Limitations in the Activity of Mobility at Age 6 Years After Difficult Birth at Term: Prospective Cohort Study. Issue 8 (1st August 2016)

• Record Type: Journal Article
• Authors: van Iersel, Patricia A.M.; Algra, Annechien M.; Bakker, Saskia C.M.; Jonker, Arnold J.H.; Hadders-Algra, Mijna
• Is Part Of: Physical therapy. Volume 96:Issue 8(2016)
• Page Start: 1225
• Page End: 1233
• Publication Date: 2016-08-01
• Subjects: Physical therapy -- Periodicals; Physical therapy; Physical Therapy Modalities; Rehabilitation; Physical and Rehabilitation Medicine; Periodicals; 615.8205
• DOI: 10.2522/ptj.20150201
• Languages: English
• ISSNs: 0031-9023

Abstract

Abstract: Background: A difficult birth at term (DBAT) may manifest as fetal acidosis and low Apgar scores and is often referred to as "perinatal asphyxia, " especially when infants show signs of neonatal encephalopathy (NE). In contrast to DBAT resulting in moderate-to-severe NE, which is associated with neurodevelopmental disorders, little is known about the prognosis of less severe forms of DBAT, with or without NE. Objective: The purpose of this study was to evaluate the International Classification of Functioning, Disability and Health, Children & Youth Version activity "mobility" and other neurodevelopmental sequelae in infants with DBAT at age 6 years. Methods: The index cohort (n=62; 35 boys, 27 girls) consisted of consecutive term infants with DBAT based on clinical criteria in a Dutch nonacademic hospital from 1999 to 2005. Neonatal encephalopathy was assessed according to the Sarnat grading system and excluded infants with severe NE. The matched reference cohort (n=81; 49 boys, 32 girls) consisted of healthy term infants. The primary outcome at 6 years was limited mobility (Movement Assessment Battery for Children score ≤15th percentile). Secondary outcomes included learning and behavioral problems and the presence of minor neurological dysfunction. Results: Three children developed cerebral palsy and were excluded from analyses. Children with DBAT more often had limited mobility than children without DBAT (risk ratio [RR]=2.44; 95% confidence interval [95% CI]=1.16, 5.14). The risk of limited mobility rose with increasing severity of NE (mild NE: RR=3.38; 95% CI=1.40, 8.16; moderate NE: RR=4.00; 95% CI=1.54, 10.40), and manual abilities especially were affected (RR=4.12; 95% CI=1.40, 12.14). Learning problems, need for physical therapy, and complex minor neurological dysfunction were more common in children with DBAT than in children without DBAT. Conclusions: Term infants who develop mild or moderate NE following DBAT are at increased risk for limited mobility at age 6 years. Routine monitoring of neuromotor development in these children is warranted.