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Perinatal correlates of major and minor neurological dysfunction at school age: a multivariate analysis
M Hadders-Algra1, H J Huisjes, B C Touwen
1Department of Developmental Neurology, University Hospital Groningen, The Netherlands.
Insights
This study identified risk factors for later handicap in infants, finding that neonatal neurological issues and low Apgar scores are key indicators. It also distinguished two types of minor neurological dysfunction (MND) based on distinct risk profiles.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Neonatology
Background:
- Identifying early predictors of neurological handicap in infants is crucial for timely intervention.
- Minor neurological dysfunction (MND) can impact long-term development and requires further etiological investigation.
Purpose of the Study:
- To prospectively investigate risk factors for neurological handicap and minor neurological dysfunction (MND) in a cohort of 747 infants followed to nine years of age.
- To differentiate etiological and clinical subtypes of MND based on neurological assessment and associated risk factors.
Main Methods:
- Prospective cohort study of 747 infants (neurologically abnormal, mild abnormalities, normal).
- Re-examination at nine years focusing on minor neurological dysfunction (MND).
- Collection of extensive data on obstetrical history, neonatal course, interval complications, and social class.
Main Results:
- Neurological handicap was absent in initially normal newborns.
- Significant risk factors for later handicap included neonatal neurological abnormality, low one-minute Apgar scores, disturbed neonatal course, low social class, and interval complications.
- Two distinct types of MND were identified: MND-1 (associated with low birthweight and male gender) and MND-2 (associated with neonatal neurological findings, social class, obstetrical optimality, and gender).
Conclusions:
- Neonatal neurological status and Apgar scores are significant predictors of later neurological handicap.
- Minor neurological dysfunction presents with distinct etiological profiles (MND-1 and MND-2), highlighting the heterogeneity of these conditions.
- Obstetrical events were not significant predictors of later handicap, emphasizing the importance of neonatal and interval factors.
Abstract:
A prospective study was carried out on 747 infants: 147 neurologically abnormal, 300 with mild neurological abnormalities and 300 normal infants. They were re-examined at nine years of age, with special attention being paid to minor neurological dysfunction (MND). Extensive data on obstetrical history, neonatal course and interval complications were collected. Neurological handicap was not found on follow-up in the group of normal newborns. Other than neonatal neurological abnormality, risk factors contributing significantly to later handicap were low one-minute Apgar scores, a disturbed neonatal course, low social-class and interval complications; obstetrical events were conspicuous by their absence. Two aetiologically and clinically distinct kinds of MND were distinguished on the basis of a neurological cluster profile: MND-1 (one or two abnormal clusters) was only associated with a birthweight below the 2.3 centile and male gender, and MND-2 (more than two abnormal clusters) was associated with neonatal neurological findings, social class, obstetrical optimality score and gender.