181 - Does 12-month motor evaluation with the WIDEA parental questionnaire predict motor outcomes at 2 years in infants with hypoxic-ischemic encephalopathy (HIE)?

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 181
Publication Number: 181.137

Natalie H. Chan, UCSF, San Francisco, CA, United States; Sarah E. Monsell, University of Washington, Seattle, WA, United States; Bryan Comstock, University of Washington School of Medicine, Seattle, WA, United States; Elizabeth E. Rogers, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Hannah C. Glass, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Jean Lowe, University of New Mexico School of Medicine, Albuquerque, NM, United States; Patrick Heagerty, University of Washington, seattle, WA, United States; Sandra Juul, Sandra Juul, Bellevue, WA, United States; Yvonne Wu, UCSF, San Francisco, CA, United States

Presenting Author(s)

Natalie H. Chan, MD, MPH (she/her/hers)

Assistant Professor, Department of Pediatrics Neonatologist, Director of ICN Follow-Up Program
UCSF (University of California, San Francisco)
San Francisco, California, United States

Background:

Infants with HIE have a high risk of abnormal motor outcomes. Early identification of delays in motor development can help direct early intervention with a goal of improving functional skills. Specialized assessments such as the General Movements Assessment or the Hammersmith Infant Neurological Exam often require expert training and are not universally accessible. Questionnaires such as the Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA) can increase accessibility and do not require in-person evaluation.

Objective:

To determine whether a low motor score on the WIDEA at 11-13 months (“1 year”) predicts adverse motor outcomes at 22-36 months (“2 years”) in infants with HIE.

Design/Methods:

This is a secondary analysis of infants with moderate-severe HIE enrolled in the HEAL trial who had motor function assessed at 1 year with the WIDEA, and at 2 years with the Bayley Scales of Infant Development, 3^rd edition (Bayley-III). Low WIDEA motor score was defined as < 25 (10^th centile), and low Bayley-III motor score as < 85 (1 standard deviation below mean). Presence and type of cerebral palsy (CP) (diplegia – DP, hemiplegia – HP, quadriplegia – QP) and Gross Motor Function Classification Scale (GMFCS) level were determined by in-person neurological evaluation. A GMFCS ≥1 indicates inability to walk 10 steps independently.

Results:

Of 435 HEAL survivors, 375 (86%) underwent both the WIDEA questionnaire at 1 year and a Bayley-III motor examination at 2 years of age. Of these 375 infants, 160 (43%) had a low WIDEA motor score and 92 (25%) had a low Bayley-III motor score. A low WIDEA motor score was correlated with a low Bayley-III motor score (beta: 1.7, 95% CI 1.5 - 1.9, p-value < 0.001, , adjusted R² 0.41) (Figure 1). A low WIDEA score was seen in all 39 infants with a GMFCS ≥1, and in 91% (51/56) of infants with CP (Figure 2). Low motor score on the WIDEA at 1 year has a high sensitivity for both CP (91%) and for GMFCS ≥1 (100%), with specificities ranging from 64%-67% (Table 1).

Conclusion(s):

A low WIDEA motor score at 1 year has high sensitivity and moderate specificity for CP, and a normal score is highly predictive of no CP. The WIDEA may be a useful screening tool among infants with HIE to identify those requiring more in-depth motor evaluation and targeted early detection of CP.

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