[Handicaps and the perinatal period. II. Perinatal pathology and severe deficiencies]. / Handicaps et périnatalité. II. Pathologie périnatale et déficiences graves.

BACKGROUND: In the last two decades, the infant mortality rate has dramatically declined. But improved management of newborns may induce an increased prevalence of neurodevelopmental handicaps. The aim of this paper is to estimate the rate of major disabilities and their relationships to perinatal events. POPULATION AND METHODS: Three hundred and sixteen children born in 1984 and registered by the "Commission Départementale de l'Education Spéciale" (CDES) were included in the study. Among these, 97 had either cerebral palsy, blindness, deafness, or mental retardation. These 97 children were compared to 602 school age controls using a multivariate analysis (logistic regression). RESULTS: The rate of major disabilities among the 6-year old children is 3.4/1000. It was 5/1000 in 1972 and 4.3/1000 in 1976. This frequency is higher in the children who were preterm (odds ratio--OR = 4.8), small for gestational age (OR = 3.3) or suffered from perinatal asphyxia (OR = 32.8). These three factors accounted for 37.4% of major disabilities. CONCLUSION: This study emphasizes the relationships between perinatal events and some major handicaps but also shows that antenatal factors may be involved in neurodevelopmental problems.

[Handicaps in the perinatal period. I. Perinatal pathology and difficulties in school]. / Handicaps et périnatalité. I. Pathologie périnatale et difficultés scolaires.

BACKGROUND: Major handicaps are closely related to perinatal events. However, relationship of these events with other moderate disabilities such as school problems are still unclear. POPULATION AND METHODS: A representative sample of 1,408 children at school age and born in Lorraine in 1984 was studied. Two hundred and fifty children with problems were compared with 602 controls without school problems, using a multivariate analysis. RESULTS: The incidence of school difficulties among 6-year old children (in the last year of nursery school) is 17.8%. Children are at higher risk of school problems if their parents are not (odds ratio [OR] = 7.9) or are poor school graduate (OR = 2.7), if they are boys (OR = 2.0), if they are born at the end of the year (OR = 1.1) and also if they are preterm (OR = 2.7) or small for gestational age (OR = 2.5). Preterm delivery and intra-uterine growth retardation accounted for 9.6% of school difficulties. CONCLUSION: The relationship between perinatal events and school difficulties warrants to continue with prevention during pregnancy, especially among groups with multiple risk factors.