Predictors of Developmental Delays and Therapy Resource Utilization in Craniosynostosis Patients

Rates of developmental and speech delays in the general population range from 2% to 19%. Although craniosynostosis has been linked to developmental delays, this study aims to uncover patient characteristics that may independently impact rates of cognitive and speech delays in synostosis patients.

A retrospective chart review identified craniosynostosis patients undergoing surgical correction at our institution from 2016 to 2023. Logistic regression identified predictors of developmental and speech delays. Variables included age, sex, insurance status, sutural involvement, surgical approach, revision surgery, and neurodevelopmental comorbidities. Delay comorbidities were defined as coexistent patient conditions impacting long-term speech and cognition apart from their synostosis. Syndromic cases were excluded from predictive analysis.

A total of 259 nonsyndromic patients underwent either endoscopic (53%) or open (47%) surgical correction. Median age at surgery was 4.2 months [IQR: 2.7-10.4 mo]. Revision surgery was performed in 3.1% of patients. Developmental delay was diagnosed in 10.0%; 14.7% had speech delays. The most prevalent neurodevelopmental comorbidities included autism (3.9%), hydrocephalus (3.9%), hearing loss (3.5%), and epilepsy (1.5%). Delay comorbidities [OR: 1.31; 95% CI: 1.17-1.47; P <0.001] and need for revision surgery [OR: 1.46; 95% CI: 1.19-1.80; P <0.001] increased the odds of a concurrent developmental delay diagnosis. Odds of speech delay were also increased by delay comorbidities [OR: 1.43; 95% CI: 1.25-1.64; P <0.001] and revision surgery [OR: 1.38; 95% CI: 1.08-1.78; P =0.01]. Factors associated with longitudinal rehabilitation resource utilization at latest follow-up were delay comorbidities [OR: 1.49; 95% CI: 1.26-1.76; P <0.001], age at surgery >6 months [OR: 1.26; 95% CI: 1.06-1.49; P =0.008], male sex [OR: 1.13; 95% CI: 1.01-1.26; P =0.04], and use of early intervention/school programs [OR: 1.53; 95% CI: 1.16-2.02; P =0.003].

Rates of developmental delays in patients undergoing surgical correction of craniosynostosis mirror those of the general population. Consistent predictors of developmental delays in craniosynostosis patients include the need for revision surgery and coexistent developmental comorbidities. Notably, surgical approach, sutural involvement, and age at surgery >6 months were not independent predictors of developmental or speech delays. Future studies linking synostosis to developmental delays and assessing neuropsychological outcomes after surgery should control for these factors.