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Impact of Neonatal Body (Dis)Proportionality Determined by the Cephalization Index (CI) on Gross Motor Development in
Asija Rota Čeprnja1, Shelly Melissa Pranić2, Martina Šunj3
1Department of Physical and Rehabilitation Medicine, University Hospital Split, Spinčićeva 1, 21000 Split, Croatia.
Insights
Children with Down syndrome (DS) and disproportionate body proportions (cephalization index ≥ 1.1) show delayed motor development compared to those with proportionate proportions. This highlights the need for individualized assessment of developmental milestones in DS.
Area of Science:
- Pediatrics
- Developmental Biology
- Genetics
Background:
- Children with Down syndrome (DS) experience developmental delays.
- Body proportionality may influence the acquisition of developmental milestones in children with DS.
- The cephalization index (CI) is a measure of body proportionality.
Purpose of the Study:
- To compare the acquisition of developmental milestones in children with DS based on body proportionality, specifically comparing those with a disproportionate CI (≥ 1.1) to those with a proportionate CI (< 1.1).
- To develop a motor development model to predict milestone acquisition times in children with DS.
Main Methods:
- A 20-year prospective cohort study involving 47 children with DS (aged 3 months to 5 years).
- Children were grouped into proportionate (CI < 1.1) and disproportionate (CI ≥ 1.1) based on head circumference to birth weight ratio.
- A modified Munich Functional Developmental Diagnostic Scale assessed 28 motor milestones; linear regression predicted acquisition times.
Main Results:
- Children with disproportionate CI were delayed in acquiring a prone position (2.81 months), standing before walking (1.29 months), and a supine position (1.61 months) compared to proportionate CI.
- Both groups took longer to reach standing after independent walking, with disproportionate CI children showing a greater delay (4.50 vs. 4.09 months).
- Milestone acquisition order was predictable but slower in the disproportionate CI group.
Conclusions:
- Children with Down syndrome and disproportionate body proportions exhibit slower motor milestone acquisition.
- These findings suggest a need to categorize motor developmental delays in DS into distinct functional groups for better clinical assessment.
- Individualized assessment considering body proportionality is crucial for understanding developmental trajectories in children with DS.
Abstract:
Background: Children with Down syndrome (DS) lag behind typical children in the acquisition of developmental milestones, which could differ depending on body proportionality. We aimed to determine the difference in the acquisition of developmental milestones in children with DS with a disproportionate cephalization index (CI) compared to a proportionate CI. We created a motor development model that predicted milestone acquisition times. Methods: In this 20-year prospective cohort study, 47 children with DS aged 3 months to 5 years, followed up to 2020, were grouped according to the ratio of head circumference to birth weight (HC/BW) or CI into proportionate (CI < 1.1) and disproportionate (CI ≥ 1.1). We used a modified Munich Functional Developmental Diagnostic Scale that was assessed for reliability and content validity (Levene’s test and discriminant analysis) to determine 28 motor milestones. Linear regression was used to predict time to milestone acquisition, controlling for sex, maternal age, and birth weight. Results: Compared to proportionate CI, children with disproportionate CI were delayed in the milestone acquisition of a prone position by 2.81 months, standing before walking by 1.29 months, and a supine position by 1.61 months. Both groups required more time to reach standing after the acquisition of independent walking, but children with disproportionate CI reached those milestones later (4.50 vs. 4.09 months, p < 0.001). Conclusion: Children with disproportionate CI acquired milestones in a predictable order but slower than those with a proportionate CI. Our findings support the need to classify the degree of motor developmental delay in children with DS into unique functional groups rather than rely on clinicians’ arbitrary descriptions of the timing of developmental delays in children with DS.
