Early development of infants with untreated metopic craniosynostosis.

BACKGROUND

The purpose of this archival descriptive study was to examine the associations among craniosynostosis, perinatal risk factors or complications, and early cognitive development in infants diagnosed with craniosynostosis before they underwent surgery, to provide a greater empirical basis for surgical decision making and other early interventions. Specifically, it was hypothesized that there would be a greater number of infants with developmental delays than seen in the normative population. Furthermore, it was hypothesized that greater severity of synostosis would be correlated with lower cognitive and developmental scores. The secondary purpose of this study was to examine specific developmental domains such as language and motor skills in children with metopic craniosynostosis.

METHODS

The research subjects for this retrospective cross-sectional study were a consecutive series of 22 infants diagnosed with metopic synostosis: 86 percent male, ages 3.6 to 25.3 months (mean +/- SD, 10.6 +/- 6.4 months). Mean gestational age was 38.8 (2.3) months, mean birth weight was 107.7 ounces, and 48.1 percent subsequently had craniovault reconstruction. Severity of craniosynostosis was assessed by a plastic surgeon (Buchman) and a neurosurgeon (Muraszko) and was confirmed radiographically by an independent rater (Angobaldo). Cognitive status was assessed with the Bayley Scales of Infant Development, Second Edition, at a mean age 11.6 (4.8) months.

RESULTS

The mean Mental Development Index score for the sample was 96.0 (14.5), falling within the average range. Severity of synostosis was not significantly correlated with the overall Mental Development Index score. The mean language quotient for the sample was 77.3 (21.1).

CONCLUSIONS

Despite suspicions that increased severity of deformity in infants with metopic craniosynostosis correlates with decreased cognitive and motor development, no such associations could be demonstrated. The results of this study did suggest, however, that children with isolated metopic craniosynostosis might show specific developmental delays in language acquisition. Finally, there were no significant correlations between cognitive development and prenatal risk factors.