School-age outcomes of children after perinatal brain injury: a systematic review and meta-analysis

Abstract

BackgroundOver 3000 children suffer a perinatal brain injury in England every year according to national surveillance. The childhood outcomes of infants with perinatal brain injury are however unknown.MethodsA systematic review and meta-analyses were undertaken of studies published between 2000 and September 2021 exploring school-aged neurodevelopmental outcomes of children after perinatal brain injury compared with those without perinatal brain injury. The primary outcome was neurodevelopmental impairment, which included cognitive, motor, speech and language, behavioural, hearing or visual impairment after 5 years of age.ResultsThis review included 42 studies. Preterm infants with intraventricular haemorrhage (IVH) grades 3–4 were found to have a threefold greater risk of moderate-to-severe neurodevelopmental impairment at school age OR 3.69 (95% CI 1.7 to 7.98) compared with preterm infants without IVH. Infants with perinatal stroke had an increased incidence of hemiplegia 61% (95% CI 39.2% to 82.9%) and an increased risk of cognitive impairment (difference in full scale IQ −24.2 (95% CI –30.73 to –17.67) . Perinatal stroke was also associated with poorer academic performance; and lower mean receptive −20.88 (95% CI –36.66 to –5.11) and expressive language scores −20.25 (95% CI –34.36 to –6.13) on the Clinical Evaluation of Language Fundamentals (CELF) assessment. Studies reported an increased risk of persisting neurodevelopmental impairment at school age after neonatal meningitis. Cognitive impairment and special educational needs were highlighted after moderate-to-severe hypoxic-ischaemic encephalopathy. However, there were limited comparative studies providing school-aged outcome data across neurodevelopmental domains and few provided adjusted data. Findings were further limited by the heterogeneity of studies.ConclusionsLongitudinal population studies exploring childhood outcomes after perinatal brain injury are urgently needed to better enable clinicians to prepare affected families, and to facilitate targeted developmental support to help affected children reach their full potential.

Primary school attainment outcomes in children with neurodisability: Protocol for a population-based cohort study using linked education and hospital data from England

“…A similar pattern of attainment is observed in a cohort of children with ADHD in Scotland, whereby these children were more likely to underperform on national standardised assessments and leave school before age 16 3 . This pattern of underperformance is further observed in a range of neurodisability conditions, including autism spectrum disorder (ASD) 4 , cerebral palsy 5 , hearing loss 6 , perinatal brain injury 7 , and learning disabilities 8 .…”

“…Further, children aged 7-16 years in Wales with a diagnosis of ASD and ADHD are at twice the risk of being excluded or absent from school 10 . Thus, it is possible that greater healthcare needs result in higher rates of absenteeism, contributing to worse educational outcomes for children with neurodisability compared to their unaffected peers 2,[4][5][6][7][8] . As education is a key social determinant of health in adulthood, it is crucial to understand how the complex health needs of children with neurodisability affect schooling to adequately support this population.…”