[Perinatal events and handicaps].

It is difficult to assess how large is the proportion of handicap in the pediatric age related to perinatal events; this is mainly due to the following reasons: lack of uniform criteria and accuracy in defining both "handicap" and the "perinatal period"; variable involvement of perinatal factors in the genesis of the different types of impairment; and multifactorial origin of most sensory, neural and developmental damages. For the same reasons it is no easy to assess if handicaps of perinatal origin are declining or increasing with time. Cerebral palsy (CP), retinopathy of prematurity (ROP), deafness and relational problems are probably the clinical conditions most strictly related to perinatal events, tough recently biological and familial prenatal factors have also been proposed as important antecedents of CP. No important variation in the incidence of CP has been reported for the last 20 years, notwithstanding a supposed better perinatal care as documented by the decreased neonatal mortality; on the contrary a new epidemic of ROP is being described. This is probably the consequence of the increasing survival of babies at highest risk for subsequent handicap, namely those weighing less than 1500 gm and, chiefly, those weighing less than 1000 gm. Available data on the incidence or prevalence of deafness in infancy do not permit a meaningful analysis of their variations with time. Perinatal asphyxia, neonatal convulsions, intraventricular hemorrhage, CNS leukomalacia, mechanical ventilation and mother-infant separation are probably the most important "markers" of risk for subsequent sequelae; they must be distinguished from the "causes", which are unknown in many instances. Owing to this difficulty it is not possible to establish a straight correlation between perinatal care and handicap. The strategy of intervention must be aimed at the prevention of the situations outlined above, and it must rely both on technical and political solutions, which include the prevention of preterm birth, an effective regionalization of care and a constant evaluation of the results.