Temporal and demographic trends in cerebral palsy - Fact and fiction
Temporal and demographic trends in cerebral palsy - Fact and fiction
复制标题
DOI：
10.1067/mob.2003.204
复制
发表时间：
2003-03-01
影响因子：
9.8
通讯作者：
Hankins, GDV
中科院分区：
文献类型：
--
作者：
Clark, SL;Hankins, GDV
在过去的30年里，发达国家的脑瘫发病率并没有下降，尽管电子胎心监护的广泛使用和同期剖宫产率增加了5倍。然而，新生儿存活率在这几十年中有所改善。这些观察结果导致了一种假设，即早产儿、神经功能受损婴儿的存活率增加可能掩盖了由于使用电子监护和避免产时窒息而导致的足月儿脑瘫的实际减少。对医学文献的回顾，以及对美国足月和早产率的人口统计学分析，从四个方面驳斥了这一假设。首先，对足月儿脑瘫的患病率进行了单独分析，结果显示30年来没有变化。其次，脑性瘫痪的患病率在不发达国家与发达国家相同或更低;在前者，基于电子监测数据的紧急剖宫产的可用性有限或不存在。第三，低出生体重儿脑瘫患病率的增加和基于胎儿窘迫的剖宫产率的增加并不是同时发生的，前者比后者早十年。自20世纪80年代以来，新生儿存活率的提高与神经功能缺损率的稳定或下降有关，因此不能掩盖足月窒息减少的改善。最后，与因胎儿窘迫而剖宫产的婴儿数量相比，出生在最脆弱体重组的婴儿数量根本不足以对因胎儿窘迫而剖宫产的婴儿的结局产生任何影响，即使是最小的改善。除了在极少数情况下，脑瘫是一种发育事件，鉴于我们目前的技术状况，这是无法预防的。
The rate of cerebral palsy has not decreased in developed countries over the past 30 years, despite the widespread use of electronic fetal heart rate monitoring and a 5-fold increase in the cesarean delivery rate over the same period of time. However, neonatal survival has improved during these decades. These observations have lead to the hypothesis that increased survival of premature, neurologically impaired infants may have masked an actual reduction in cerebral palsy among term infants as a result of the use of electronic monitoring and the avoidance of intrapartum asphyxia. A review of the medical literature, as well as a demographic analysis of term and preterm birth rates in the United States, refutes this hypothesis on four grounds. First, cerebral palsy prevalence has been separately analyzed in term infants and shows no change over 30 years. Second, the prevalence of cerebral palsy is the same or lower in underdeveloped countries than in developed nations; in the former, the availability of emergency cesarean delivery based on electronic monitor data is limited or absent. Third, the increase in prevalence of cerebral palsy among low-birth-weight infants and the increase in cesarean sections based on presumed fetal distress were not simultaneous events-the former preceded the latter by a decade. Improved neonatal survival since the 1980s has been associated with a stable or decreasing rate of neurologic impairment and thus could not have obscured improvement from reduced term asphyxia. Finally, compared with the number of infants born by cesarean section for fetal distress, there are simply not enough infants born in the most vulnerable weight groups to make any impact on even a minimal improvement of outcome in the group delivered by cesarean section for presumed fetal distress. Except in rare instances, cerebral palsy is a developmental event that is unpreventable given our current state of technology.