Historically the evaluation and reporting of neurodevelopmental outcomes following perinatal brain injury have been limited to good outcome/poor outcome or disabled/not disabled. More infants are surviving and new treatments to protect the brain require careful testing. Sensitive measures of evaluating developmental outcome in infants with the poorest outcome are required. The aims of this thesis are to describe developmental measures widely used; to examine data arising from a key developmental measure in two groups of children with perinatal brain injury; to use the data to quantify the abilities of even the most severely affected and to compare these findings with neuroimaging in infants with Post Haemorrhagic Ventricular Dilatation (PHVD); and to compare findings of two different editions of the key measure in a group of infants with Neonatal Encephalopathy (NE). Formal assessment at 2 years using the Bayley Scales of Infant Development (Bayley-2) confirmed wide-ranging, but frequently poor outcome, in infants with PHVD. Bayley Developmental Quotients (DQ), used in preference to conventional Bayley-2 Index scores, were found to differentiate between grades of functional ability and disability, even in the most severely delayed infants. Bayley DQ correlated strongly with parenchymal lesion area measured on neonatal cranial ultrasound scans but increasing ventricular size was not associated with reductions in Bayley DQ in infants with preceding grade 3 IVH. Cerebral, thalamic and cerebellar brain volumes from MRI scanning at term age were found to be significantly affected in this cohort. Smaller brain volumes were associated with decreasing Bayley DQ and with motor development in particular. These findings have the potential to enhance the precision of outcome prediction in infants with PVHD which may be of use to clinicians in informing early direction of care and in providing information to families about developmental challenges facing their baby. Comparative study of Bayley-2 scores with revised Bayley Scales of Infant and Toddler Development (Bayley-3) in infants with NE, found higher than expected Bayley-3 scores particularly in those with severe delay. Increased Bayley-3 cut-off thresholds for severe disability are recommended when comparing outcomes using different versions of the test.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:665148 |
| Date | January 2014 |
| Creators | Jary, Sally Louise |
| Publisher | University of Bristol |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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