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- 您请求的操作仅限于组中的用户:==流行病学和病因学==不幸的是,很难获得和澄清资源贫乏环境中残疾的流行率和发病率(Gladstone, 2010)。不仅儿童残疾的患病率在上升,脑瘫是最昂贵的慢性疾病之一,而且预期寿命也在提高,这增加了脑瘫的负担(Papavasiliou, 2009)。相比之下,在美国,大约有70万儿童患有脑瘫,每1000名新生儿中有2-5名。脑瘫是儿童时期最常见的运动障碍。脑瘫的病因是非常多样化和多因素的。病因有先天性、遗传性、炎症性、感染性、缺氧性、创伤性和代谢性。发育中的大脑损伤可能发生在产前、分娩或产后。多达75%-80%的病例是由于产前损伤,不到10%是由于严重的出生创伤或窒息。最重要的危险因素似乎是早产和低出生体重,脑瘫的风险随着胎龄和出生体重的降低而增加。来自世界各地的基于人群的研究报告,脑瘫的患病率估计从每1000名活产婴儿或特定年龄范围的儿童中1.5人到4人以上不等。 Recent advances in neonatal management and obstetric care have not shown a decline in the incidence of Cerebral Palsy. With a decline in infant mortality rate, there has actually been an increase in the incidence and severity of Cerebral Palsy. The incidence in premature babies is much higher than in term babies. Cerebral Palsy is more common among boys than among girls and more common among black children than among white children.
Most of the children identified with Cerebral Palsy have Spastic Cerebral Palsy (77, 4%). Over half of the children identified with Cerebral Palsy (58, 2%) can walk independently, 11, 3% walks using a handheld mobility device and 30, 6% has limited or no walking ability. Many children with Cerebral Palsy also do have at least one co-occurring condition (e.g. 41% Epilepsy).
The incidence of Cerebral Palsy has not declined despite the improved perinatal and obstetric care. Even at centres where optimal conditions exist for perinatal care and birth asphyxia is relatively uncommon, the incidence of Cerebral Palsy in term babies has remained the same. The overall prevalence worldwide has increased during the last decades because of increased survival rates. Here are some facts on the epidemiology of Cerebral Palsy: * The incidence is 2-2,5/1000 live births in Western Countries * The prevalence varies between 1-5/1000 babies in different countries. * There are no reliable statistics from Asian countries. * Some affected children do not survive * Aetiology Improved medical care has decreased the incidence of Cerebral Palsy among some children. Medical advances have also resulted in the survival of children who previously would have died at a young age. The type of cerebral palsy has also changed: * In the 60’s Athetoid / Dyskinetic Cerebral Palsy accounted for approximately 20% of children with Cerebral Palsy. * Today only 5 to 10% have this type, with Spastic Cerebral Palsy now accounting for 80-90% of children with Cerebral Palsy. * This decrease is mainly due to advances in the treatment of hyperbilirubinemia (Bilirubin is toxic to cells of the brain. If a baby has severe jaundice, there's a risk of bilirubin passing into the brain ie. acute bilirubin encephalopathy. Prompt treatment may prevent significant lasting damage)Mayo clinic [https://www.mayoclinic.org/diseases-conditions/infant-jaundice/symptoms-causes/syc-20373865 Infant jaundice] Available from: https://www.mayoclinic.org/diseases-conditions/infant-jaundice/symptoms-causes/syc-20373865 (last accessed 1.11.2019). * The increase of Spastic Cerebral Palsy is predominantly a result of higher survival rates for (very small premature) babies. * The most common cause of Cerebral Palsy is idiopathic which means that the cause of damage to the brain during pregnancy is not known.