Академический Документы
Профессиональный Документы
Культура Документы
Sarah Winter, MD*; Andrew Autry, PhD; Coleen Boyle, PhD; and Marshalyn Yeargin-Allsopp, MD
ABSTRACT. Objective. To determine trends in the
prevalence of congenital cerebral palsy (CP) over a 16year period for 1-year survivors using a large, population-based surveillance program.
Methods. We determined birth weight-specific trends
in the prevalence of CP in live birth and 1-year survivor
cohorts of children in a 5-county metropolitan Atlanta
area for the periods from 19751977, 19811985, and 1986
1991. We ascertained children with CP in metropolitan
Atlanta by record review as part of an ongoing developmental disability surveillance program conducted by the
Centers for Disease Control and Prevention and the
Georgia Department of Human Resources. A total of 110,
262, and 443 cases of congenital CP were identified for
the birth years 19751977, 19811985, and 1986 1991, respectively. Data were analyzed by birth weight, race,
subtypes of CP, and whether the CP existed as an isolated
disability or was accompanied by another disability.
Results. There was a modest increase in the overall
prevalence of congenital CP from 1.7 to 2.0 per 1000
1-year survivors during the period from 19751991. This
trend was primarily attributable to a slight increase in CP
in infants of normal birth weightCP rates in moderately low and very low birth weight infants did not show
consistent trends. There was an increase in the proportion of children who had CP and no other disabilities
that was most apparent in infants of normal birth weight
from 17% in 19751977 to 39% in 1986 1991. For children
weighing <1500 g, the proportion of children with spastic diplegic CP increased over time (7% of cases in 1975
1977, 36% in 19851988, and 32% in 1986 1991).
Conclusions. In the only ongoing population-based
study of CP in the United States, there has been a modest
increase in the prevalence of CP in 1-year survivors born
from 19751991. This increase however was seen only in
infant survivors of normal birth weight. No change was
seen in the trends in CP prevalence in low birth weight
and very low birth weight infant based on infant
survivors. Pediatrics 2002;110:1220 1225; cerebral palsy,
epidemiology, trends, prevalence, developmental disability.
ABBREVIATIONS. CP, cerebral palsy; CDC, Centers for Disease
Control and Prevention.
1220
Denominator Data
The number of births and infant deaths for the 5-county metropolitan Atlanta area for the periods of interest were obtained
from the Georgia Department of Human Resources. One-year
survivors, defined as born alive and surviving the first birthday in
the state of Georgia, for the 19811985 and 1986 1991 birth cohorts
were determined by subtracting the number of infant deaths from
the number of live births, stratified by race, gender, and birth
weight. For the 19751977 cohort, the number of 1-year survivors
was not available by birth weight. Therefore, linear regression
TABLE 1.
1986 1991
15002499
2500
Total
RESULTS
Overall, there was a modest increase in the prevalence of CP from 19751991, from 1.7 to 2.0 per 1000
1-year survivorsa similar trend was noted when
live births were used as the denominator (Table 1).
This suggestive trend was driven primarily by a
small increase in CP rates in normal birth weight
infants. Importantly, no change in the prevalence of
CP over time was found for infants survivors born
moderately low and very low birth weight, although
there was an upward trend in the lowest birth weight
category when live births was used as the denominator (Fig. 1).
Prevalence of CP in Live Births and Infant Survivors by Birth Weight: A Comparison Between 19751977, 19811985, and
Birth Weight
(Grams)
1500
Parameter
Birth Cohort
19751977*
19811985
19861991
Cochran-Armitage
Trend Test
P Value
27
65.2 (43.4, 93.5)
84
58.6 (47.0, 72.0)
144
59.5 (50.3, 69.6)
.377
.054
30
6.9 (4.6, 9.8)
70
7.6 (5.9, 9.6)
87
6.2 (5.0, 7.7)
.224
.297
53
0.9 (0.6, 1.2)
108
0.8 (0.7, 1.0)
212
1.1 (0.9, 1.2)
.047
.045
110
1.7 (1.4, 2.0)
262
1.9 (1.6, 2.1)
443
2.0 (1.9, 2.2)
.028
.024
ARTICLES
1221
Fig 1. Filled circles indicate 1500 g; filled triangles indicate 1500 2499 g; filled squares indicate 2500 g.
As shown in Table 2, the rates of CP were somewhat higher for whites than black infants in the low
birth weight categories, but the reverse higher
black rates compared with white ratesin the normal birth weight categories. However, the birth
weight/race-specific trends over the 16-year period
were similar for white and black infants.
For children weighing 1500 g at birth, 40% to
50% of CP occurred as an isolated disability; and this
pattern remained relatively constant over time. In
contrast, for children of normal birth weight, we
observed an increase in the proportion of children
with isolated CP over time, from 17% in 19751977 to
39% in 1986 1991 (Table 3).
