Neurodevelopment in Children with Single-Suture Craniosynostosis and Plagiocephaly without Synostosis

Abstract

The objective of this study was to determine whether children with nonsyndromic craniosynostosis and plagiocephaly without synostosis demonstrated cognitive and psychomotor delays when compared with a standardized population sample. This was the initial assessment of a larger prospective study, which involved 21 subjects with nonsyndromic craniosynostosis (mean age, 10.9 months) and 42 subjects with plagiocephaly without synostosis (mean age, 8.4 months). Each child was assessed using the Bayley Scales of Infant Development-II (BSID-II) for cognitive and psychomotor development before therapeutic intervention (surgery for craniosynostosis and molding-helmet therapy for plagiocephaly without synostosis). The distribution of the scores was divided into four groups: accelerated, normal, mild delay, and significant delay. The distributions of the mental developmental index (MDI) and the psychomotor developmental index (PDI) were then compared with a standardized Bayley's age-matched population, using Fisher's exact chi-square test. Within the craniosynostosis group, the PDI scores were significantly different from the standardized distribution (p < 0.001). With regard to the PDI scores, 0 percent of the subjects in the craniosynostosis group were accelerated, 43 percent were normal, 48 percent had mild delay, and 9 percent had significant delay. In contrast, the MDI scores were not statistically different (p = 0.08). Within the group with plagiocephaly without synostosis, both the PDI and MDI scores were significantly different from the normal curve distribution (p < 0.001). With regard to the PDI scores, 0 percent of the subjects in the group with plagiocephaly without synostosis were accelerated, 67 percent were normal, 20 percent had mild delay, and 13 percent had significant delay. With regard to the MDI scores, 0 percent of the subjects in this group were accelerated, 83 percent were normal, 8 percent had mild delay and 9 percent had significant delay. This study indicates that before any intervention, subjects with single-suture syndromic craniosynostosis and plagiocephaly without synostosis demonstrate delays in cognitive and psychomotor development. Continued postintervention assessments are needed to determine whether these developmental delays can be ameliorated with treatment.

Early Neurodevelopment in Infants With Deformational Plagiocephaly

“…10,17,18 Our findings are also consistent with the 2 prospective investigations of the Panchal group, 12,13 which found that none of their sample of infants with DP displayed accelerated functioning in cognition or motor skill development. Because motor development is particularly rapid during this early stage of development, it may be the skill domain that is most vulnerable.…”

Neurodevelopmental functioning of infants with untreated single-suture craniosynostosis during early infancy

“…Findings appear consistent with much of the previous literature, in showing that during the early infancy period and prior to surgical correction of the deformity, infants with craniosynostosis display motor and/or mental developmental abilities within the normal range as a group, although the distribution of scores appear lower than expected. Hence, these infants are more likely to display average to below average performances, and not display accelerated performances in the developmental areas assessed [26][27][28][29][30][31]. Motor skills appear most susceptible to impairment at this developmental phase, with these infants being 2.2 times more likely to display motor developmental delay than the general population.…”

“…However, others have shown that these infants perform significantly below normative expectations or control samples [26,27] with higher than expected prevalence of mild to significant delay in cognition [26]. Studies which have addressed motor function have reported significantly lower performances on motor skill abilities on the Bayley scales in untreated patients with mixed forms of singlesuture synostosis compared with normative population estimates or control group samples [26][27][28][29][30]. In fact, motor skills appear to be the area of most significant deficit, with scores in several of these studies falling around the mildly delayed range [28] compared with cognitive scores, which fell typically within normal limits.…”

Neurodevelopmental Delays in Children with Deformational Plagiocephaly

“…[1][2][3][4][5][6][7][8][9][10] Unfortunately, the phenomenon of deformational plagiocephaly seems to have been forgotten somewhat in this debate. Most researches have presumed that plagiocephaly without synostosis is not associated with any developmental delays.…”