Abstract
Background and Objectives: Late long-term outcomes of perinatal asphyxia (PA) in school-age are often unclear. To assess long-term outcomes at an early school age in children who had experienced perinatal hypoxia or asphyxia, where therapeutic hypothermia was not applied. Materials and Methods: The case group children were 8–9-year-old children (n = 32) who were born at full term and experienced hypoxia or asphyxia at birth, where therapeutic hypothermia (TH) was not applied. The control group consisted of 8–9-year-old children (n = 16) born without hypoxia. A structured neurological examination was performed at an early school age. The neuromotor function was assessed using the Gross Motor Function Classification System (GMFCS). Health-related quality-of-life was assessed using the Health Utilities Index (HUI) questionnaire. Intellectual abilities were assessed using the Wechsler Intelligence Scale for Children (WISC). Results: The case group, compared with controls, had significantly (p = 0.002) lower mean [SD] full-scale IQ (87(16.86) vs. 107(12.15)), verbal-scale IQ (89(17.45) vs. 105(11.55)), verbal comprehension index (89(17.36) vs. 105(10.74)), working memory index (89(15.68) vs. 104(11.84)), performance IQ (87(16.51) vs. 108(15.48)) and perceptual organization index (85(15.71) vs. 105(15.93)). We did not find any significant differences in the incidence of disorders of neurological examination, movement abilities and health-related quality of life at an early school age between the case and the control group children. Conclusion: In children who experienced perinatal asphyxia but did not have cerebral paralysis (CP), where therapeutic hypothermia was not applied, cognitive assessment scores at an early school age were significantly lower compared to those in the group of healthy children, and were at a low average level.
Highlights
Perinatal asphyxia in full-term neonates is one of the most common causes of neonatal morbidity and mortality in most countries of the world
We did not find any significant differences in the incidence of disorders of neurological examination, motor function and health-related quality-of-life at an early school age between the case and the control group children (Table 3)
The assessment of health-related quality-of-life showed that 12.5% of the case group children had mild vision disorders, 3.1% had hearing disorders, 6.3% had speech disorders, 9.4% experienced pain, 25.0% of the children had ambulation disorders, 6.2% had dexterity disorders, and 31.3% had cognitive disorders, but we found no significant differences in the incidence of such disorders between the case and the control group children
Summary
Perinatal asphyxia in full-term neonates is one of the most common causes of neonatal morbidity and mortality in most countries of the world. Long-term outcomes of perinatal asphyxia include severe disability (impaired mental and motor development, cortical blindness, sensorineural hearing loss, epilepsy, and cerebral palsy) and death. A number of studies analyzing the long-term outcomes of perinatal asphyxia at a preschool age showed that the incidence of severe disability ranged from 11 to 19% [2,3], the incidence of cerebral palsy from 5.5 to 52% [3,4,5,6,7,8], the incidence of various motor disorders from 1.3 to 40% [4,7,9,10,11], the incidence of hearing impairment from 2 to 20% [3,7,10], the incidence of visual impairment from 1.8 to 40% [3,6,7,12], and the incidence of speech disorders from 4.2 to 21% [3,4,5]. According to the literature data, children who required post-natal resuscitation and experienced neonatal hypoxic-ischemic encephalopathy (HIE)
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