1
|
Active head lifting from supine in infancy in the general population: Red flag or not? Early Hum Dev 2021; 163:105466. [PMID: 34543946 DOI: 10.1016/j.earlhumdev.2021.105466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Previously it had been had reported that active head lifting from supine (AHLS) in high-risk infants was associated with lower cognitive scores in the second year. AHLS was generally accompanied by stereotyped leg movements. AIMS To examine in a standardized way whether AHLS with or without stereotyped leg movements in the general population is associated with prenatal, perinatal, neonatal and socio-economic risk factors or with lower scores on concurrent infant tests. STUDY DESIGN Cross-sectional study SUBJECTS: 1700 infants aged 2-18 months representative of the Dutch population. OUTCOME MEASURES Infant Motor Profile (IMP) and Standardized Infant NeuroDevelopmental Assessment (SINDA). Assessments were video-recorded and included at the youngest ages 3min of behaviour in supine. AHLS and the presence of stereotyped leg movements were recorded. Standardized information on early risk factors was available. RESULTS AHLS occurred at 4-9 months (prevalence per months: 1-14%; highest prevalence at 6 months). It was not associated with early risk factors or scores on infant tests. When AHLS was accompanied by stereotyped leg movements it was associated with a higher prevalence of an IMP-variation score < P15 (Odds Ratio (OR) 2.472 [95%CI 1.017; 6.006]). Stereotyped leg movements irrespective of AHLS were associated with more unfavourable total IMP scores and IMP performance scores (B coefficients -3.212 [-4.065; -2.360], -2.521 [-3.783; -1.259]) and IMP variation and SINDA neurological scores (ORs 5.432 [3.409; 8.655], 3.098 [1.548; 6.202]). CONCLUSIONS The data suggest that AHLS is not a red flag. Rather its co-occurring stereotyped leg movements may signal less favourable neurodevelopment.
Collapse
|
2
|
Romeo DM, Cowan FM, Haataja L, Ricci D, Pede E, Gallini F, Cota F, Brogna C, Vento G, Romeo MG, Mercuri E. Hammersmith Infant Neurological Examination for infants born preterm: predicting outcomes other than cerebral palsy. Dev Med Child Neurol 2021; 63:939-946. [PMID: 33336801 DOI: 10.1111/dmcn.14768] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/22/2022]
Abstract
AIM We explored the ability of the Hammersmith Infant Neurological Examination (HINE) to identify typical and delayed cognitive performance in a large population of infants born preterm, both with and without cerebral palsy (CP). METHOD We conducted a retrospective study of infants born preterm who had repeated HINEs between 3 and 12 months corrected age. At 2 years, cognition was assessed using the Mental Development Index (MDI; from the Bayley Scales of Infant Development, Second Edition) and the presence and severity of CP was determined. All children were classified as cognitively typical/mildly delayed or significantly delayed (MDI <70) and CP. The predictive validity of HINE scores for significantly delayed cognitive performance, in children with and without CP, was calculated using specific cut-off scores according to age at assessment. RESULTS Of 1229 eligible infants (gestational age 25-36wks, mean [SD] 34.9 [2.3]; 646 males, 583 females), 1108 did not develop CP, 891 had an MDI that was typical/mildly delayed, and 217 had an MDI less than 70. Of the 121 infants who developed CP, the MDI was typical in 28, mildly delayed in 27, and less than 70 in 66. HINE scores showed a good sensitivity and specificity, especially after 3 months, for detecting significantly delayed cognitive performance in infants without CP. In those who developed CP, the score was associated with their cognitive level. INTERPRETATION The HINE provides information about the risk of delayed cognitive performance in infants born preterm with and without CP. What this paper adds The Hammersmith Infant Neurological Examination (HINE) can be used in the first year to identify infants born preterm at risk for delayed cognitive performance. Age-dependent HINE cut-off scores are proposed for detecting increased risk of delayed cognitive performance.
Collapse
Affiliation(s)
- Domenico M Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | | | - Leena Haataja
- Division of Pediatric Neurology, Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki, Finland
| | - Daniela Ricci
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients, IAPB Italia Onlus, Rome, Italy
| | - Elisa Pede
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Francesca Gallini
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Cota
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Brogna
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mario G Romeo
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Catania, Catania, Italy
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| |
Collapse
|
3
|
Gunkel J, de Vries LS, Jongmans M, Koopman-Esseboom C, van Haastert IC, Eijsermans MCJ, van Stam C, van Zanten BGA, Wolfs TFW, Nijman J. Outcome of Preterm Infants With Postnatal Cytomegalovirus Infection. Pediatrics 2018; 141:peds.2017-0635. [PMID: 29330315 DOI: 10.1542/peds.2017-0635] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess whether preterm infants with postnatal cytomegalovirus infection develop neurologic sequelae in early childhood. METHODS Infants <32 weeks' gestation were prospectively screened for cytomegalovirus (CMV) at term-equivalent age. Neurodevelopment was compared between CMV-positive and CMV-negative infants by using the Griffiths Mental Development Scales (GMDS) at 16 months' corrected age (CA); the Bayley Scales of Infant and Toddler Development, Third Edition or the GMDS at 24 to 30 months' CA; and the Wechsler Preschool and Primary Scale of Intelligence, Third Edition and Movement Assessment Battery for Children, Second Edition at 6 years of age. At 6 years old, hearing was assessed in CMV-positive children. RESULTS Neurodevelopment was assessed in 356 infants at 16 months' CA, of whom 49 (14%) were infected and 307 (86%) were noninfected. Infected infants performed significantly better on the GMDS locomotor scale. There were no differences at 24 to 30 months' CA on the Bayley Scales of Infant and Toddler Development, Third Edition or GMDS. At 6 years of age, infected children scored lower on the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, but mean scores were within normal range, reaching significance only in verbal IQ (96 [SD 17] vs 103 [SD 15] points; P = .046). Multiple regression indicated no impact of CMV status but significant influence of maternal education and ethnicity on verbal IQ. No significant differences in motor development were found and none of the infected children developed sensorineural hearing loss. CONCLUSIONS In this cohort study, postnatal cytomegalovirus infection in preterm children did not have an adverse effect on neurodevelopment within the first 6 years of life.
