Outlook for the low birthweight baby--then and now.

This study examines the prevalence of cerebral palsy (CP) in two north‐east Italian provinces, Padua and Rovigo (overall population 1 030 000). Six‐hundred and ten children with a diagnosis of CP (330 male, 280 female), born between 1965 and 1989, were studied. The prevalence of CP progressively increased from the 1960s to the mid‐1980s, and then decreased in the 5‐year period, 1985 to 1989. These quantitative changes were associated with qualitative ones. For example, the number of low‐birthweight (LBW) infants progressively increased, similar to results of epidemiological studies from other European countries. The clinical features of the types of CP in this study (hemiplegia, diplegia, ataxic diplegia, quadriplegia, pure ataxia, dyskinesia) generally correspond with those described in other studies. However, the prevalence of quadriplegia in this study is higher. The prevalence of types of CP related to preterm birth, such as diplegia, increased over the years, while those associated with term babies, such as dyskinesia, decreased. This study suggests that prenatal factors are associated with some types of CP, while in others, such as diplegia, quadriplegia, and dyskinesia, the perinatal factors are notable. Perinatal factors were associated with LBW children, while prenatal factors were greater for normal‐birthweight infants. The variation in the prevalence of CP over the years, with two peaks corresponding with the introduction of neonatal intensive care units in Padua and Rovigo, suggests that changes in neonatal care could influence the levels of CP, independent of the original presence of predisposing prenatal factors.

Section: Discussionsupporting

confidence: 83%

Prevalence of cerebral palsy in north‐east Italy from 1965 to 1989

Bottos

Granato

Allibrio

et al. 1999

“…Neonatal intensive care was introduced in Western Australia in 1969, perhaps some years later than in Sweden and the United Kingdom. Predictions were made that intensive-care management of LBW infants would increase the number of survivors, but also would increase the number who were handicapped (Drillien 1958, Davies 1976, Franco and Andrews 1977, Thompson and Reynolds 1977. This pessimistic prognosis for LBW infants seems to be undergoing revision in some countries (Steward and Reynolds 1974, Hagberg 1975a), but not in Western Australia or Eire (Cussen et al 1979), or recently in Sweden (Hagberg 1979).…”

Section: Incidence and Morbiditymentioning

confidence: 99%

Spastic Diplegia Among Children of Low and Normal Birthweight

Atkinson

Stanley

1983

SUMMARY Data from a population‐based Cerebral Palsy Register in Western Australia were analysed for children born between 1956 and 1975, and low birthweight (LBW) and normal birthweight (NBW) infants were compared. Control populations of similar birthweight to the cases were available from Western Australia live births. The incidence of spastic diplegia among LBW infants was higher than among those of NBW. The relative risk for LBW infants increased from 12‐ to 26‐fold between 1961 and 1975, and those who previously would have died were surviving to be more severely disabled, both physically and intellectually. For LBW infants the risk of spastic diplegia increased both with increasing maternal age and with birth order; for NBW infants birth order was of main importance. LBW singletons, NBW twins and those born in rural hospitals had increased risk of spastic diplegia. More antenatal problems were seen in the LBW group, whereas the NBW group had higher rates of perinatal problems. Thus the groups may differ aetiologically, the LBW group having a greater likelihood of being damaged in utero, whereas the NBW group may have become brain‐damaged as a result of traumatic deliveries. RÉSUMÉ Diplégie spastique chez les enfants de poids de naissance faible et normal Les données provenant d'un recueil d'informations sur l'IMC dans la population en Australie Occidentale et portant sur les enfants nés entre 1956 et 1965 ont permis de comparer des nourrissons à faible poids de naissance (LBW) et des nourrissons à poids de naissance normal (NBW). Un contrôle de population normale et de poids de naissance similaire a pu être effectuéà partir des données concernant les enfants nés vivants. L'incidence de la diplégie spastique dans le groupe LBW est apparue plus élevée que dans le groupe NBW. Le risque relatif pour le groupe LBW est passé de 12 à 26 fois entre 1961 et 1975 et les enfants qui seraient antérieurement morts ont survécu avec des infirmités plus graves tant physiques qu'intellectuelles. Dans le groupe LBW, le risque de diplégie spastique apparait accru avec avec l'âge de la mère et le rang de naissance. Dans le groupe NBW, I'ordre de naissance est apparu fondamental. Le risque de diplégie spastique parait plus élevé pour les enfants LBW nés seuls, les jumeaux NBW et les enfants nés en Hôpitaux ruraux. Les difficultés prénatales sont apparues plus fréquentes dans le groupe LBW. Les difficultés périnatales dans le groupe NBW. Les deux groupes different donc étiologiquement, le groupe LBW présentant une plus grande probabilité de lésions in utero, tandis qu'un traumatisme d'accouchement peut être le responsable d'une lésion cérébrale dans le groupe NBW. ZUSAMMENFASSUNG Spastische Diplegie bei Kindern mit geringem und normalem Geburtsgewicht Die Daten eines Cerebralparese‐Registers in West Australien wurde nach Kindern durchgesehen, die zwischen 1956 und 1975 geboren worden waren und es wurden die Kinder mit geringem Geburtsgewicht (GGW) mit den Kindern mit normalem Geburtsgewicht (NGW) verglichen. Kontrollkinder mit ent...

