Long-Term Neurodevelopmental Outcome with Hypoxic-Ischemic Encephalopathy

Abstract

OBJECTIVES: To determine the long-term neurodevelopmental outcome for children after hypoxic-ischemic encephalopathy (HIE) without major disability, and to examine neonatal injury patterns detected on cerebral magnetic resonance imaging (MRI) in relation to later deficits. STUDY DESIGN: Prospectively enrolled children with HIE and neonatal cerebral MRI data (n = 68) were examined at a mean age of 11.2 years (range, 8.2-15.7 years). Eleven children had a major disability (ie, cerebral palsy or mental retardation). Brain injury was scored according to the region and extent of injury. RESULTS: Children without major disability (n = 57) had lower full-scale and performance IQ scores compared with norms (P = .02 and .01, respectively), and the proportion of children with an IQ <85 was higher than expected (P = .04). Motor performance on the Zurich Neuromotor Assessment was affected in the pure motor, adaptive fine motor, and gross motor domains, as well as in the movement quality domain (all P < .001). Watershed injury pattern on neonatal MRI correlated with full-scale and verbal IQ scores (P = .006 and <.001, respectively), but neonatal MRI pattern did not correlate with motor performance in children without major disability. CONCLUSION: Children who sustained neonatal HIE without major disability are at increased risk for long-term intellectual, verbal, and motor deficits. The severity of watershed injury is correlated with later intellectual performance. Long-term follow-up examinations are necessary for early detection of neurodevelopmental impairment and early initiation of adequate therapies. AbstractObjectives: To determine the long-term neurodevelopmental outcome for children after hypoxic-ischemic encephalopathy without major disability and to examine the role of neonatal cerebral MRI injury patterns in relation to later deficits.Study design: Sixty-eight prospectively enrolled children with hypoxic-ischemic encephalopathy and neonatal cerebral MRI were examined at a mean age of 11.2 years (range 8.2 -15.7 years). Eleven children had a major disability (cerebral palsy or mental retardation). Brain injury was scored according to region and extent of injury.Results: Children without major disability (n=57) had lower total and performance IQ scores compared to the norm (p=0.02 and 0.01, respectively) and the proportion of children with an IQ < 85 was higher than that expected (p= 0.04). Motor performance on the Zurich Neuromotor Assessment was affected in the domains 'pure motor', 'adaptive fine' and 'gross motor' as well as in the domain 'movement quality' (all p-values< 0.001). Watershed injury pattern on neonatal MRI correlated with total and verbal IQ (p=0.006 and < 0.001, respectively), while neonatal MRI pattern did not correlated with motor performance in children without major disability. Conclusions:Children after neonatal hypoxic-ischemic encephalopathy without major disability are at higher risk for long-term intellectual, verbal and motor deficits. Severity of watershed injury correlates ...

Severe Neonatal Anaemia, MRI Findings and Neurodevelopmental Outcome

“…Third, a full neurodevelopmental assessment was not performed routinely. It would therefore be desirable to have a follow-up in these patients at school age to study whether the white matter lesions are associated with school performance, as has previously been shown in survivors with white matter injury in the context of hypoxic ischaemic encephalopathy [13]. More insight in the association between patterns of damage and possible pathophysiological mechanisms, combined with neurological outcome, will hopefully provide more insight in how to predict future disabilities during the newborn period.…”

Comparison of early and late MRI in neonatal hypoxic–ischemic encephalopathy using three assessment methods

“…It distinguished normal/subnormal MR images (normal MRI, punctate periventricular white matter injury pattern, and watershed pattern with a W score ≤2) and abnormal MR images (watershed pattern with W score >2, central or diffuse pattern). Punctate periventricular white matter injuries and watershed injuries limited to anterior or posterior white matter are known to be associated with a favorable outcome -no or mild to moderate neurodevelopmental disabilities in childhood -in studies performed before the introduction of hypothermia [4,22,[24][25][26][27]. More extensive watershed injuries and central and diffuse patterns are associated with a poor outcome [1,24].…”

“…The overall BG score was 4, whereas the conventional imaging BG score was 2 Results are expressed as number of neonates with abnormal posterior limb of internal capsule signal intensity/ total number of neonates most watershed zone injuries were associated with central lesions or involved diffuse white matter and were classified as diffuse patterns according to our criteria. In some studies watershed injuries have been classified as watershedpredominant patterns of injury, involving lesions of more heterogeneous severity [15,16,25,27,[34][35][36]. The use of a diffuse pattern in our classification was interesting because it enabled more severe injuries to be classified in a separate group.…”

Long - Term Outcomes of Hypoxic - Ischemic Encephalopathy of Newborns

“…Діти, які зазнали ушкодження центральної нер-вової системи (ЦНС) в перинатальному періоді та не мали важкої інвалідності, мають підвищений ризик для довгострокового інтелектуального роз-витку, мовних та рухових порушень [4], а також помірно негативний вплив на розвиток поведін-кових порушень [5].…”