School outcomes after HIE: a population-based cohort study

Philippa Rees¹, Mithilesh Dronavalli², Ben Carter³, Barbara Bajuk⁴, Lucinda Burns⁵, Michelle Dickson⁶, John Eastwood^{7

8}, Sadia Hossain^{2

9}, Kate Lawler¹⁰, Evelyn Lee^{11

12}, Sithum Munasinghe², Andrew Page², Hannah Uebel¹³, Lauren Dicair¹⁴, Charles Green¹⁵, Chris Gale¹⁶, Ju Lee Oei^{17

18}

Affiliations

¹ Population Policy and Practice, University College London Institute of Child Health, London, UK p.rees@ucl.ac.uk.
² Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia.
³ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁴ NSW Pregnancy and Newborn Services Network, Sydney Children's Hospitals Network, St Pauls, New South Wales, Australia.
⁵ National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia.
⁶ The Poche Centre for Indigenous Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.
⁷ National Public Health Service, Te Whatu Ora-Health New Zealand, Dunedin, New Zealand.
⁸ School of Population Health, University of New South Wales, Kensington, New South Wales, Australia.
⁹ School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia.
¹⁰ Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
¹¹ Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
¹² Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia.
¹³ Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, New South Wales, Australia.
¹⁴ Private Practice, Havertown, Pennsylvania, USA.
¹⁵ Alpha Maxx Healthcare, Memphis, Tennessee, USA.
¹⁶ Academic Neonatal Medicine, School of Public Health, Imperial College London, London, UK.
¹⁷ Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.
¹⁸ School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.

PMID: 40484626
DOI: 10.1136/archdischild-2024-328346

School outcomes after HIE: a population-based cohort study

Philippa Rees et al. Arch Dis Child Fetal Neonatal Ed. 2025.

. 2025 Jun 8:fetalneonatal-2024-328346.

doi: 10.1136/archdischild-2024-328346. Online ahead of print.

Authors

Affiliations

¹ Population Policy and Practice, University College London Institute of Child Health, London, UK p.rees@ucl.ac.uk.
² Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia.
³ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁴ NSW Pregnancy and Newborn Services Network, Sydney Children's Hospitals Network, St Pauls, New South Wales, Australia.
⁵ National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia.
⁶ The Poche Centre for Indigenous Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.
⁷ National Public Health Service, Te Whatu Ora-Health New Zealand, Dunedin, New Zealand.
⁸ School of Population Health, University of New South Wales, Kensington, New South Wales, Australia.
⁹ School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia.
¹⁰ Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
¹¹ Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
¹² Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia.
¹³ Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, New South Wales, Australia.
¹⁴ Private Practice, Havertown, Pennsylvania, USA.
¹⁵ Alpha Maxx Healthcare, Memphis, Tennessee, USA.
¹⁶ Academic Neonatal Medicine, School of Public Health, Imperial College London, London, UK.
¹⁷ Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.
¹⁸ School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.

PMID: 40484626
DOI: 10.1136/archdischild-2024-328346

Abstract

Objective: To study the school performance of children with hypoxic ischaemic encephalopathy (HIE) relative to population controls from childhood to early adolescence.

Design: Population-based cohort study.

Setting: New South Wales, Australia.

Patients: All 564 159 live-born infants ≥35 weeks' gestation born between 2008 and 2013 were eligible; 550 with HIE and 558 355 population controls.

Exposure: Mild, moderate-severe HIE.

Main outcome measures: National school assessment performance at 8-9, 10-11 and 12-13 years.

Secondary outcomes: reading, writing, spelling, grammar and numeracy scores at these ages. Linear regression models estimated the adjusted mean difference (aMD) at each timepoint. Hierarchical growth-curve modelling assessed academic trajectories (adjusted β).

Results: Children with moderate-severe HIE had significantly lower total z-scores compared with controls at 8-9 years (aMD -0.70; 95% CI -0.84 to -0.52), 10-11 years (aMD -0.96; 95% CI -1.19 to -0.57) and 12-13 years (aMD -0.82; 95% CI -1.12 to -0.53), especially in reading and writing. The gap in overall mean scores remained fixed over time. Despite a lower likelihood of passing each year compared with controls, most infants with moderate-severe HIE passed each year (n=103, 62.4%). Children with mild HIE did not perform significantly differently from controls at 8-9 years (aMD -0.09; 95% CI -0.32 to 0.15), although there was a signal of worsening performance with age (β=13.54; 95% CI -21 to -6.07).

Conclusions: Children with moderate-severe HIE perform at a lower academic level than their peers, yet most meet national standards up to early adolescence. In contrast, children with mild HIE perform on par with their peers. This information is crucial for families: providing reassurance and a basis for needed support.

Keywords: Epidemiology; Follow-Up Studies; Neonatology.

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Conflict of interest statement

Competing interests: None declared.

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School outcomes after HIE: a population-based cohort study

Affiliations

School outcomes after HIE: a population-based cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

LinkOut - more resources

Full Text Sources

Miscellaneous