Neurodevelopment in the transition to school in children subjected to hypothermia due to neonatal hypoxic-ischemic encephalopathy: A prospective study

Abstract

Introduction

Despite therapeutic hypothermia (TH), children with neonatal hypoxic-ischemic encephalopathy (HIE) still have a high risk of developing long-term neurodevelopmental disabilities. Magnetic resonance imaging (MRI) is a good predictor of severe injury, but neurodevelopmental prognosis in milder forms is challenging.

Aims

To characterize and compare the neurodevelopmental trajectory of children with HIE who underwent TH during the transition to school and determine the prognostic value of neonatal brain MRI.

Methods

Newborns undergoing TH were subjected to prospective neurodevelopmental and clinical follow-ups. MRI images were classified according to Weeke's score. Neurodevelopmental outcomes at 18–36 and 48–78 months of age were graded as: moderate-severe, mild, or no disabilities. Weeke's total score and gray matter (GM) and white matter (WM) subscores' predictive value were calculated at 48–78 months.

Results

Fifty-eight infants were included. Eight died (13.8 %). At 18–36 months, 72.0 % had no disability, 8.0 % mild, and 20.0 % moderate-severe. At 48–78 months, 43.6 % had no disability, 23.0 % mild, and 33.3 % moderate-severe. Comparing both time points, cognitive performance declined in 11 children (28.0 %; p = 0.002). Fifty-six percent developed neurodevelopmental sequelae. The MRI total score, GM, and WM subscores were good predictors of disability, particularly moderate-severe or death. Children with mild disability had higher MRI WM subscores than GM subscores and higher WM subscores than those with no disability.

Conclusions

Long-term follow-up is essential, even for children with normative early neurodevelopment. Neonatal MRI has strong prognostic value in distinguishing disability from no disability but is less effective in mild impairment prediction.