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Social Communication Development In Children Aged 6-8 Years, Without Cerebral Palsy Cooled For Neonatal Hypoxic Ischaemic Encephalopathy.

Authors
Robb T.J., Tonks J., Jary S., Byrne H.Y., Thoresen M., Chakkarapani E.

Institution(s)
Translational Health Sciences, St Michael’s Hospital, University of Bristol, UK. University of Exeter, UK. Division of Physiology, Institute of Basic Medical Sciences, University of Oslo, Norway.

Introduction
School-age children without cerebral palsy (CP), who were treated with therapeutic hypothermia for neonatal hypoxic ischaemic encephalopathy (HIE), have worse cognitive and behavioural scores compared with peers.1 Communication abilities in these children have not been studied. Given the impaired cognitive skills, we hypothesised that school-aged children without CP cooled for HIE will have impaired communication abilities compared with peers.

Methods
Parents and caregivers completed the validated communication screening questionnaire, the Children’s Communication Checklist (CCC-2), for 51 children without CP who were cooled for HIE between 2008-2013 (case) and 43 age, sex and social class matched controls during an assessment day. The CCC-2 consists of 10 subscales. Sum of 8 subscales yield general communication composite (GCC) with mean (SD) of 80(15). GCC<55 indicates clinically significant communication problems.2 Children with permanent hearing loss were excluded. Case-control group differences in GCC and subscale scores were compared using unpaired t-tests.

Results
Case children did not differ from controls for age (mean (SD): 83.84 months (6.86) vs 84.56 (6.3)), sex (female:
39% vs 49%) and social class. Two case children with permanent hearing loss were excluded. Cases had significantly lower mean (SD) GCC scores than controls (75.2 (19.6) vs 83.06 (17.0), p=0.04). There was a higher proportion of case children with GCC<55 than controls (14.2% vs 4.6%). In considering the subscales of the CCC-2, cases had a significantly lower median (IQR) ‘Syntax’ (structural language awareness) subscale score (10, (7.5, 12) compared to controls (12 (9,12), p=0.02. Cases compared with controls also had a significantly lower median (IQR) ‘inappropriate initiation’ subscale score (9 (7,11) vs 10 (9,12), p=0.04) and ‘Interests’ (restricted interests) subscale score (9 (7,10) vs 10(8,11), p=0.04).

Conclusions
Our findings indicate that children without CP who were cooled for neonatal HIE are at increased risk of subtle communication difficulties compared to matched controls and therefore ongoing monitoring of communication-specific abilities is recommended in childhood and adolescence.

References
Lee-Kelland R, et al. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2020 Jan 1;105(1):8-13.
Norbury C F, et al. Int J Lang Comm Dis 2004; 39 (3): 345-364.

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