Collapse
Affiliation(s)
| | | | - Marian Jongmans
- Departments of Neonatology.,Child, Family, and Education Studies
| | | | | | - Maria C J Eijsermans
- Child Development and Exercise Center, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | | |
Collapse
|
4
|
Being Small for Gestational Age: Does it Matter for the Neurodevelopment of Premature Infants? A Cohort Study. PLoS One 2015; 10:e0125769. [PMID: 25965063 PMCID: PMC4428889 DOI: 10.1371/journal.pone.0125769] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/26/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Whether being small for gestational age (SGA) increases the risk of adverse neurodevelopmental outcome in premature infants remains controversial. OBJECTIVE to study the impact of SGA (birthweight < percentile 10) on cognition, behavior, neurodevelopmental impairment and use of therapy at 5 years old. METHODS This population-based prospective cohort included infants born before 32 weeks of gestation. Cognition was evaluated with the K-ABC, and behavior with the Strengths and Difficulties Questionnaire (SDQ). Primary outcomes were cognitive and behavioral scores, as well as neurodevelopmental impairment (cognitive score < 2SD, hearing loss, blindness, or cerebral palsy). The need of therapy, an indirect indicator of neurodevelopmental impairment, was a secondary outcome. Linear and logistic regression models were used to analyze the association of SGA with neurodevelopment. RESULTS 342/515 (76%) premature infants were assessed. SGA was significantly associated with hyperactivity scores of the SDQ (coefficient 0.81, p < 0.04), but not with cognitive scores, neurodevelopmental impairment or the need of therapy. Gestational age, socio-economic status, and major brain lesions were associated with cognitive outcome in the univariate and multivariate model, whereas asphyxia, sepsis and bronchopulmonary dysplasia were associated in the univariate model only. Severe impairment was associated with fetal tobacco exposition, asphyxia, gestational age and major brain lesions. Different neonatal factors were associated with the use of single or multiple therapies: children with one therapy were more likely to have suffered birth asphyxia or necrotizing enterocolitis, whereas the need for several therapies was predicted by major brain lesions. DISCUSSION In this large cohort of premature infants, assessed at 5 years old with a complete panel of tests, SGA was associated with hyperactive behavior, but not with cognition, neurodevelopmental impairment or use of therapy. Birthweight <10th percentile alone does not appear to be an independent risk factor of neurodevelopmental adverse outcome in preterm children.
Collapse
|
5
|
Rihar A, Mihelj M, Kolar J, Pašič J, Munih M. Sensory data fusion of pressure mattress and wireless inertial magnetic measurement units. Med Biol Eng Comput 2014; 53:123-35. [PMID: 25367736 DOI: 10.1007/s11517-014-1217-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/20/2014] [Indexed: 11/28/2022]
Abstract
Head movement of infants is an important parameter for analysing infant motor patterns. Despite its importance, this field has received little sensory-based research in the past years. Therefore, we present a sensory-supported data fusion model for head movement analysis of infants in supine position. The sensory system comprises a pressure mattress and two wireless inertial magnetic measurement units, rendering precise, objective and non-intrusive information on pressure distribution and 3D trunk orientation, respectively. Algorithms first perform pressure data pre-processing and calculate image moments to acquire 2D trunk orientation. Afterwards, unscented Kalman filter is used for sensory data fusion. After additional data processing, head and trunk coordinates are calculated along with head displacement distance. The sensory system was tested on experimental measurements, performed in eight normally developing infants aged from 1 to 5 months. Results of several algorithm combinations were compared to referential video recordings in terms of head lifts. Combination of algorithms, incorporating head tracking and sensory data fusion provides completely accurate results in comparison to normative data. Statistical data analysis and referential optoelectronic measurements were performed to evaluate accuracy of the sensory fusion model. Suitability of the proposed sensory system for head movement analysis of infants in supine position was verified.
