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Children Who Receive Therapeutic Hypothermia for HIE but did not develop Cerebral Palsy, have Reduce Cognitive and Motor Performance at 6-8 years

Presented at the Neonatal Society 2017 Spring Meeting.

Lee-Kelland R1, Tonks J1, Jary S1, Cowan F1, Thoresen M1,2, Chakkarapani E1

1 University of Bristol, UK
2 University of Oslo, Norway

Background: In the pre therapeutic hypothermia (TH) era, school aged children who had hypoxic-ischaemic encephalopathy (HIE) in the newborn period, even in the absence of cerebral palsy (CP), were reported to have lower cognitive scores than typically developing peers (1). No equivalent data exists for non-CP related motor performance. It is unknown whether the cognitive and motor performance of this group, having received TH would differ from typically developing children. We hypothesize that children who received TH for HIE, but who did not develop CP would have reduced cognitive and motor performance at 6 to 8 years.

Methods: Forty-eight children (28 cases and 20 age, sex and social class matched controls) were assessed between 6- 8 years of age. All cases were treated for moderate/severe HIE with TH at St Michael’s Hospital, Bristol. The children completed a cognitive assessment administered by psychologists blinded to case/control status using the Wechsler Intelligence Scales (WISC-IV). A paediatrician administered the Movement ABC-2 (MABC-2) to assess motor performance and a neurological examination to exclude CP. The study was funded by the Baily Thomas, David Telling, Moulton and SPARKS Charitable Trusts and received ethical approval (14.sw.0148). Mann-Whitney U test was used to compare the distribution of test scores.

Results: Children who received TH for HIE had significantly lower distributions of WISC-IV full-scale IQ scores than the control group (median (IQR)): 92 (85-99) vs 103.5 (96.25-117.75) p=0.001). This included the subscales of verbal comprehension, (median (IQR): 95 (89-99) vs 104 (96.25-109.5) p=0.003), perceptual reasoning (90 (82-98) vs 100 (92.5-112) p=0.001) and processing speed (97 (88-103) 106 (97-122.5) p=0.021). MABC-2 total scaled scores were also significantly lower (median (IQR) 8 (6-10.75) vs 10 (8-11.75) p=0.047) compared to typically developing children as well as manual dexterity scores (median (IQR): 8 (5-10.75) vs 10 (9-12) p=0.017) No statistically significant difference was found in the MABC-2 aiming or catching or balance subscales.

Conclusion: Despite the improvement in outcomes in HIE following the introduction of TH [2], affected children, even those who do not develop CP, remain at increased risk of cognitive and motor difficulties compared to agematched controls.

Corresponding author: ela.chakkarapani@bristol.ac.uk

1. Marlow et al 2005
2. Jacobs el al 2013

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