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Significance of microcephaly among children with developmental disabilities
Nathan Watemberg1, Sarah Silver, Shaul Harel
1Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel.
Insights
Microcephaly affects 15.4% of children with developmental delays. While often linked to intellectual disability, many microcephalic children have normal intelligence, with prematurity and brain bleeds being key associated factors.
Area of Science:
- Pediatrics
- Neurology
- Developmental Biology
Background:
- Microcephaly is a condition where the head circumference is smaller than expected for age and sex.
- Its prevalence and clinical impact in children with developmental disabilities require further elucidation.
Purpose of the Study:
- To assess the clinical significance of microcephaly in children aged 0-5 years with developmental disabilities.
- To identify associated perinatal conditions and neurological findings in microcephalic children.
Main Methods:
- Retrospective chart review of 1393 children referred to a child development center.
- Comparison of clinical outcomes between microcephalic and normocephalic children, and between those with and without cerebral palsy.
Main Results:
- Microcephaly was present in 15.4% of the study population.
- Associated conditions included prematurity, perinatal asphyxia, small for gestational age, respiratory distress syndrome, and brain hemorrhage.
- While mental retardation was more common in microcephalic children (especially those with cerebral palsy), nearly half had normal intelligence.
- Hypotonia, spasticity, cerebral palsy, epilepsy, and strabismus were common neurological findings and diagnoses.
Conclusions:
- Microcephaly is a frequent finding in children evaluated for developmental disabilities.
- Perinatal factors like respiratory distress syndrome and intraventricular hemorrhage strongly correlate with microcephaly.
- Microcephaly is a risk factor for mental retardation in children with cerebral palsy, but not for other neurological complications.
Abstract:
To assess the clinical impact of microcephaly among children with developmental disabilities, we reviewed the charts of 1393 consecutive patients from birth to 5 years of age referred to our child development center. Comparisons were made between normal and low IQ microcephalic patients and between children with cerebral palsy with and without small head circumference. Microcephaly was detected in 15.4% of patients. Although mental retardation was more common among microcephalic children (P < .001), almost half had normal intelligence. Prematurity (P < .001), perinatal asphyxia (P < .001), small for gestational age (P < .001), respiratory distress syndrome (P < .001), and brain hemorrhage (P < .001) were associated with microcephaly. Hypotonia (P < .001) and spasticity (P < .001) were the most common neurologic findings. Cerebral palsy (P < .001), growth retardation (P < .001), epilepsy (P < .001), and strabismus (P < .001) were the main associated diagnoses found. Mental retardation was significantly more common among microcephalic patients with cerebral palsy than among normocephalic ones (P < .0004). Microcephaly is common among children evaluated for developmental disabilities. Many of these patients have normal or borderline IQ. Of several perinatal conditions associated with later microcephaly, respiratory distress syndrome and intraventricular hemorrhage show the strongest correlation. Mental retardation is not a risk factor for other neurologic complications in microcephalic children. However, in children with cerebral palsy, microcephaly is a risk factor for mental retardation.