早產不好，晚生也不好，對於cerebral palsy而言
CP的風險在GA 40 wks 最低 ，37wk or >42wk 最高
我們該因此改變小朋友的delivery timing嗎?
尚無定論
Gestational Age and Risk for Cerebral Palsy: A Surprising Discovery
Among term and postterm newborns, CP prevalence is lowest at 40 weeks' gestation and highest at 37 and ≥42 weeks' gestation.
Cerebral palsy (CP) is a nonprogressive motor encephalopathy characterized by impairment of movement or posture and is presumed to be the result of injury or anomaly in the developing brain. Prevalence of CP has remained at 1.5 to 2.5 per 1000 live births for several decades. Although the etiology in most cases is unknown, the strongest risk factor for CP is preterm birth (<37 weeks' gestation). However, about 75% of infants with CP are born after 36 weeks' gestation. In a population-based study, researchers examined the association between gestational age and CP in nearly 1.7 million term and postterm singleton newborns (gestational age, 37–44 weeks) recorded in the Medical Birth Registry of Norway from 1967 through 2001. Gestational age was based on last menstrual period. Infants with congenital anomalies were excluded.
Follow-up through 2005 indicated that 1938 children with CP were registered in the national health insurance system. Prevalence of CP was lowest among infants born at 40 weeks' gestation, and risk was higher with earlier or later delivery (see the table). In a subset of infants with ultrasound measurements of gestational age, the association between CP risk and gestational age was even stronger.
Comment: Full-term infants account for most cases of CP, and this study indicates that risk differs for term and postterm deliveries. Risk is lowest at 40 weeks' gestation and highest at 37 weeks and at 42 weeks or later. The study's strengths include the population-based design in a country with universal health insurance and a national registry of children with developmental disabilities. Should we consider changing the timing of delivery as a way to reduce the incidence of CP? The authors caution: "Until the biological mechanisms for these patterns of risk in term and postterm births are better understood, it would be hasty to assume that interventions on gestational age at delivery could reduce the occurrence of CP."
— Martin T. Stein, MD
Published in Journal Watch Pediatrics and Adolescent Medicine September 22, 2010
Citation(s):
Moster D et al. Cerebral palsy among term and postterm births. JAMA 2010 Sep 1; 304:976.
* Original article (Subscription may be required)
* Medline abstract (Free)
我們該因此改變小朋友的delivery timing嗎?
尚無定論
Gestational Age and Risk for Cerebral Palsy: A Surprising Discovery
Among term and postterm newborns, CP prevalence is lowest at 40 weeks' gestation and highest at 37 and ≥42 weeks' gestation.
Cerebral palsy (CP) is a nonprogressive motor encephalopathy characterized by impairment of movement or posture and is presumed to be the result of injury or anomaly in the developing brain. Prevalence of CP has remained at 1.5 to 2.5 per 1000 live births for several decades. Although the etiology in most cases is unknown, the strongest risk factor for CP is preterm birth (<37 weeks' gestation). However, about 75% of infants with CP are born after 36 weeks' gestation. In a population-based study, researchers examined the association between gestational age and CP in nearly 1.7 million term and postterm singleton newborns (gestational age, 37–44 weeks) recorded in the Medical Birth Registry of Norway from 1967 through 2001. Gestational age was based on last menstrual period. Infants with congenital anomalies were excluded.
Follow-up through 2005 indicated that 1938 children with CP were registered in the national health insurance system. Prevalence of CP was lowest among infants born at 40 weeks' gestation, and risk was higher with earlier or later delivery (see the table). In a subset of infants with ultrasound measurements of gestational age, the association between CP risk and gestational age was even stronger.
Comment: Full-term infants account for most cases of CP, and this study indicates that risk differs for term and postterm deliveries. Risk is lowest at 40 weeks' gestation and highest at 37 weeks and at 42 weeks or later. The study's strengths include the population-based design in a country with universal health insurance and a national registry of children with developmental disabilities. Should we consider changing the timing of delivery as a way to reduce the incidence of CP? The authors caution: "Until the biological mechanisms for these patterns of risk in term and postterm births are better understood, it would be hasty to assume that interventions on gestational age at delivery could reduce the occurrence of CP."
— Martin T. Stein, MD
Published in Journal Watch Pediatrics and Adolescent Medicine September 22, 2010
Citation(s):
Moster D et al. Cerebral palsy among term and postterm births. JAMA 2010 Sep 1; 304:976.
* Original article (Subscription may be required)
* Medline abstract (Free)
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