I. Olow

The changing panorama of cerebral palsy in Sweden. IV. Epidemiological trends 1959-78.

From a population‐based series of 773 patients with cerebral palsy (CP) born in 1959–78, an analysis was made of the epidemiological trends over this period of 20 years, divided into five 4‐year periods with emphasis on the last two. After a significantly decreasing incidence of CP in the first three periods (1959–70) from 1.9 to 1.4 per thousand, there was a significant increase in the last two periods, reaching 2.0 per thousand in the period 1975–78. Both the decreasing trend in the earlier periods and the increasing trend in the more recent ones were mainly referrable to spastic/ataxic diplegia in preterm CP, and to dyskinetic syndromes in CP infants born at term. With respect to pathogenesis, the corresponding changes in CP incidence were mainly accounted for by the group with potential perinatal risk factors. When analysed on the basis of surviving babies in birth‐weight‐specific groups, the incidence of CP in 1971–78 was found to have increased in all groups, but this was only statistically significant in the low birth weight group of 2 000–2 500 g. Changing trends in incidences ran parallel with a steadily progressive decline in perinatal mortality through all five periods. A considerable and cumulative net gain of surviving non‐CP children was continuously achieved; this was also true for 1970–78, in spite of an increasing CP morbidity during these last two 4‐year periods.

The changing panorama of cerebral palsy in Sweden. VI. Prevalence and origin during the birth year period 1983-1986.

The prevalence and origin of cerebral palsy in children born between 1983 and 1986 are reported. The crude live‐birth prevalence was 2.49 per 1000; 1.56 for term births, 0.93 for preterm births. The increasing trend from 1970 persisted and was statistically significant for both groups. The most pronounced increase during 1983–1986 occurred in term cerebral palsy. The increasing use of neuroimaging techniques made the timing of damaging events more reliable. In term cerebral palsy, the origin was convincingly prenatal in 28% of cases and perinatal in 25%. The particular critical period for the brain damage underlying cerebral palsy was considered to be weeks 26–34 of gestation, i.e. when periventricular structures are extraordinarily vulnerable. In term infants, this occurs during late intrauterine life, while in the majority of preterms it occurs in early neonatal life. In total, two‐thirds of cerebral palsy lesions might have been acquired during these decisive months of brain development.

The changing panorama of cerebral palsy in Sweden 1954-1970. III. The importance of foetal deprivation of supply.

Abstract. From record data derived from an unselected series of 560 Swedish cases of cerebral palsy, born in 1954‐70, the significance of prenatal factors associated with materno‐foetal vascular insufficiency causing foetal deprivation of supply (FDS) was investigated. Cerebral palsied children were found to have, on an average, retarded intrauterine growth when compared with a normal population. The incidence of bleeding during pregnancy, maternal toxaemia and multiple pregnancies were significantly increased (p<0.0001). The incidence of the prenatal factors in question had remained unchanged through the years 1954‐70. An additive interplay between factors of FDS and asphyxia/cerebral haemorrhage was revealed. As a whole the findings support the conclusion that FDS plays a major role in the pathogenesis of cerebral palsy today, particularly among the multihandkapped.

Gains and Hazards of Intensive Neonatal Care: an Analysis from Swedish Cerebral Palsy Epidemiology

In order to evaluate the benefits and hazards of intensive neonatal care, an analysis was made of 752 unselected cases of cerebral palsy born in Sweden between 1954 and 1976. It was found that during the period 1971–1976‐when more aggressive and specialized methods of neonatal care were introduced‐there was a slight increase in the incidence of cerebral palsy among newborn infants, which contrasted with the significant decrease during the period 1959 to 1970. Although the increase after 1970 must be seen in the context of a concomitant continuous decrease in perinatal, neonatal and infant mortality, the authors urge caution in the steadily increasing intensive efforts in neonatology, and continuous review by means of epidemiological follow‐up studies.

Polycystic Kidneys in Newborns, Infants and Children A Clinical and Pathological Study

Twenty‐eight cases of polycystic kidneys in newborn, infants and children have been investigated clinically and histopathologically. Three more or less distinct morphological types of polycystic kidneys are described and in addition single cases of deviating appearance. The clinical and hereditary aspects are discussed. In Group I (spongy kidney) a single gene recessive heredity has been proved.

DECREASING INCIDENCE OF LOW BIRTH WEIGHT DIPLEGIA—AN ACHIEVEMENT OF MODERN NEONATAL CARE?

The clinical syndromes of 429 cerebral palsied children born in 1959–68 and constituting a representative and unselected Swedish series were analysed with respect to the changing panorama of the various syndromes. The main preliminary finding was a significantly decreased total incidence due to a likewise significantly lowered number of diplegic babies with a birth weight less than 2 500 g.

32. THE SUCCESSIVE CHANGES IN THE SWEDISH PANORAMA OF CEREBRAL PALSY DURING THE LAST 20 YEARS

Recent experience from a field study comprising 429 Swedish cerebral palsied children born 1959-68 (Acta Paediat. Scand. 62:1973) brought about an expanded investigation for the further analysis of certain trends within the changing panorama of cp-syndromes. In addition to the already demonstrated and significantly decreasing number of prematurely born diplegic babies appearing from the middle of 1960’s, the following preliminary conclusions could be drawn. Spastic heiniplegic syndromes seem to have diminished, but it has hitherto not been possible to demonstrate statistical significance. The small percentage (2-5 O/o) of severe spastic tetraplegic syndromes has remained unaltered, most of these being of prenatal developmental origin. There was a gradual disappearance of pure choreoathetosis due to kernicterus in Swedish babies born between 1950--60, and no single case has been diagnosed in Gothenburg since that time. Dyskinetic syndromes due to perinatal asphyxia have remained quantitatively unchanged during the last 15 years in spite of all obstetric and neonatologic efforts. However, a qualitative improvement might have occurred with a smaller number of very severely damaged children appearing today. The incidence of congenital ataxic syndromes has also remained unchanged through the years, while postnatally acquired ataxia and ataxic diplegia due to expanding hydrocephalus seem to have decreased parallel to the institution of modern active shunt procedures.

Renal Hyperehloremic Acidosis

A case of renal hyperchloremic acidosis (Lightwood) is reported. The patient, a girl 2 years old has suffered from vomiting, loss of weight and constipation for 1½ years. Marked hypersodiemia, hyperchloremia, azotemia and acidosis of the blood, but alkaline urine were found together with signs of renal insufficiency but no ne‐phrocalcinosis. By charging the patient with ammonium chloride by mouth, the pH of the urine did not change. Therapy with sodium citrate was unsuccessful.