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Randomized Controlled Trial
. 2015 Mar;135(3):e624-34.
doi: 10.1542/peds.2014-1566.

Cognitive outcomes after neonatal encephalopathy

Athina Pappas  1 , Seetha Shankaran  2 , Scott A McDonald  3 , Betty R Vohr  4 , Susan R Hintz  5 , Richard A Ehrenkranz  6 , Jon E Tyson  7 , Kimberly Yolton  8 , Abhik Das  9 , Rebecca Bara  2 , Jane Hammond  9 , Rosemary D Higgins  10 ; Hypothermia Extended Follow-up Subcommittee of the Eunice Kennedy Shriver NICHD Neonatal Research Network
Collaborators, Affiliations
Randomized Controlled Trial

Cognitive outcomes after neonatal encephalopathy

Athina Pappas et al. Pediatrics. 2015 Mar.

Abstract

Objectives: To describe the spectrum of cognitive outcomes of children with and without cerebral palsy (CP) after neonatal encephalopathy, evaluate the prognostic value of early developmental testing and report on school services and additional therapies.

Methods: The participants of this study are the school-aged survivors of the National Institute of Child Health and Human Development Neonatal Research Network randomized controlled trial of whole-body hypothermia. Children underwent neurologic examinations and neurodevelopmental and cognitive testing with the Bayley Scales of Infant Development-II at 18 to 22 months and the Wechsler intelligence scales and the Neuropsychological Assessment-Developmental Neuropsychological Assessment at 6 to 7 years. Parents were interviewed about functional status and receipt of school and support services. We explored predictors of cognitive outcome by using multiple regression models.

Results: Subnormal IQ scores were identified in more than a quarter of the children: 96% of survivors with CP had an IQ <70, 9% of children without CP had an IQ <70, and 31% had an IQ of 70 to 84. Children with a mental developmental index <70 at 18 months had, on average, an adjusted IQ at 6 to 7 years that was 42 points lower than that of those with a mental developmental index >84 (95% confidence interval, -49.3 to -35.0; P < .001). Twenty percent of children with normal IQ and 28% of those with IQ scores of 70 to 84 received special educational support services or were held back ≥1 grade level.

Conclusions: Cognitive impairment remains an important concern for all children with neonatal encephalopathy.

Keywords: cognitive outcomes; hypoxic ischemic encephalopathy; neonatal encephalopathy.

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Figures

FIGURE 1
FIGURE 1
Follow-up of a study population with moderate and severe neonatal encephalopathy. Among 140 survivors to 6–7 years, 110 infants (79%) had both 18- to 22-month and 6- to 7-year assessments and make up the participants of this study.
See this image and copyright information in PMC

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