Developmental outcomes found after traumatic brain injury in young children

Young children with severe traumatic brain injury (TBI) will experience little recovery, according to a recent study.

Some of the highest rates of pediatric TBI are seen in preschool-aged children, but the long-term outcomes of TBI in this age group are unclear. As skills in very young children undergo rapid development, concerns have arisen over the effects of injury on this development.

Severe TBI has been associated with lower cognition and academic performance in children injured as infants and toddlers. Studies have also recorded slight difference in intelligence and behavior for very young children with mild TBI.

To evaluate longitudinal outcomes in very young children with mild and severe TBI, investigators examined outcomes in the first 3 years following TBI in children aged under 31 months.

Participants were recruited from Primary Children’s Hospital in Salt Lake City, Utah, and the University of Texas Health Science Center at Houston. Severe developmental delay and very preterm birth were exclusion criteria for the study.

Data analysis occurred from May 12 to October 20, 2021. Children were categorized into a TBI group and comparison group. TBI severity was measured for children in the TBI group through the lowest emergency department pediatric Glasgow Coma Scale. Mild, moderate, and severe levels of TBI were recorded.

In the comparison group, children had an upper or lower extremity long bone fracture, with no clinical signs of TBI. The comparison group was implemented into the study to determine that the effects of TBI are not related to general injuries.

Data on demographic characteristics, developmental outcomes, and family function and support were collected through a survey administered to parents. This data was collected as soon as possible following injury, with follow-ups occurring at 3, 12, 24, and 36 months.

Parents reported communication, gross motor, fine motor, problem-solving, and personal social skills in their children aged 1 to 60 months through the Ages & Stages Questionnaire-3 (ASQ-3), with a higher score indicating more advanced development. The mean score in a reference population was 50.

There were 168 children in the study who completed at least 1 follow-up assessment, 160 of which completed a 12-month follow-up and 134 a 36-month follow-up. Mild TBI was seen in 48 children in the study cohort, while complicated mild or moderate TBI was seen in 54 and severe TBI in 21. Finally, 45 participants presented with orthopedic injury (OI).

Family function, social capital, and income were similar across injury groups preinjury. However, mean ASQ-3 scores were significantly worse in children with severe TBI for all domains compared to other groups. 

During follow-ups, children with mild or moderate TBI performed similarly to those with OI, while children with severe TBI showed deficits in all domains. While there was a slight decrease in score for children with mild or moderate TBI, the differences were not statistically significant.

As children with severe TBI showed little recovery, investigators recommended early childhood intervention to manage longitudinal developmental outcomes.

Reference

Keenan HT, Clark A, Holubkov R, Ewing-Cobbs L. Longitudinal developmental outcomes of infants and toddlers with traumatic brain injury. JAMA Netw Open. 2023;6(1):e2251195. doi:10.1001/jamanetworkopen.2022.51195