Collapse
Affiliation(s)
- Andraž Rihar
- Laboratory of Robotics, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia,
| | | | | | | | | |
Collapse
|
6
|
Hitzert MM, Roze E, Van Braeckel KNJA, Bos AF. Motor development in 3-month-old healthy term-born infants is associated with cognitive and behavioural outcomes at early school age. Dev Med Child Neurol 2014; 56:869-76. [PMID: 24766572 DOI: 10.1111/dmcn.12468] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2014] [Indexed: 11/29/2022]
Abstract
AIM To determine whether motor development at 3 months of age is associated with cognitive, motor, and behavioural outcomes in healthy children at early school age. METHOD In this cohort study, we included 74 term-born, healthy children (44 males, 30 females; median gestational age 40.1 wks, range 38.0-42.6 wks). From video recordings (median 12.9 wks, range 9.3-18.6 wks), we assessed the quality of fidgety movements, and calculated a motor optimality score. At school age (median 5 y 11 mo, range 5 y 8 mo-7 y 6 mo), we performed detailed cognitive, motor, and behavioural assessments. We examined whether aspects of motor development were associated with functional outcomes. RESULTS An age-adequate motor repertoire, in particular the presence of antigravity, midline leg, and manipulation movements, was related to poorer cognition, whereas variable finger postures was related to better cognition. Children with a monotonous concurrent motor repertoire had better ball skills but experienced more behavioural problems. The presence of antigravity movements tended to be associated with abnormal recognition (odds ratio [OR] 4.4, 95% confidence interval [CI], 0.9-21; R(2) =0.17; p=0.070), where the absence of variable finger postures was associated with borderline and abnormal visual-spatial perception (OR 20, 95% CI, 1.7-238; R(2) =0.39; p=0.018). INTERPRETATION Detailed aspects of motor development at 3 months of age are associated with cognition and behaviour, but not with motor outcome, in healthy children at early school age. Our findings suggest that early motor development may be the basis for later cognitive and behavioural performance. Since the associations were only moderate, possible environmental influences should be acknowledged.
Collapse
Affiliation(s)
- Marrit M Hitzert
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | | |
Collapse
|
7
|
Alderliesten T, Lemmers PMA, van Haastert IC, de Vries LS, Bonestroo HJC, Baerts W, van Bel F. Hypotension in preterm neonates: low blood pressure alone does not affect neurodevelopmental outcome. J Pediatr 2014; 164:986-91. [PMID: 24484771 DOI: 10.1016/j.jpeds.2013.12.042] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/21/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare neurodevelopmental outcome, mean arterial blood pressure (MABP), and regional cerebral oxygenation (rSco2) between preterm neonates treated for hypotension and controls. STUDY DESIGN Preterm neonates (N = 66) with a gestational age (GA) ≤32 weeks, without a patent ductus arteriosus, treated for hypotension (dopamine ≥5 μg/kg/min) were included. Neonates were matched to controls for GA, birth weight, sex, and year of birth. The rSco2 was determined by using near-infrared spectroscopy. Monitoring of MABP, rSco2, and arterial saturation was started at admission and continued for at least 72 hours. Neurodevelopmental outcome was assessed at 18 and 24 months' corrected age by using the Griffiths Mental Development Scales or the Bayley Scales of Infant and Toddler Development, Third Edition. RESULTS Infants treated for hypotension spent more time with an MABP less than GA (median 9% vs 0%, P < .001) and time with an MABP/rSco2 correlation >0.5 (27% vs 17%, P < .001). Time spent with an rSco2 <50% and neurodevelopmental outcome at 18 and 24 months' corrected age were not significantly different between infants treated for hypotension and controls. The 26 neonates with an rSco2 <50% for >10% of time had a lower neurodevelopmental outcome at 18 months (median 99 vs 104, P = .02). CONCLUSION An MABP less than GA (in weeks) was not associated with lower rSco2 or with lower neurodevelopmental outcome scores. However, regardless of MABP, low rSco2 was associated with lower neurodevelopmental outcome scores. Perfusion/oxygenation variables could be of additional value in neonatal intensive care.
Collapse
Affiliation(s)
- Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Petra M A Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ingrid C van Haastert
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hilde J C Bonestroo
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem Baerts
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
8
|
Bibliography. Current world literature. Neonatology and perinatology. Curr Opin Pediatr 2013; 25:275-81. [PMID: 23481475 DOI: 10.1097/mop.0b013e32835f58ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Abstract
PURPOSE To evaluate longitudinal applicability of the gross motor function measure (GMFM) in infants younger than 2 years. METHODS Twelve infants at very high risk for cerebral palsy were enrolled between 1 and 9 months corrected age. The children were assessed 4 times during 1 year with the GMFM-66, GMFM-88, and other neuromotor tests. RESULTS Longitudinal use of the GMFM in infancy was hampered by age and function-specific limitations. The GMFM-66 differentiated less at lower-ability levels than at higher-ability levels. The GMFM-88 demonstrated flattening of the developmental curve when infants had developed more motor abilities. We formulated adaptations for the longitudinal use of GMFM in infancy. CONCLUSIONS To facilitate use of the GMFM in infancy, an adapted version may be an option. Further research is required to assess reliability and validity, and in particular, the sensitivity to change of the suggested adaptations.
Collapse
|