2013 - ISBTS 2013 Symposium

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Posters and Exhibition

15.86 - A Prospective Pilot Study of Neurodevelopmental Outcomes of Infants with Intestinal Failure

Presenter: Stephanie, So, , Canada
Authors: Stephanie So1,6, Anna Gold2,6, Catherine Patterson1,6, Alaine Rogers3,6, Aliza Friedman2, Karolina M. Burghardt4,6, Yaron Avitzur4,6, Paul W. Wales5,6

A Prospective Pilot Study of Neurodevelopmental Outcomes of Infants with Intestinal Failure

Stephanie So1,6, Anna Gold2,6, Catherine Patterson1,6, Alaine Rogers3,6, Aliza Friedman2, Karolina M. Burghardt4,6, Yaron Avitzur4,6, Paul W. Wales5,6

1Department of Rehabilitation Services, Division of Physiotherapy, Hospital for Sick Children, Toronto, ON, Canada; 2Department of Psychology, Hospital for Sick Children, Toronto, ON, Canada; 3Department of Rehabilitation Services, Division of Occupational Therapy, Hospital for Sick Children, Toronto, ON, Canada; 4Department of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada; 5Department of General Surgery, Hospital for Sick Children, Toronto, ON, Canada; 6Group for the Improvement of Intestinal Function and Treatment (GIFT), Hospital for Sick Children, Toronto, ON, Canada

 

Purpose: Infants with intestinal failure (IF) may be at increased risk of developmental delay. This study examines neurodevelopmental outcomes in a cohort of children with IF from 0-15 months.
 
Method: Prospective neurodevelopmental assessment over the first 15 months of life in infants admitted to IF program during 2011. Instruments applied included: General Movements Assessment (GM), Movement Assessment of Infants (MAI), Alberta Infant Motor Scales (AIMS) and Mullen Scales of Early Learning.
 
Results:12 infants [5 males, median gestational age 34.5(IQR 29.8-36.0) weeks, birth weight (BW) 2.14(IQR 1.18-2.44) kg]. Eleven patients had abnormal GM scores. At 4 months, 9/12 scored ≤10% (relative to age-matched norms) on the AIMS and 8/12 had ≥8 total-risk points (moderate/high risk for neuromotor dysfunction) on the MAI. At 8 months, 8/12 were ≤10% on the AIMS and 10/12 were moderate/high risk on the MAI. At 12-15 months, 5 children scored both ≤5% on the AIMS and below average/very low on the Mullen early learning composite score and 10 children scored below average/very low on the Mullen gross motor scale.
 
Factors associated with outcome at 12-15 months: BW <1.5kg was associated with scores ≤10% on the AIMS (p=0.023). Duration of NICU admission and abnormal brain imaging was associated with below average/very low scores on Mullen fine motor scale (p=0.004 and p=0.01, respectively). Hospital admission days trended to below average/very low scores on the Mullen gross motor scale (p=0.061). Greater than 2 septic episodes was associated with below average/very low scores on Mullen expressive (p=0.05) and receptive language (p=0.038) and >2 surgeries with average/very low scores on receptive language (p=0.028). A normal result on the 4 month MAI was associated with a 62% relative risk reduction in scoring ≤10% on the AIMS at 12-15 months.
 
Conclusion: This pilot study suggests multiple risk factors may contribute to developmental delay in children with IF within the first 15 months of life. Ongoing developmental follow-up and referral to appropriate community therapy services is needed for this population. 

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