(50) Early Neuromotor Impairments in Infants with down Syndrome

Background:

Background: Developmental delays are well-documented in infants with Down Syndrome (DS), but less is known about neurological screening in this population. The Hammersmith Infant Neurological Examination (HINE) and General Movement Assessment (GMA) assess early neuromotor function and screen for cerebral palsy (CP).

Objectives:

Objectives:  To examine neuromotor findings in infants with DS at 3-5 months corrected age (mo CA) using HINE and GMA. Understanding results of these tools may allow clinicians guidance for prescribing interventions and parent counseling.

Design/Methods:

Design/Methods:  Infants with DS born 2019-2024 evaluated with GMA and or HINE at Lurie Children’s Hospital of Chicago at 3-5 months CA were included. HINE is a neurologic exam that provides a total and asymmetry score from 2-24 mo CA. High-risk cut off score is < 57. GMA is a video evaluation of spontaneous movements by certified examiners. Global ratings of fidgety movements (normal, abnormal, or absent) and detailed scoring (Motor Optimality Score-Revised, MOS-R) are obtained. Absent fidgety are strongly correlated to development of severe neurological impairment or CP. The MOS-R quantifies movement and postural pattern. MOS-R scores >25 are considered optimal.

Results:

Results:  50 infants were studied (Table 1). The GMA was performed in 39 infants (normal fidgety movements, n= 37, absent fidgety movements, n=2). 86% of the infants had MOS-R < 25 (M 22.6, SD 3.2). Infants with and without cardiac surgery (n=31) did differ in their GMA results.

Of 31 infants tested with the HINE, 71% scored < 57 (Table 2). The 17 infants with cardiac surgery had lower total scores (p=.002) and lower movement (p=.024) and tone (p=.005) sub scores than those without. 2 infants had absent fidgety movements: one was labeled high-risk for CP by physiatry at 7 months CA and later died. The other has not been diagnosed with CP but has global developmental delay. One infant with brain injury was diagnosed with CP had normal fidgety but 7 HINE asymmetries.

Conclusions:

Conclusion: Most infants with DS had fidgety movements. High rates of early neuromotor impairments and scores below cutoffs on both HINE and GMA were observed with poorer movements and muscle tone after cardiac surgery. Establishing expected scores in infants with DS may guide providers in high-risk screening. Larger studies and follow up over time will be beneficial. These results support very early intervention and therapies for infants with DS.