Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke · 2001
[Cerebral palsy as indicator of quality of neonatal care].
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Meberg A, Broch H, Irgens L M
Аннотация
BACKGROUND: An investigation of the prevalence of cerebral palsy in relation to neonatal intensive care.
MATERIAL AND METHODS: Population based study in live-born children with birthweight > or = 500 g in the Norwegian county of Vestfold over the 25-year period 1970-94 (n = 58,448). Retrospective and prospective control of cases (cases with a postneonatal origin of cerebral palsy excluded) with a minimum follow-up to four years of age.
RESULTS: Cerebral palsy was diagnosed in 139 cases (2.4 per 1,000). The prevalence declined from 2.8 per 1,000 in the first five-year cohort born 1970-74, to 2.2 per 1,000 in children born in each of the three five-year cohorts born 1980-84, 1985-89, and 1990-94 (p = 0.24). The neonatal mortality rate declined significantly from 8.7 per 1,000 in the first to 2.8 per 1,000 in the last five-year cohort (p < 0.0001). The low birthweight (500-2,499 g) rate in live-born infants increased significantly in 1990-94 compared to 1985-89 (4.5% vs 3.9% respectively; p < 0.05). After a local ventilator treatment programme (operative from 1989) was established, transports of infants with severe respiratory distress syndrome to the regional hospital declined from 3 per 1,000 live-born infants to 1 per 1,000 (p < 0.0001).
INTERPRETATION: A decentralised neonatal intensive care programme can be developed, with substantial decline in neonatal mortality without a corresponding increase in cerebral palsy prevalence.
MATERIAL AND METHODS: Population based study in live-born children with birthweight > or = 500 g in the Norwegian county of Vestfold over the 25-year period 1970-94 (n = 58,448). Retrospective and prospective control of cases (cases with a postneonatal origin of cerebral palsy excluded) with a minimum follow-up to four years of age.
RESULTS: Cerebral palsy was diagnosed in 139 cases (2.4 per 1,000). The prevalence declined from 2.8 per 1,000 in the first five-year cohort born 1970-74, to 2.2 per 1,000 in children born in each of the three five-year cohorts born 1980-84, 1985-89, and 1990-94 (p = 0.24). The neonatal mortality rate declined significantly from 8.7 per 1,000 in the first to 2.8 per 1,000 in the last five-year cohort (p < 0.0001). The low birthweight (500-2,499 g) rate in live-born infants increased significantly in 1990-94 compared to 1985-89 (4.5% vs 3.9% respectively; p < 0.05). After a local ventilator treatment programme (operative from 1989) was established, transports of infants with severe respiratory distress syndrome to the regional hospital declined from 3 per 1,000 live-born infants to 1 per 1,000 (p < 0.0001).
INTERPRETATION: A decentralised neonatal intensive care programme can be developed, with substantial decline in neonatal mortality without a corresponding increase in cerebral palsy prevalence.