“…Advances in perinatal and neonatal care of the low-birthweight (LBW) infant have produced a diminution in their neonatal mortality rate (Davies 1976). As the neonatal mortality rate decreases, it is important to continue to improve the quality of the infants who survive.…”

Section: Introductionmentioning

confidence: 99%

Aberrations in Sucking Behavior of Low‐birthweight Infants

Cowett

Lipsitt

Vohr

et al. 1978

SUMMARY The purpose of this study was to determine (1) if infants of low birthweight who had been severely stressed during the perinatal‐neonatal period had aberrant sucking behavior in contrast to low‐birthweight infants who had been mildly stressed during the same period; (2) if the mildly‐stressed infants had patterns of sucking behavior similar to infants born at term without complications; and (3) if sucking behavior at the time of discharge from hospital would differentiate those infants who showed aberrant neurological findings at one year of age. Sucking behavior in 22 low‐birthweight infants (mean gestational age 31 weeks) was recorded during the week before discharge from hospital. The infants were divided into two groups on the basis of the severity of their clinical course: those infants with three or less clinical complications were assigned to the mildly‐stressed group; those with four or more clinical complications to the severely‐stressed group. The responses of these infants were compared with a group of 11 infants born at term who had no perinatal or neonatal difficulties. Sucking activity (nutritive and non‐nutritive) in the mildly‐stressed group was comparable to the sucking activity recorded for the normal, term infants. The severely‐stressed infants, however, generally showed significantly retarded patterns of sucking activity compared with both the mildly‐stressed group and the term infants. Seventeen of the low‐birthweight infants were seen at one year of age and 15 were judged to be neurologically normal. Neither sucking behavior nor the distinction between a mildly‐stressed and severely‐stressed neonatal course appeared to be related to neurological outcome at the one‐year follow‐up. RÉSUMÉ Perturbations du comportement de succion chez les nourrissons de faible poids de naissance Le but de cette étude était de déterminer (1) si les nourrissons de faible poids de naissance gravement perturbés durant la période péri et néo‐natale avaient un comportement de succion aberrant par comparaison avec des nourrissons de faible poids de naissance moins sévèrement perturbés durant la même période, (2) si les nourrissons faiblement agressés avaient des allures de comportement de succion semblables à celles de nourrissons nés à terme sans complications et (3) si le comportement de succion au moment de quitter l'hôpital différenciait les nourrissons présentant à l'âge d'un an des signes neurologiques anormaux. Le comportement de succion chez 22 nourrissons de faible poids de naissance (âge moyen de gestation: 31 semaines) a été noté durant la semaine précédant le départ de l'hôpital. Les nourrissons étaient classés en deux groupes sur la base de la gravité de leurs manifestations cliniques: les nourrissons avec trois complications cliniques ou moins étaient situés dans le groupe modérément perturbé; ceux avec quatre ou plus complications cliniques dans le groupe gravement perturbé. Les réponses de ces nourrissons ont été comparées à un groupe de 11 nourrissons nés à terme sans difficultés péri ou néo‐n...