The proportion of children with spastic diplegia
who were born weighing 1500 g increased from 7%
in 19751977 to 32% in 1986 1991 (Table 4). Spastic
quadriplegia was the predominant type of CP overall
in the majority of birth weight categories.
DISCUSSION
In our analysis of the only ongoing US CP surveillance program data, we found that the overall prevalence of CP in 1-year survivors increased from
19751991 by 18%. However, the increase was noted
only in infant survivors who weighed 2500 g or
more. Given that the magnitude of this change is
relatively small and may be attributable to methodologic issues, such as changes in diagnostic procedures over time or ascertainment issues, continued
monitoring of CP rates, especially into the 1990s, is
warranted.
Because 25% to 35% of children with CP are born
1222
.241
.062
.419
.236
.076
.180
.064
.124
.280
.416
.486
.201
.078
.187
.070
.145
42.0
39.2
7.8
5.1
1.0
1.2
1.7
2.6
63.8
58.2
8.0
5.2
1.0
1.2
1.7
2.6
Total
2500
15002499
53
91
45
42
121
89
219
222
45.7
32.0
8.5
6.7
0.75
1.1
1.5
2.5
74.7
50.2
8.8
6.9
0.75
1.1
1.5
2.5
39
45
36
34
55
51
130
130
30.0
27.9
7.1
5.8
0.9
0.9
1.4
2.1
70.4
60.9
7.7
6.2
0.9
0.9
1.5
2.2
White
Black
White
Black
White
Black
White
Black
1500
10
17
16
14
34
19
60
50
Live Birth
BasedPrevalence
Rates
19861991
19811985
19751977
Number of
Children
With CP*
CP Prevalence
Rate (per
1000 Infant
Survivors)
CP Prevalence
Rate (per
1000 Live
Births)
Number of
Children
With CP
CP Prevalence
Rate (per
1000 Infant
Survivors)
CP Prevalence
Rate (per
1000 Live
Births)
Number of
Children
With CP
CP Prevalence
Rate (per
1000 Infant
Survivors)
CP Prevalence
Rate (per
1000 Live
Births)
Infant
Survivor-Based
Prevalence
Rates
Cochran-Armitage Trend
Test P Value
Birth Cohort
Race
Birth
Weight
(Grams)
Prevalence of CP in Infant Survivors by Birth Weight and Race: A Comparison Between 19751977, 19811985, and 1986 1991
TABLE 2.
ARTICLES
1223
TABLE 3.
Prevalence of CP Prevalence as an Isolated Disability and With Other Disabilities: A Comparison Between 19751977, 1981
1985, and 1986 1991
Birth Weight
(Grams)
CP Type
Birth Cohort
19751977*
1500
2500
19861991
Number of Cases
Percent
Number of Cases
Percent
Number of Cases
Percent
11
16
8
22
9
44
41
59
27
73
17
83
39
45
31
39
34
74
46
54
45
55
31
69
73
71
39
48
83
129
51
49
45
55
39
61
Isolated CP
CP and other disability
Isolated CP
CP and other disability
Isolated CP
CP and other disability
15002499
19811985
TABLE 4.
1991
Difference in the Types of Spastic CP at Different Birth Weights: A Comparison Between 19751977, 19811985, and 1986
Birth Weight
(Grams)
1500
15002499
2500
Type of CP
Birth Cohort
19751977*
SD
SH
SQ
Nonspastic
Total
SD
SH
SQ
Nonspastic
Total
SD
SH
SQ
Nonspastic
Total
19811985
19861991
Number
of Cases
Percent
Number
of Cases
Percent
Number
of Cases
Percent
2
7
13
5
27
5
7
14
4
30
10
12
15
16
53
7
26
48
19
100
17
23
47
13
100
19
23
28
30
100
30
23
25
6
84
19
11
30
10
70
19
31
39
19
108
36
27
30
7
100
27
16
43
14
100
18
29
36
17
100
46
27
51
20
144
17
16
33
21
87
22
58
64
68
212
32
19
35
14
100
20
18
38
24
100
10
27
31
32
100
6.
7.
8.
9.
REFERENCES
1. Boyle CA, Yeargin-Allsopp M, Doernberg NS, Holmgreen P, Murphy
CC, Schendel DE. Prevalence of selected developmental disabilities in
children 310 years of age: the Metropolitan Atlanta Developmental
Disabilities Surveillance Program, 1991. MMWR CDC Surveill Summ.
