The Hospital for Sick Children
Neurodevelopmental motor outcomes in young children pre and post liver transplant
Catherine Patterson1,2,5, Stephanie So1,2,5, Alaine Rogers1,3,5, Falen Fernandes1, Vicky Ng4,5.
1Rehabilitation Services, The Hospital for Sick Children, Toronto, ON, Canada; 2Physical Therapy, University of Toronto, Toronto, ON, Canada; 3Occupational Therapy, University of Toronto, Toronto, ON, Canada; 4Divison of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada; 5Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
Introduction: Motor skill acquisition in children plays an important role in their physical activity participation and overall social and physical health.1 Limited studies have examined motor development in children pre and post liver transplant (LT).
Methods: Single centre review of motor assessments performed pre-and one-year post-LT in children (0-6 years of age) who underwent a LT between January 2013-March 2018 (excluding urea cycle disorders).
Measures include: Alberta Infant Motor Scale (AIMS) which provides percentile scores and Peabody Developmental Motor Scales (PDMS-2) which provides motor quotients. Children scoring <10th percentile on the AIMS or ≥1 SD below the normative mean of 100 on PDMS-2 quotients were classified as at risk of motor delay or having below average motor skills respectively. Association of medical variables with motor outcomes was explored.
Results: The study cohort included 33 (57% female) children with diagnoses of biliary atresia (70 %), Alagille syndrome (21%), other (9%). Median age at LT was 10 (IQR 7.0-20.50) months. Developmental assessments were completed in 29 children pre-LT (median age 7 months, (IQR 4.0-11.0)) and 33 children post-LT (median age 24 months, (IQR 18.5-32.5)). Over 75% of children (22/29) were at risk for motor delay pre-LT. Gross, fine and total motor quotient mean scores one-year post-LT were significantly lower than normative data (p<.001).
A greater number of children had delays in the gross motor quotient, with 17/33 children (52%) ≥1 SD below the mean compared with 7/32 children (22%) on the fine motor and 13/32 (41%) on the total motor quotient. Children identified pre-LT to be at risk/delayed had a significantly increased risk of scoring below average on the gross motor quotient post-LT (odds ratio 11.43, 95% CI 1.12-116.7, p=0.017). International normalized ratio (INR) pre-LT correlated inversely with total motor quotient post-LT (r=-0.43, p=0.02), and height z-scores both pre-LT (r=0.45, p=0.01) and post-LT (r=0.48, p<0.01) had a positive correlation with gross motor quotients post-LT. There were no correlations between motor quotients and presence of ascites, time on wait list, length of hospitalization or age at LT.
Conclusion: Young children have an increased risk of motor delay pre-LT, which may persist one year post-LT. The severity of liver disease and growth delays may impact the development of motor skills, highlighting the need for ongoing monitoring and rehabilitation both pre and post-LT to optimize motor outcomes.
 Poitras, V. J., Gray, C. E., Borghese, M. M., Carson, V., Chaput, J.-P., Janssen, I., ...Tremblay, M. S. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Applied Physiology, Nutrition, and Metabolism.2016;41:6 S3, S197+.
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