Neonatal hypoxic-ischaemic encephalopathy: Motor impairment beyond cerebral palsy
Section snippets
Background
Neonatal hypoxic-ischemic encephalopathy (HIE) is a condition which occurs in approximately 1.5 per 1000 live births in high income countries and more frequently in middle- and low-income countries [1,2]. Clinicians had little to offer until therapeutic hypothermia (TH) emerged. Several large randomised controlled trials have shown that TH reduces both mortality and severe neurodisability (Cerebral Palsy, CP), and these effects appear to continue to school age [3]. Commonly, children are
Materials and methods
Ethics approval for the study was given by the NHS Health Research Authority National Research Ethics Service Ethics Committee North West – Lancaster REC reference 15/NW/0292. Written informed consent was obtained from the parents, and assent from the children.
Demographics
Twenty-seven children with HIE without cerebral palsy (CP) were included in the study, along with 20 typically developing children (“comparison group”). The clinical characteristics for both groups are shown in Table 1. Mean age at assessment was significantly different (p < 0.001) between the groups, but no significant differences in distribution of sex between groups were seen (p = 0.080). Hearing and visual impairment were more common in children with HIE; this did not affect children's
Discussion
In this small sample, MND, neuromotor difficulties, in particular manual dexterity and balance skills, and difficulties with inattention in the school setting, were more frequent in children with HIE than in the comparison group. MND was associated with poorer motor skills, and the prevalence of clinically significant motor impairment was higher in the HIE group, which was consistent with parental concerns about motor skills in daily life. Interestingly, although general cognitive abilities,
Conclusions
In the absence of CP, about 1/5 of children with HIE treated with TH had significant motor impairment at school age. This was associated with the presence of MND and parent reports indicate that this has implications for daily functioning. Motor function impairment was associated with general cognitive difficulties and attention problems at school. It is important to keep in mind that early neurodevelopmental assessments may be poor predictors of later motor function. Injury to the caudate
Declaration of competing interest
None.
Acknowledgements
We thank all the children and parents/caregivers who participated in the study. We also thank Dr M. Schreglmann for contributions to study set-up and data collection.
Funding: This work was supported by the Sir Halley Stewart Trust, UK. The Sir Halley Stewart Trust had no role in the study design, the collection, analysis and interpretation of data, the writing of the report, or the decision to submit the article for publication.
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Contributed equally; joint first authors.