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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 1  |  Issue : 2  |  Page : 84-87

Evaluation of functional performance assessment in preterm infants with Infant Neurological International Battery


Department of Neurosciences, PDVVPF's College of Physiotherapy, Ahmednagar, Maharashtra, India

Date of Web Publication7-Jan-2016

Correspondence Address:
G Shinde Krishna
(MPTh Neurosciences), Boys Hostel, PDVVPF's Medical College, Infront of Milk Dairy, Ahmednagar, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2395-4264.173439

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  Abstract 

Context: Many studies have found that there is an increased risk of neurodevelopmental impairments in preterm and low birth weight (LBW) infants, so it is desirable to make early predictions with regard to outcome. This is important for the family, for the researchers designing appropriate follow-up and intervention programs, and for the pediatric neurologist who has to give meaningful feedback to obstetricians and neonatologists. Several studies have tried to identify infants at particularly high risk of neurological damage. In 1972, Drillien described transitory dystonia of the LBW premature infant as a common developmental deviation of motor function during the 1 st year of life.
Aims: To evaluate the functional performance (age specific motor development) in preterm infants using Infant Neurological International Battery (INFANIB).
Settings and Design: Observational study design conducted at physiotherapy OPD.
Subjects and Methods: An observational study was carried out in 100 infants who were born at 24-31 weeks gestation with age group from 4 to 9 months with a mean age of 4.3 months. The sample selection was based on convenient sampling method. The infants were evaluated according to their gestational age. The study was approved by Institutional Ethical Committee. The guardians signed an informed consent form allowing the infant's participation. INFANIB was administered on 100 preterm infants, and collected data were compared with standard values of INFANIB.
Statistical Analysis Used: Unpaired t-test was used for between group comparisons.
Results: The present study shows that premature infants have high risk of delayed pattern of motor development which is different from those infants born at term.
Conclusions: The premature infants show delayed pattern of motor development that is different from those born at term.

Keywords: Birth asphyxia, Infant Neurological International Battery, low birth weight, preterm infants


How to cite this article:
Krishna G S, Suvarna S G. Evaluation of functional performance assessment in preterm infants with Infant Neurological International Battery. Indian J Cereb Palsy 2015;1:84-7

How to cite this URL:
Krishna G S, Suvarna S G. Evaluation of functional performance assessment in preterm infants with Infant Neurological International Battery. Indian J Cereb Palsy [serial online] 2015 [cited 2017 Jul 27];1:84-7. Available from: http://www.ijcpjournal.org/text.asp?2015/1/2/84/173439


  Introduction Top


The survival of high-risk infants with premature delivery, low birth weight (LBW), intrauterine growth retardation, birth asphyxia, intraventricular hemorrhage, or chronic lung diseases has increased significantly all through the development of medical technology for perinatal care. In 2010, the World Health Organization reported that the incidence of premature delivery is 10%, and 54% of premature infants are born in Asia. [1] Premature infants comprise a special group of high-risk infants. Their motor development is different from that of healthy full-term infants, and their incidence of motor disorders is higher than their incidence of recognition and behavioral disorders. [2] The evidence is growing that the 1 st year of an infant's life is a critical period for brain development due to brain plasticity. [3],[4],[5],[6] Motor development during the 1 st year of life is rapid and extensive and is influenced by biological, environmental, and social factors. Many studies found that there is increased risk of neurodevelopmental impairments, in preterm and LBW infants, so it is desirable to make early predictions with regard to outcome. This is important for the family, for the researchers designing appropriate follow-up and intervention programs, and for the pediatric neurologist who has to give meaningful feedback to obstetricians and neonatologists. Several studies have tried to identify infants at particularly high risk of neurological damage. [1],[2] Wei Liao, En-yi Wen, Chao Li, et al. described predicting neurodevelopmental outcomes for at-risk infants: Reliability and predictive validity using a Chinese version of the Infant Neurological International Battery (INFANIB) at 3, 7, and 10 months In 1972, he concluded that the Chinese version of the INFANIB can be useful for screening infants with high-risk for neuromotor abnormality in Chinese primary care settings. Drillien described transitory dystonia of the LBW premature infant as a common developmental deviation of motor function during the 1 st year of life. Ellison et al. developed the INFANIB for the assessment of neuromotor developmental disorders in infants aged 0-18 months. It is used to evaluate infants who are born prematurely, treated in neonatal intensive care, affected by sicknesses such as meningitis and heart failure or infants whose development is slow. This scale does not require any special training to the therapists to administer. It is used to distinguish infants with a normal neuromotor function from those with the abnormal findings and to predict the need for follow-up treatment. SJ Pedersen, K Sommerfelt et al. (2000) concluded that the specificity of motor evaluation at 7 months corrected age regarding CP is unsatisfactory, since dystonia at this age is most often transient. A normal neuromotor assessment at 7 months is highly predictive of subsequent normal motor function.


