Abstract
Background. Data on long-term outcomes in the era before therapeutic hypothermia (TH) showed a higher incidence of cognitive problems. Since the introduction of TH, data on its results are limited. Methods. Our sample population consisted of 40 children with a history of hypoxic-ischemic encephalopathy (HIE) treated with TH, with an average age of 6.25 years (range 5.5, 7.33), 24 (60%) males; and 33 peers with an average age of 8.8 years (6.08, 9.41), 17 (51%) males. Long-term follow-up data belong to two centers in Padova and Torino. We measured general intelligence (WPPSI-III or WISC-IV) and neuropsychological functioning (language, attention, memory, executive functions, social skills, visual motor abilities). We also administered questionnaires to their parents on the children’s psychopathological profiles and parental stress. Results. We found differences between groups in several cognitive and neuropsychological domains: intelligence, visuomotor skills, executive functions, and attention. Interestingly, IQ test results effectively differentiated between the groups (HIE vs. controls). Furthermore, the incidence of psychopathology appears to be significantly higher in children with HIE (35%) than in control peers (12%). Conclusions. Our study supports previous findings on a higher incidence of neuropsychological, cognitive, and psychopathological sequelae after HIE treated with TH. As hypothesized, TH does not appear to ameliorate the outcome after neonatal HIE in those children who survive without major sequelae.
Highlights
Great improvements in outcomes have been reported in children who experience neonatal hypoxic-ischemic encephalopathy (HIE) since the introduction of therapeutic hypothermia (TH)
Differences emerged in the psychopathological scores of children and controls with hypoxicischemic encephalopathy (HIE): negative predictive value 0.88, positive predictive value 0.35, specificity 0.50, sensitivity 0.80, and overall accuracy 0.58, p = 0.04
Neuropsychological, and psychopathological profiles, we aimed to compare the neurodevelopment of children with a history of HIE treated with TH to that of a group of peers without preperinatal risk factors
Summary
Great improvements in outcomes have been reported in children who experience neonatal hypoxic-ischemic encephalopathy (HIE) since the introduction of therapeutic hypothermia (TH). Long-term data (early and late childhood, adolescence) in the era before TH treatment showed a higher incidence of cognitive problems until adolescence (for a review, see [3]). The participants in these studies were all children with a history of HIE, treated with or without TH This type of comparison is optimal to highlight improvements and risks introduced by the new treatment, but not the gold standard to point out abnormal trajectories in neurodevelopment, which could emerge from comparisons with healthy controls. Data on long-term outcomes in the era before therapeutic hypothermia (TH) showed a higher incidence of cognitive problems. The incidence of psychopathology appears to be significantly higher in children with HIE (35%) than in control peers (12%). Our study supports previous findings on a higher incidence of neuropsychological, cognitive, and psychopathological sequelae after HIE treated with TH. TH does not appear to ameliorate the outcome after neonatal HIE in those children who survive without major sequelae
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