断患有神经管缺陷的儿童中有68.8%以及患有染色体异常的儿童中有45.5%有临床诊断的发育障碍。发现其他中枢神经系统缺陷预期有高度重叠（77%）。对于其他出生缺陷类别，研究组中有20%至30%被诊断为发育障碍。4岁前死亡最常发生在诊断为新生儿癫痫发作（17.1%）或“脑部疾病”（13.6%）时；癫痫或癫痫障碍、智力障碍和视力丧失的死亡率为6%至8%。该队列中大量的发育诊断表明，即使是初步诊断，对幼儿期这些疾病的监测也是可行的。获得的数据表明，许多出生缺陷与发育障碍有关；这种关联可能有助于更早地识别儿童期的发育障碍。