  Subjects and methods Top


An observational study was carried out for 1 year in 100 infants who were born at 24-31 weeks gestation with age group from 1 to 18 months with a mean age of 4.3 months [Table 1]. The sample selection was based on convenient sampling method. The infants were evaluated according to their gestational age. This study was carried out in Department of Pediatrics, Vikhe Patil Memorial Hospital, Ahmednagar. The children of 1-18 months of either sex were included in the study whereas the children who had no parental consent, uncooperative, and admitted for unstable medical conditions were excluded from the study.
Table 1: Age and sex distribution


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The study was approved by Institutional Ethical Committee of PDVVPF's, COPT Ahmednagar. The guardians signed an informed consent form allowing the infant's participation. INFANIB was administered on 100 preterm infants, and collected data were compared with standard values of INFANIB [Table 2].
Table 2: Mean score of INFANIB according to age and sex


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The INFANIB scale was used to classify age-specific motor development for the preterm infant as normal. INFANIB is a practical and short test that can be easily integrated into the evaluations of high-risk infants. It has 20 items that examine the French angles, reflexes, tone, and postures in infants [Table 3].
Table 3: Comparison of preterm and full-term infants at 3, 7 and 10 months of corrected age


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  Results Top


The present study shows that premature infants have high risk of delayed pattern of motor development life which is different from those infants born at term.


  Discussion Top


The present study shows that premature infants commonly show the delayed pattern of motor development life which is different from those infants born at term. In the present study, premature infants with corrected age up to age 18 months show a higher proportion of motor delayed as compared to those with corrected age up to age 9 months. Prematurity is a risk factor that is believed to contribute to developmental delay (Dubowitz 1985) as such much research has been undertaken in an attempt to determine the etiology of prematurity and assess its impact on a variety of infant and toddler behaviors.

The causative factor of prematurity vary ranging from the prenatal environmental issue (e.g. maternal substance abuse) to the genetic chromosomal factor to maternal complication indeed Rosenblith and Sims-Knith (1985) explain that it is difficult to study the effect of prematurity because of multiple etiology.

Prematurity may result in neurological impairment such as periventricular leukomalacia (PVL) or intraventricular hemorrhaging and physical impairment such as hypotonia or cerebral palsy. The lower the premature infants birth weight, the more significant the neurological impairment.

Periventricular leukomalacia is one of the most serious brain injuries that can be sustained with highest rate occurring in babies weighing <1000 g. According to Feldman et al. PVL is a sensitive prognostic indicator of adverse neurodevelopmental outcomes.

Concerning premature LBW babies born with physical impairment such as hypertonia, delays in the area of motor and speech-language development may occur. For example, a child may not have the strength or control to sit; an infant may be able to sit, but not be able to crawl and walk. The same child may exhibit respiratory problems due to weak thoracic musculature and experience difficulty to vocalize. Even mild degree of hypotonia may result in some difficulties with oral motor movements, thereby possibly resulting in delayed expressive language development.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm birth: A systematic review of maternal mortality and morbidity. Bull World Health Organ 2010;88:31-8.  Back to cited text no. 1
    
2.
Lorenz JM, Wooliever DE, Jetton JR, Paneth N. A quantitative review of mortality and developmental disability in extremely premature newborns. Arch Pediatr Adolesc Med 1998;152:425-35.  Back to cited text no. 2
    
3.
Vaccarino FM, Ment LR. Injury and repair in developing brain. Arch Dis Child Fetal Neonatal Ed 2004;89:F190-2.  Back to cited text no. 3
    
4.
Palmer FB, Capute AJ. Streams of development: The keys to developmental assessment. In: Crocetti M, Barone MA, editors. Oski's Essential Pediatrics. Philadelphia: Lippincott, Williams and Wilkins; 2004. p. 120-2.  Back to cited text no. 4
    
5.
Blauw-Hospers CH, Hadders-Algra M. A systematic review of the effects of early intervention on motor development. Dev Med Child Neurol 2005;47:421-32.  Back to cited text no. 5
    
6.
de Graaf-Peters VB, Hadders-Algra M. Ontogeny of the human central nervous system: What is happening when? Early Hum Dev 2006;82:257-66.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
Subjects and methods
Results
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