The Spectrum of Abnormal Neurologic Outcomes Subsequent to Term Intrapartum Asphyxia

Al-Macki, Nabil; Miller, Steven P.; Hall, Nicholas R.; Shevell, Michael

doi:10.1016/j.pediatrneurol.2009.06.001

Cited by 72 publications

(45 citation statements)

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“…13 Yet early human studies reported neurocognitive and behavioral problems even among the nondisabled survivors of HIE. [14][15][16][17][18][19][20][21] The use of more precise definitions of presumed HIE and the introduction of therapeutic hypothermia may have altered the association between neuromotor and cognitive outcomes, potentially altering the disease phenotype.We previously reported on the childhood outcomes of participants in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN) randomized controlled trial of whole-body hypothermia. 22 The aims of the current study were to describe the spectrum of cognitive outcomes of children with moderate and severe HIE with and without CP and neuromotor impairment, evaluate the prognostic value of early developmental testing and other predictors of school-age cognition, and report on special educational services and additional therapies.…”

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Cognitive Outcomes After Neonatal Encephalopathy

et al. 2015

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OBJECTIVES: To describe the spectrum of cognitive outcomes of children with and without cerebral palsy (CP) after neonatal encephalopathy, evaluate the prognostic value of early developmental testing and report on school services and additional therapies. METHODS:The participants of this study are the school-aged survivors of the National Institute of Child Health and Human Development Neonatal Research Network randomized controlled trial of whole-body hypothermia. Children underwent neurologic examinations and neurodevelopmental and cognitive testing with the Bayley Scales of Infant Development-II at 18 to 22 months and the Wechsler intelligence scales and the Neuropsychological Assessment-Developmental Neuropsychological Assessment at 6 to 7 years. Parents were interviewed about functional status and receipt of school and support services. We explored predictors of cognitive outcome by using multiple regression models.RESULTS: Subnormal IQ scores were identified in more than a quarter of the children: 96% of survivors with CP had an IQ ,70, 9% of children without CP had an IQ ,70, and 31% had an IQ of 70 to 84. Children with a mental developmental index ,70 at 18 months had, on average, an adjusted IQ at 6 to 7 years that was 42 points lower than that of those with a mental developmental index .84 (95% confidence interval, 249.3 to 235.0; P , .001). Twenty percent of children with normal IQ and 28% of those with IQ scores of 70 to 84 received special educational support services or were held back $1 grade level. CONCLUSIONS:Cognitive impairment remains an important concern for all children with neonatal encephalopathy. WHAT'S KNOWN ON THIS SUBJECT:Surviving infants with neonatal encephalopathy treated with hypothermia have lower rates of moderate to severe cerebral palsy and cognitive impairment at 18 to 24 months. Limited data exist on the association between cognitive functioning and neuromotor, behavioral, and school outcomes.WHAT THIS STUDY ADDS: Although the incidence of death or IQ ,55 is reduced after therapeutic hypothermia, survivors of neonatal encephalopathy with and without cerebral palsy are at elevated risk for subnormal IQ and the need for specialized educational services at 6 to 7 years. Dr Pappas conceptualized and designed the study, participated in data acquisition and interpretation, and drafted the initial manuscript; Dr Shankaran participated in the conceptualization and study design, data acquisition and interpretation, and review and revision of the manuscript; Mr McDonald and Dr Das participated in the study design and data interpretation, carried out the data analysis, and reviewed and revised the manuscript; Drs Vohr, Hintz, Ehrenkranz, Tyson, Yolton, Hammond, and Higgins and Ms Bara participated in the study design, data acquisition and interpretation, and review and revision of the manuscript; and all authors approved the final manuscript as submitted. (CP) proposed that an acute intrapartum event could not result in isolated cognitive deficits. 13 Yet early human studie...

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Cognitive Outcomes After Neonatal Encephalopathy

et al. 2015

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“…16 The survivors will have long-term neurodevelopmental sequelae. 17 Hypoxicischemic encephalopathy is the primary cause of 15% to 28% of cerebral palsy among children. Perinatal asphyxia progresses to HIE based on the degree of brain injury and resulting clinical presentation.…”

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Effect of early intervention in the developmental outcome of hypoxic ischemic encephalopathy infants

Meena¹,

kurup²,

Ramesh³

et al. 2014

IOSRJDMS

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“…Despite developments in prenatal and perinatal follow-up methods, the incidence of HIE in developed countries is reported to range between 1/1000 and 2/1000 live births (3)(4). Ten-15% of the babies diagnosed with HIE die in the neonatal period, 10-15% develop cerebral palsy and 40% develop significant disabilities including cognitive disorders, neuromotor developmental delay, seizures, hearing defects and blindness (5). In the studies performed in recent years, it has been reported that the mortality rates decrease and positive neurodevelopmental outcomes are obtained with cooling therapy applied in babies with mild or severe HIE (1-2, 6-11).…”

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Comparison of selective head cooling therapy and whole body cooling therapy in newborns with hypoxic ischemic encephalopathy: Short term results

Atıcı¹,

Çelik²,

Gülaşı³

et al. 2015

Turk Arch Ped

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Aim: In this study, it was aimed to investigate which method was superior by applying selective head cooling or whole body cooling therapy in newborns diagnosed with moderate or severe hypoxic ischemic encephalopathy. Material and Methods: Newborns above the 35th gestational age diagnosed with moderate or severe hypoxic ischemic encephalopathy were included in the study and selective head cooling or whole body cooling therapy was performed randomly. The newborns who were treated by both methods were compared in terms of adverse effects in the early stage and in terms of short-term results. Ethics committee approval was obtained for the study (06.01.2010/35). Results: Fifty three babies diagnosed with hypoxic ischemic encephalopathy were studied. Selective head cooling was applied to 17 babies and whole body cooling was applied to 12 babies. There was no significant difference in terms of adverse effects related to cooling therapy between the two groups. When the short-term results were examined, it was found that the hospitalization time was 34 (7-65) days in the selective head cooling group and 18 (7-57) days in the whole body cooling group and there was no significant difference between the two groups (p=0.097). Four patients in the selective head cooling group and two patients in the whole body cooling group were discharged with tracheostomy because of the need for prolonged mechanical ventilation and there was no difference between the groups in terms of discharge with tracheostomy (p=0.528). Five patients in the selective head cooling group and three patients in the whole body cooling group were discharged with a gastrostomy tube because they could not be fed orally and there was no difference between the groups in terms of discharge with a gastrostomy tube (p=0.586). One patient who was applied selective head cooling and one patient who was applied whole body cooling died during hospitalization and there was no difference between the groups in terms of mortality (p=0.665). Conclusions: There is no difference between the methods of selective head cooling and whole body cooling in terms of adverse effects and short-term results. (Türk Ped Arş 2015; 50: 27-36)

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The Spectrum of Abnormal Neurologic Outcomes Subsequent to Term Intrapartum Asphyxia

Cited by 72 publications

References 44 publications

Cognitive Outcomes After Neonatal Encephalopathy

Cognitive Outcomes After Neonatal Encephalopathy

Effect of early intervention in the developmental outcome of hypoxic ischemic encephalopathy infants

Comparison of selective head cooling therapy and whole body cooling therapy in newborns with hypoxic ischemic encephalopathy: Short term results

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