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Neurodevelopmental outcomes of infants with intestinal failure at 12 and 26 months corrected age
Stephanie So1, Catherine Patterson1, Anna Gold2
1Department of Rehabilitation Services, The Hospital for Sick Children, Toronto, Ontario, Canada; Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Infants with intestinal failure (IF) face developmental delays, particularly in gross motor skills. Cognitive deficits emerge later, emphasizing the need for early developmental monitoring in children with IF.
Area of Science:
- Pediatric Medicine
- Neurodevelopmental Pediatrics
- Gastroenterology
Background:
- Survival rates for infants with intestinal failure (IF) are improving.
- However, various medical factors can influence neurodevelopmental outcomes in these children.
Purpose of the Study:
- To examine neurodevelopmental outcomes in children with IF at 12-15 and 26-32 months corrected age.
- To identify factors associated with developmental trajectories in this cohort.
Main Methods:
- Prospective neurodevelopmental assessments using Mullen Scales of Early Learning and Vineland-II Adaptive Behaviour Scales.
- Correlation of standard scores with medical and demographic factors in children undergoing intestinal rehabilitation.
Main Results:
- At 12 months, 36.7% scored below average in early learning and 80% in gross motor skills, primarily linked to prematurity.
- By 26 months, over 50% had below-average early learning scores, and 51.9% were below average in motor skills, with IF-related variables becoming more significant.
- Parental nutrition (PN) dependency was noted in 32.2% at the second assessment.
Conclusions:
- Children with intestinal failure are at high risk for developmental delays across multiple domains.
- Gross motor skills are significantly affected early on, while cognitive deficits become more pronounced by 26 months.
- Early and ongoing developmental follow-up is crucial for children with IF.
Background:
Survival rates of infants with intestinal failure (IF) are increasing, yet multiple medical factors may impact development.
Aims:
This study examines neurodevelopmental outcomes at 12-15 and 26-32 months corrected age in a cohort of children with IF.
Study Design:
Prospective single centre neurodevelopmental assessments of children admitted to an intestinal rehabilitation program between 2011 and 2013. Outcome measures include: Mullen Scales of Early Learning (12 and 26 months), and Vineland-II Adaptive Behaviour Scales - Caregiver Report (26 months). Standard scores were correlated with medical and demographic factors.
Results:
Thirty-one children (17 males), median gestational age 34 weeks (IQR 30-36) with birth weight (BW) 2.12 kg (IQR 1.24-2.52). Ten (32.2%) were dependent on parental nutrition (PN) at the second assessment. At 12 months, 11/30 (36.7%) scored below average (>1SD below mean) on the early learning composite and 24/30 (80%) were below average on the gross motor subscale. Comparatively, at 26 months, mean early learning scores were significantly lower with >50% scoring below average. Mean gross motor scores remained low, and 14/27 (51.9%) were below average on the Vineland-II motor domain. At 12 months, factors significantly associated with lower scores are primarily related to prematurity. At 26 months, the impact of IF-related variables such as bowel length and PN days are more apparent.
Conclusion:
Children with IF are at risk of developmental delay in multiple domains. While gross motor skills appear to be most significantly affected, cognitive deficits become more apparent at 26 months, highlighting the importance of early developmental follow up.
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