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New concepts in cerebral palsy
New concepts in cerebral palsy
Epidemiology of SIDS
The incidence of cerebral palsy (CP) in the United States has been increasing, and at least part of this increase is attributable to extremely low birth weight infants. Quality studies of CP have been difficult to perform because of the inconsistency of diagnosis for various subtypes. This inconsistency spills over to practitioners as well, who may have difficulty in assigning meaningful, reproducible diagnoses to their patients. An attempt at standardization is reported in this issue of The Journal. The Extremely Low Gestational Age Newborns (ELGAN) study has developed a classification algorithm, the use of which is aided by a CD-ROM training video which describes a standardized neurologic examination. Using this tool, the group found an incidence of CP of 11% among a group of 2-year-old infants born between 23 and 27 weeks gestation. Not surprisingly, the group of children with quadripesis tended to have the most comorbidities and the greatest functional impairment. The real contribution of this study, however, is the demonstration that a standardized examination and algorithm can be used successfully in a multi-center study of this important and complex disorder. This importance is further stressed in an accompanying editorial by Accardo et al. On the spectrum of CP, children with hemiplegic involvement (HCP) generally fall on the milder end. In particular, they are more likely to complete mainstream school. Another study in this issue, by Russo et al, examined a variety of measures of quality of life in a number of children with HCP. Despite their milder involvement, these children display reductions in quality of life and self concept in comparison to typically developing peers. The impact of CP on the lives of our children and their families occurs throughout the wide range of the disease.
The “Back to Sleep” campaign has been remarkably effective at decreasing the incidence of SIDS in the United States, similar to educational programs worldwide. Chang et al report a decrease in SIDS from 1.38 for 1989 to 0.31 per 1000 live births in 2004 in California. This striking decrease in SIDS is compared with the more modest decline in overall infant mortality. The main point of the study by Chang et al is that some of the associations with SIDS have changed as the rate of SIDS has decreased. The peak age of death shifted from 2 to 3 months, seasonal variation was less evident, and the occurrence of SIDS over weekends decreased relative to weekdays. Although subtle, these changes in the epidemiology may guide new strategies to further decrease SIDS.
—Alan H. Jobe, MD, PhD page 498
—Thomas R. Welch, MD page 466 (Kuban) page 451 (editorial) page 473 (Russo)
The Journal of Pediatrics
October 2008
A3
Epidemiology of SIDS
The incidence of cerebral palsy (CP) in the United States has been increasing, and at least part of this increase is attributable to extremely low birth weight infants. Quality studies of CP have been difficult to perform because of the inconsistency of diagnosis for various subtypes. This inconsistency spills over to practitioners as well, who may have difficulty in assigning meaningful, reproducible diagnoses to their patients. An attempt at standardization is reported in this issue of The Journal. The Extremely Low Gestational Age Newborns (ELGAN) study has developed a classification algorithm, the use of which is aided by a CD-ROM training video which describes a standardized neurologic examination. Using this tool, the group found an incidence of CP of 11% among a group of 2-year-old infants born between 23 and 27 weeks gestation. Not surprisingly, the group of children with quadripesis tended to have the most comorbidities and the greatest functional impairment. The real contribution of this study, however, is the demonstration that a standardized examination and algorithm can be used successfully in a multi-center study of this important and complex disorder. This importance is further stressed in an accompanying editorial by Accardo et al. On the spectrum of CP, children with hemiplegic involvement (HCP) generally fall on the milder end. In particular, they are more likely to complete mainstream school. Another study in this issue, by Russo et al, examined a variety of measures of quality of life in a number of children with HCP. Despite their milder involvement, these children display reductions in quality of life and self concept in comparison to typically developing peers. The impact of CP on the lives of our children and their families occurs throughout the wide range of the disease.
The “Back to Sleep” campaign has been remarkably effective at decreasing the incidence of SIDS in the United States, similar to educational programs worldwide. Chang et al report a decrease in SIDS from 1.38 for 1989 to 0.31 per 1000 live births in 2004 in California. This striking decrease in SIDS is compared with the more modest decline in overall infant mortality. The main point of the study by Chang et al is that some of the associations with SIDS have changed as the rate of SIDS has decreased. The peak age of death shifted from 2 to 3 months, seasonal variation was less evident, and the occurrence of SIDS over weekends decreased relative to weekdays. Although subtle, these changes in the epidemiology may guide new strategies to further decrease SIDS.
—Alan H. Jobe, MD, PhD page 498
—Thomas R. Welch, MD page 466 (Kuban) page 451 (editorial) page 473 (Russo)
The Journal of Pediatrics
October 2008
A3