Cerebral Palsy and Growth Failure at 6 to 7 Years

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Surviving infants with hypoxic ischemic encephalopathy (HIE) treated with hypothermia have decreased rates of CP in childhood. CP is associated with increased risk of slow growth. WHAT THIS STUDY ADDS:Term children with HIE who develop moderate/severe CP are at high risk of progressive impaired growth, high rates of cognitive impairment, and rehospitalizations from infancy to school age. Gastrostomy tube placement to facilitate feeds is protective of slow growth. abstract OBJECTIVE: To evaluate the association between severity of cerebral palsy (CP) and growth to 6 to 7 years of age among children with moderate to severe (Mod/Sev) hypoxic ischemic encephalopathy (HIE). It was hypothesized that children with Mod/Sev CP would have poorer growth, lower cognitive scores, and increased rehospitalization rates compared with children with no CP (No CP).METHODS: Among 115 of 122 surviving children followed in the hypothermia trial for neonatal HIE, growth parameters and neurodevelopmental status at 18 to 22 months and 6 to 7 years were available. Group comparisons (Mod/Sev CP and No CP) with unadjusted and adjusted analyses for growth ,10th percentile and z scores by using Fisher' s exact tests and regression modeling were conducted. RESULTS:Children with Mod/Sev CP had high rates of slow growth and cognitive and motor impairment and rehospitalizations at 18 to 22 months and 6 to 7 years. At 6 to 7 years of age, children with Mod/ Sev CP had increased rates of growth parameters ,10th percentile compared with those with No CP (weight, 57% vs 3%; height, 70% vs 2%; and head circumference, 82% vs 13%; P , .0001). Increasing severity of slow growth was associated with increasing age (P , .04 for weight, P , .001 for length, and P , .0001 for head circumference). Gastrostomy feeds were associated with better growth.CONCLUSIONS: Term children with HIE who develop Mod/Sev CP have high and increasing rates of growth ,10th percentile by 6 to 7 years of age. These findings support the need for close medical and nutrition management of children with HIE who develop CP. Infants who experience moderate or severe hypoxic ischemic encephalopathy (HIE) are at increased risk of neurodevelopmental disability and moderate tosevere(Mod/Sev)cerebralpalsy(CP). [1][2][3][4][5][6][7][8] Slow growth is more common in children with Mod/Sev CP. 9,10 Decreased growth velocity in children with CP may be related to decreased oromotor coordination with suboptimal nutritional intake secondary to impaired chewing and swallowing, recurrent aspiration, chronic reflux, inadequate provision of required nutritional intake, increased caloric expenditure due to the excessive muscle contraction in spasticity for children with ambulatory CP, and the possibility of growth hormone deficiency. [10][11][12][13][14][15][16][17][18] In addition, comorbidities of CP, including gastroesophageal reflux and aspiration, are associated with slow growth and increased risk of rehospitalization. [19][20][21][22][23] Vigilance regarding growth of ...

Bayley-III Cognitive and Language Scales in Preterm Children

“…A, DAS-II GCA (n = 99); B, DAS-II Verbal (n = 100). 6,7,9 and lower rates of delay 6,9,20 compared with earlier versions on the BSID-II MDI scores and higher rates of delay when using local term-born reference data to calculate cut-points for classifying the level of delay. 5,6 Importantly, the current study contributes to this body of research by revealing discordance between developmental delay on the Bayley-III and later cognitive impairment.…”

“…Unfortunately, initial reports suggest that the Bayley-III underestimates rates of developmental delay in preterm and term-born infants across cognitive, language, and motor domains. [5][6][7][8][9][10] In light of these reports, it is important to assess the Bayley-III's capacity to predict later cognitive, language, and motor impairments.…”

White Matter Injury and General Movements in High-Risk Preterm Infants

“…13 The assessments were performed by 2 experienced testers, unaware of the brain MR imaging findings. Because the BSID-III scores significantly underestimate cognitive and language delay by approximately 11 points, [14][15][16] we designated infants with scores of Յ85 as having adverse neurodevelopmental outcomes.…”

Hypoxic-Ischemic Encephalopathy in Neonates Born to Severe Birth Asphyxia

“…Дети, получающие более быстрое расширение энтеральной нагрузки, имели более высокие темпы роста и низкий риск развития инвалидности [50].…”