School-age outcomes of children without cerebral palsy cooled for neonatal hypoxic-ischaemic encephalopathy in 2008-2010.
OBJECTIVE
Since therapeutic hypothermia became standard care for neonatal hypoxic-ischaemic encephalopathy (HIE), even fewer infants die or have disability at 18-month assessment than in the clinical trials. However, longer term follow-up of apparently unimpaired children is lacking. We investigated the cognitive, motor and behavioural performances of survivors without cerebral palsy (CP) cooled for HIE, in comparison with matched non-HIE control children at 6-8 years.


DESIGN
Case-control study.


PARTICIPANTS
29 case children without CP, cooled in 2008-2010 and 20 age-matched, sex-matched and social class-matched term-born controls.


MEASURES
Wechsler Intelligence Scales for Children, Fourth UK Edition, Movement Assessment Battery for Children, Second Edition (MABC-2) and Strengths and Difficulties Questionnaire.


RESULTS
Cases compared with controls had significantly lower mean (SD) full-scale IQ (91 [10.37]vs105[13.41]; mean difference (MD): -13.62, 95% CI -20.53 to -6.71) and total MABC-2 scores (7.9 [3.26]vs10.2[2.86]; MD: -2.12, 95% CI -3.93 to -0.3). Mean differences were significant between cases and controls for verbal comprehension (-8.8, 95% CI -14.25 to -3.34), perceptual reasoning (-13.9, 95% CI-20.78 to -7.09), working memory (-8.2, 95% CI-16.29 to -0.17), processing speed (-11.6, 95% CI-20.69 to -2.47), aiming and catching (-1.6, 95% CI-3.26 to -0.10) and manual dexterity (-2.8, 95% CI-4.64 to -0.85). The case group reported significantly higher median (IQR) total (12 [6.5-13.5] vs 6 [2.25-10], p=0.005) and emotional behavioural difficulties (2 [1-4.5] vs 0.5 [0-2.75], p=0.03) and more case children needed extra support in school (34%vs5%, p=0.02) than the control group.


CONCLUSIONS
School-age children without CP cooled for HIE still have reduced cognitive and motor performance and more emotional difficulties than their peers, strongly supporting the need for school-age assessments.
['Lee-Kelland|Richard|R|', 'Jary|Sally|S|', 'Tonks|James|J|', 'Cowan|Frances M|FM|', 'Thoresen|Marianne|M|', 'Chakkarapani|Ela|E|http://orcid.org/0000-0003-3380-047X']
D016022:Case-Control Studies D002648:Child D002653:Child Behavior Disorders D032882:Comprehension D000080103:Emotional Regulation D005260:Female D005500:Follow-Up Studies D006801:Humans D007036:Hypothermia, Induced D020925:Hypoxia-Ischemia, Brain D007231:Infant, Newborn D008297:Male D008570:Memory, Short-Term D009048:Motor Skills D065886:Neurodevelopmental Disorders D009483:Neuropsychological Tests D011446:Prospective Studies D011597:Psychomotor Performance D006113:United Kingdom D014888:Wechsler Scales
school-age hypoxic-ischaemic encephalopathy therapeutic hypothermia cognitive motor behavioural outcomes