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Developmental profile at initial presentation in children with infantile spasms
Samanmali P Sumanasena1, Jithangi Wanigasinghe2, Carukshi Arambepola3
1Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Insights
Infants with infantile spasms often have severe developmental delays, particularly in cognitive and communication skills. Delayed presentation and neonatal factors significantly worsen these outcomes, highlighting the need for early intervention.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Neonatology
Background:
- Infantile spasms are a severe epilepsy syndrome in infants.
- Early diagnosis and intervention are crucial for optimal developmental outcomes.
- Understanding factors influencing development in affected infants is essential.
Purpose of the Study:
- To characterize the baseline developmental profile of infants with newly diagnosed infantile spasms.
- To investigate the impact of clinical and demographic factors on developmental skills in this population.
Main Methods:
- A cross-sectional, longitudinal study involving 95 infants diagnosed with infantile spasms.
- Bayley Scales of Infant and Toddler Development assessments were used for cognitive, communication, and motor skills.
- Visual, auditory, and social behavior assessments were also conducted, alongside identification of risk factors.
Main Results:
- Over 90% of infants exhibited impairments across all developmental domains, with most showing severe delays.
- Delayed presentation was linked to receptive communication delay (OR=5.35).
- Early onset (≤6 months) affected auditory and visual behaviors, while neonatal infections impacted communication skills. Neonatal seizures influenced visual, auditory, and social impairments.
Conclusions:
- Adverse developmental status is common at presentation for infantile spasms.
- Delayed presentation and neonatal risk factors are associated with poorer developmental outcomes.
- Clinicians should be vigilant for at-risk infants and pursue timely interventions.
Aim:
To describe the baseline developmental profile and influence of clinical and demographic factors on the developmental skills of infants diagnosed with infantile spasms.
Method:
Ninety-five infants (55 males, 40 females) newly diagnosed with infantile spasms were recruited for a cross-sectional, longitudinal study. All infants underwent Bayley Scales of Infant and Toddler Development assessments in the cognitive, receptive communication, expressive communication, and fine and gross motor developmental domains; they also underwent visual, auditory, and social behaviour assessments. Infants were categorized as 'early' (<6mo) or 'late' (≥6mo) presenters; if presented within 28 days, this was considered as 'early presentation', whereas a delay greater than 28 days was considered as a 'delay in presentation'. Antenatal, perinatal, and postnatal risk factors were identified.
Results:
Over 90% of infants showed impairment in all domains, with the majority having severe delay; 99% showed cognitive impairment. Delayed presentation was significantly associated with receptive communication delay (odds ratio [OR]=5.35; 95% confidence interval [CI]=1.05-27.32). Onset at 6 months or less influenced auditory (OR=2.8; 95% CI=1.16-6.8) and visual (OR=3.03; 95% CI=1.22-7.57) behaviours. Neonatal infections impacted both receptive (OR=1.12; 95% CI=1.04-1.2) and expressive communication (OR=1.08; 95% CI=1.02-1.14) delay. Neonatal seizures significantly influenced visual, auditory, and social impairments. Expressive communication and gross motor development shared common perinatal risk factors.
Interpretation:
Adverse developmental status at presentation, associated with delayed presentation and neonatal risk factors should alert clinicians to the surveillance of at-risk infants and seek out timely interventions.
What This Paper Adds:
Ninety per cent of infants showed impaired cognitive, communication, and motor skills at presentation. Visual, auditory, and social behaviour impairments were significantly associated with perinatal risks. Visual, auditory, and social behaviour impairments were significantly associated with neonatal seizures.
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