1996;45:114
2. Cummins SK, Nelson KB, Grether JK, Velie EM. Cerebral palsy in four
northern California counties, births 1983 through 1985. J Pediatr. 1993;
123:230 237
3. Glenting P. Cerebral palsy in Eastern Denmark 19651974. I. Decreased
frequency of congenital cases. Cerebral Palsy Registry of Denmark
Report No. VII. Neuropediatrics. 1982;13:7276
4. Grether JK, Cummins SK, Nelson KB. The California Cerebral Palsy
Project. Paediatr Perinat Epidemiol. 1992;6:339 351
5. Hagberg B, Hagberg G, Olow I, van Wendt L. The changing panorama
1224
10.
11.
12.
13.
14.
15.
of cerebral palsy in Sweden. VII. Prevalence and origin in the birth year
period 198790. Acta Paediatr. 1996;85:954 960
Hagberg B, Hagberg G, Olow I. The changing panorama of cerebral
palsy in Sweden. VI. Prevalence and origin during the birth year period
19831986. Acta Paediatr. 1993;82:387393
Murphy CC, Yeargin-Allsopp M, Decoufle P, Drews CD. Prevalence of
cerebral palsy among ten-year-old children in metropolitan Atlanta,
1985 through 1987. J Pediatr. 1993;123:S13S20
Mutch L, Alberman E, Hagberg B, Kodama K, Perat MV. Cerebral palsy
epidemiology: where are we now and where are we going? [see comments]. Dev Med Child Neurol. 1992;34:547551
Pharoah PO, Cooke T, Rosenbloom I, Cooke RW. Trends in birth
prevalence of cerebral palsy. Arch Dis Child. 1987;62:379 384
Stanley FJ, Watson L. The cerebral palsies in Western Australia: trends,
1968 to 1981. Am J Obstet Gynecol. 1988;158:89 93
Stanley FJ, Watson L. Trends in perinatal mortality and cerebral palsy in
Western Australia, 1967 to 1985. BMJ. 1992;304:1658 1663
Yeargin-Allsopp M, Murphy CC, Oakley GP, Sikes RK. A multiplesource method for studying the prevalence of developmental disabilities in children: the Metropolitan Atlanta Developmental Disabilities
Study [published erratum appears in Pediatrics. 1992;90:1001; see comments]. Pediatrics. 1992;89:624 630
Stanley F, Blair E, Alberman E. Cerebral Palsies: Epidemiology and Causal
Pathways. 1st ed. London, United Kingdom: Mac Keith Press; 2000
Hagberg G, Olow I. The changing panorama of cerebral palsy in Sweden 1954 1970. II. Analysis of the various syndromes. Acta Paediatr
Scand. 1975;64:193200
Hagberg B, Hagberg G, Olow I, von Wendt L. The changing panorama
16.
17.
18.
19.
20.
of cerebral palsy in Sweden. V. The birth year period 1979 82. Acta
Paediatr Scand. 1989;78:283290
Bhushan V, Paneth N, Kiely JL. Impact of improved survival of very
low birth weight infants on recent secular trends in the prevalence of
cerebral palsy [see comments]. Pediatrics. 1993;91:1094 1100
OShea TM, Klinepeter KL, Goldstein DJ, Jackson BW, Dillard RG.
Survival and developmental disability in infants with birth weights of
501 to 800 grams, born between 1979 and 1994. Pediatrics. 1997;100:
982986
OShea TM, Preisser JS, Klinepeter KL, Dillard RG. Trends in mortality
and cerebral palsy in a geographically based cohort of very low birth
weight neonates born between 1982 to 1994. Pediatrics. 1998;101:642 647
Grether JK, Nelson KB. Possible decrease in prevalence of cerebral palsy
in premature infants [letter]. J Pediatr. 2000;136:133
Buehler JW, Kleinman JC, Hogue CJ, Strauss LT, Smith JC. Birth weight
21.
22.
23.
24.
25.
specific infant mortality, United States, 1960 and 1980. Public Health Rep.
1987;102:151161
Torfs CP, van den Berg B, Oechsli FW, Cummins S. Prenatal and
perinatal factors in the etiology of cerebral palsy. J Pediatr. 1990;116:
615 619
Haerer AF, Anderson DW, Schoenberg BS. Prevalence of cerebral palsy
in the biracial population of Copiah County, Mississippi. Dev Med Child
Neurol. 1984;26:195199
Agresti A. Categorical Data Analysis. New York, NY: John Wiley and
Sons, Inc; 1990
Hagberg B, Hagberg G, Beckung E, Uvebrant P. Changing panorama of
Cerebral palsy in Sweden. VIII. Prevalence and origin in the birth year
period 1991-94. Acta Paediatr. 2001;90:271277
Soll RF. Prophylactic synthetic surfactant for preventing morbidity and
mortality in preterm infants. Cochrane Database Syst Rev. 2000;2
Noted by JFL, MD
ARTICLES
1225
References
Citations
Subspecialty Collections
Reprints
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
/content/110/6/1220.full.html