F. Stanley and E. Atberman (eds) THE EPIDEMIOLOGY OF THE CEREBRAL PALSIES Clinics in Developmental Medicine No. 87 Spastic International Medical Publications Philadelphia: JB Uppincott Co., 1984
Sophisticated perinatal care, including intensive neonatal management, is creating a revolution in improved newborn survival. This is particularly true of very low birth weight infants who had an extraordinarily high mortality only a few years ago. The effect on subsequent development morbidity of the "new" population of survivors, however, is far from clear today. Follow-up experience to date in this new era is stilt not definitive or may indeed be changing. The question remains an open one as to whether in fact there is a reduced, altered, or even increased risk for development abnormality among today's survivors. Many feel that on the basis of clinical experience and available data there is evidence of an emerging major public health problem of handicapped children.
The difficulty of reaching toward a more accurate and rational basis fer understanding what is happening is based upon a number of factors. Among these are problems in early identification of developmental disorders, and overlapping in conditions which have multiple clinical features. Above all, there has not been a systematic effort to study the problem in a broad way.
At last there appears to be a beginning approach to dealing with this situation through utilization of epidemiological principles and methods as set forth in this text edited by Stanley and Alberman. A number of experts in the epidemiology field have joined together for a broad overview specifically in relation to the field of cerebral palsy. The initial chapters deal largely with problems in classification and existing methods of counting. The need for a uniform international system is stressed.
Of particular interest to pediatricians and other clinicians is a basic discussion of normal and abnormal brain development. This is followed by reviews of studies concerning cerebral palsy prevalence in various areas of the world, and current epidemiologie data on birth weight, gestational age, social, biological, pre, perinatal and postnatal factors in relation to cerebral palsy. An analysis is also made of content and design of present perinatal follow-up studies.
Finally, guidelines are suggested for future epidemiological research and study designs in the area. This is a fairly technical discussion which would require either special interest or background.
This work is one of the first to set the stage for developing a body of knowledge on the magnitude and trends in the emerging field of children's developmental disabilities. It would be of particular interest to all those who deal with the handicapped child and especially professionals with responsibility for organizing or planning needed clinical and supportive services.