School-age outcomes of children without cerebral palsy cooled for neonatal hypoxic–ischaemic encephalopathy in 2008–2010

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Abstract
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.
Funding Information
  • David Telling Charitable Trust
  • SPARKS Children’s Charity
  • JP Moulton Charitable Trust
  • Baily Thomas Charitable Fund

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