Minor neurological dysfunction in children aged 5 to 7

Background/Aim. Assessment of minor neurological dysfunction (MND) provides information about a child's neurological condition which helps to identify the vulnerability of the child to the development of motor impairment, difficulties in learning or behavioral disorders. The aim of this study was to determine differences in the prevalence of MND in children from the general population with respect to age (5 and 6 years old) and sex. Methods. The examination was carried out in a preschool institution in the city of Novi Sad, Serbia. The total sample included 120 children divided into two groups according to age: 60 children aged 5 (group A) and 60 children aged 6 years (group B). The children were recruited at three randomly selected kindergartens and approximately equal sex representation, randomly selected as well. The testing was done by the Touwen's test, modified by Hadders-Algra. The results were classified into three groups: the absence of MND, presence of simple MND (presence of one or two domains of dysfunction) and the presence of complex MND (presence of at least three domains of dysfunction). Results. Sixtyseven children out of 120 (55.8%) had a normal neurological condition, while 53 (44.2%) showed MND [49 (40.8%) simple, and 4 (3.4%) complex]. MND occurred more frequently in the youngest age group than in the older children (57% vs. 32%; p = 0.01). MND was also more frequent in boys than in girls, but this difference was not statistically significant. Conclusion. Our results show the importance of testing children at preschool age in order to detect potential neurological vulnerability and timely begin with the appropriate therapy.

Limitations in the Activity of Mobility at Age 6 Years After Difficult Birth at Term: Prospective Cohort Study

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.