Preschool Language Outcomes following Perinatal Hypoxic-Ischemic Encephalopathy in the Age of Therapeutic Hypothermia

Abstract

Early studies following perinatal hypoxic-ischemic encephalopathy (HIE) suggested expressive language deficits and academic difficulties, but there is only limited detailed study of language development in this population since the widespread adoption of therapeutic hypothermia (TH). Expressive and receptive language testing was performed as part of a larger battery with 45 children with a mean age of 26 months following perinatal HIE treated with TH. Overall cohort outcomes as well as the effects of gender, estimated household income, initial pH and base excess, and pattern of injury on neonatal brain MRI were assessed. The cohort overall demonstrated expressive language subscore, visual-reception subscore, and early learning composite scores significantly below test norms, with relative sparing of receptive language subscores. Poorer expressive language manifested as decreased vocabulary size and shorter utterances. Expressive language subscores showed a significant gender effect, and estimated socioeconomic status showed a significant effect on both receptive and expressive language subscores. Initial blood gas markers and modified Sarnat scoring did not show a significant effect on language subscores. Binarized MRI abnormality predicted a significant effect on both receptive and expressive language subscores; the presence of specific cortical/subcortical abnormalities predicted receptive language deficits. Overall, the language development profile of children following HIE in the era of hypothermia shows a relative strength in receptive language. Gender and socioeconomic status predominantly predict expressive language deficits; abnormalities detectable on MRI predominantly predict receptive language deficits.

Early Neurological Assessment in Infants with Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia

“…All of them had a normal MRI or minimal basal ganglia lesions, optimal HINE scores in 73% and suboptimal but above 67 in the other 27%. These results are consistent with the few studies investigating language development in children with HIE post-TH, also showing significantly lower scores in expressive language even in the absence of more serious cognitive or motor difficulties or with minimal or no MRI lesions [19,20]. The interpretation of this finding is difficult for several reasons.…”

“…In the present study there was an overall higher number of males then females; this is not surprising, as the male sex is recognized to be a risk factor for neonatal HIE during the perinatal period even in those treated with hypothermia [22]; males are reported to be twice more likely to experience prenatal anoxia, hemorrhage, and infection and ischemic injury appears to be more common in boys regardless of lesion types [22]; sex differences in inflammatory responses, microglial activation, metabolic profile, brain structure and plasticity have been suggested to have a role [22,23]. It is of interest that in our cohort, males appeared to be at higher risk of lower scores on the hearing and speech subscale, in agreement with other studies also reporting that girls had better performance than boys on the expressive language [19,20].…”

Children with neonatal Hypoxic Ischaemic Encephalopathy (HIE) treated with therapeutic hypothermia are not as school ready as their peers

“…6 Twoyear-old children with HIE treated with TH, when compared to test norms, scored significantly lower on tests of expressive language and visual reception, but not on tests of receptive language 18 and speech output and complexity. 30 Currently, few studies have examined the long-term (i.e., beyond toddler age) impact of HIE on language. Future work should continue to fully evaluate potential long-term effects on language production, processing and understanding in children with HIE treated with TH.…”

The Johns Hopkins Neurosciences Intensive Care Nursery Tenth Anniversary (2009-2019): A Historical Reflection and Vision for the Future

“…This information aids in the long-term prediction of outcomes and family counseling. 11,15,[33][34][35][36][37][38] Well-established interdepartmental protocols and direct communication between neonatal intensive care unit nursing and pediatric radiology technologists greatly influence successful acquisition of diagnostic examinations.…”