Cerebral palsy: why we must plan for survival

Article Abstract:

Cerebral palsy is a paralysis that affects both sides of the body and results from developmental defects in the brain or injury at birth. The condition is associated with high costs, including the costs of settlements in cases in which it was considered to result from medical negligence around the time of delivery. The affected individual and family suffer both financial and personal losses. There is limited information about the life expectancy of patients with cerebral palsy. However, the organization and funding of services to maximize the quality of life of affected persons require planning. Previous studies examining the outcome of patients with cerebral palsy have included only small numbers of patients who require long-term institutional care. The survival of children with cerebral palsy was assessed using data from a register of children born in the South East Thames region of London between 1970 and 1979 and diagnosed with some form of cerebral palsy. The results showed that 651 of 732 children studied are still alive, indicating a high rate of survival among children with cerebral palsy. However, survival differs with various forms of cerebral palsy. The most severe forms of cerebral palsy include spastic quadriplegia, dyskinetic, and 'mixed' cerebral palsy. Immobility and severely impaired mental ability increase the risk of death in children with cerebral palsy. However, even the most severely affected children with cerebral palsy can survive to adulthood. Hence, planning for the survival of children with cerebral palsy is essential and involves financing and evaluating services to maximize health, independence, and quality of life for these individuals. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment

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Certified cause of death in children and young adults with cerebral palsy

Article Abstract:

Chronic conditions are often under-represented in mortality statistics. Cerebral palsy causes bilateral and symmetrical paralysis of the body resulting from developmental defects in the brain or brain injury at birth. Data on life expectancy, cause of death, and causes of disease are beneficial for those involved in the long-term care of patients with cerebral palsy. However, if the proportion of deaths due to cerebral palsy are also misrepresented, mortality statistics may be misleading. The certified cause of death in 732 children and adolescents with cerebral palsy were reviewed. The children were born between 1970 and 1979, and were assessed at the end of 1989. Copies of the death certificates of 73 children who died between four weeks and almost 16 years of age were obtained. Infantile cerebral palsy was recorded as the cause of death in 22 percent of these patient. Cerebral palsy was not indicated at all on 28 death certificates. The proportion certificates without mention of cerebral palsy increased with age of the patient. Respiratory causes accounted for death in 20 cases. Autopsy was performed in 23 cases, although in some cases, the information provided in the autopsy report was limited to a 'terminal event'. Death certificates containing sufficient and appropriate data are important in determining correct national statistics. Accurate documentation of mortality and the contribution of cerebral palsy or other chronic conditions needs to be provided to avoid underreporting of these diseases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Death, Examinations, Test validity, Cerebral palsied children, Certification

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Screening infants for hearing loss

Article Abstract:

Mandatory auditory screening programs for eight-month-old infants have been established and are recommended as the initial way to identify those infants who may have impaired hearing. The effectiveness of the distraction hearing test with respect to the percentage of eligible infants tested, referral rate of potentially impaired patients and the false-positive rate was monitored through a computerized child health register. Fewer than 60 percent (1,109) of 1,990 eligible infants were screened. Successful participation in the auditory screening program directly correlated with participation in the immunization program. The fairly low participation rate may be attributed to inability to account for all the infants that were actually screened, parents who were unwilling or unable to keep appointments, or children on the register who had been tested elsewhere, or had moved or even died. Eighty percent of the 1,190 tested cases had no problem successfully completing the screening. Ultimately, 5 percent of the 1,109 tested cases were referred for additional expert testing and about 48 percent of those children had confirmed conductive hearing impairment. Sensorineural impairment in three children was not detected or recognized. The value of the distraction hearing test is questionable and ways to increase the participation rate are being considered. The computerization of heath records made long-term tracking of children more manageable and could be applied to other health concerns. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Testing, Children, Deaf, Deaf children, Hearing loss, Hearing impaired children

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