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Published on: January 20, 2023
Longitudinal Developmental Outcomes of Infants and Toddlers With Traumatic Brain Injury
Heather T Keenan1, Amy Clark1, Rich Holubkov1
1Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City.
Insights
Infants and toddlers with severe traumatic brain injury (TBI) show limited developmental recovery over three years. Milder TBI or orthopedic injuries (OI) do not significantly impact development, suggesting targeted early intervention for severe TBI cases.
Area of Science:
- Pediatric neurology
- Developmental pediatrics
- Trauma research
Background:
- Infants and toddlers experience high rates of traumatic brain injury (TBI).
- Longitudinal developmental outcome data for this age group post-TBI is limited.
- Understanding developmental trajectories is crucial for guiding post-TBI surveillance and intervention.
Purpose of the Study:
- To evaluate the 3-year developmental outcomes of infants and toddlers following TBI.
- To compare developmental trajectories between children with TBI and those with orthopedic injury (OI).
- To identify factors influencing developmental outcomes after pediatric injury.
Main Methods:
- Longitudinal observational cohort study at two Level 1 pediatric trauma centers.
- Inclusion of children younger than 31 months with TBI or OI.
- Developmental assessment using the Ages & Stages Questionnaire-3 (ASQ-3) at baseline and 3, 12, 24, and 36 months post-injury.
- Statistical analysis using linear mixed models, adjusting for multiple covariates.
Main Results:
- Children with mild or complicated mild/moderate TBI showed similar development to OI group at 36 months.
- Children with severe TBI exhibited significantly poorer outcomes in communication, gross motor, problem-solving, and personal-social domains, with minimal recovery over time.
- Abusive injuries were associated with declines in fine motor and personal-social skills.
- Social capital demonstrated a protective effect on communication and problem-solving skills.
Conclusions:
- Severe TBI in infants and toddlers is associated with persistent developmental deficits and limited recovery.
- Early childhood intervention is recommended for children with severe TBI.
- Children with milder TBI or OI generally remain on their developmental track, warranting routine surveillance.
Importance:
Among children, infants and toddlers have some of the highest rates of traumatic brain injury (TBI), but longitudinal information on their developmental outcomes to guide postinjury surveillance is sparse.
Objective:
To evaluate infants' and toddlers' development over 3 years following TBI compared with those with orthopedic injury (OI).
Design, Setting, And Participants:
A longitudinal observational cohort study was conducted at 2 level 1 pediatric trauma centers from January 20, 2013, to September 30, 2015; data analysis was performed from May 12 to October 20, 2021. Participants included children injured when younger than 31 months with TBI or OI who received emergency department care.
Exposures:
Mild, moderate, or severe TBI or OI.
Main Outcomes And Measures:
Parents completed baseline measures representing preinjury status and 3-, 12-, 24-, and 36-month postinjury status, using the Ages & Stages Questionnaire-3 (ASQ-3), with a mean reference value of 50 and higher scores indicating more advanced development. Linear mixed models characterized children's outcomes for each ASQ-3 domain after adjustment for baseline ASQ-3, injury severity and group, age, injury mechanism (abuse or not), sex, prematurity, family function, social capital, and time. Interactions with time were evaluated.
Results:
Consent for participation was provided for 195 children; 184 parents (94%) completed a baseline survey. The cohort included 168 children who completed at least 1 follow-up survey: 48 (29%) mild; 54 (32%) complicated mild/moderate; 21 (13%) severe TBI; and 45 (27%) orthopedic injury. The cohort included 95 boys (57%), 49% injured before age 1 year; and 13% injured by abuse. Mean (SD) age at the time of injury was 13.9 (9.4) months. At 36 months, children with mild or complicated mild/moderate TBI performed similarly to children with OI across ASQ-3 domains. Children with severe TBI performed poorly as shown by negative mean differences in communication (-8.8; 95% CI, -13.8 to -3.8); gross motor (-10.1; 95% CI, -15.1 to -5.1); problem solving (-6.6; 95% CI, -11.2 to -1.9), and personal social (-6.3; 95% CI, -10.4 to -2.1) domains with little recovery over time. Children with abusive injury experienced decrements in ability over time in fine motor and personal social skills. Social capital was protective in communication (mean, 1.5; 95% CI, 0.3-2.7) and problem solving (mean, 1.2; 95% CI, 0.1-2.3) domains.
Conclusions And Relevance:
In this cohort study of children with TBI, children with severe injury showed little recovery. These findings suggest that early childhood intervention is needed, while children with milder injury remained on their developmental track and should continue routine developmental surveillance.
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