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Resuscitation at birth and cognition at 8 years of age: a cohort study
David E Odd1, Glyn Lewis, Andrew Whitelaw
1Clinical Science at North Bristol, University of Bristol, Bristol, UK. david.odd@nbt.nhs.uk
Insights
Infants resuscitated at birth, even without signs of encephalopathy, face a higher risk of lower childhood intelligence quotient (IQ) scores. This highlights potential long-term cognitive impacts of neonatal resuscitation.
Area of Science:
- Neonatal care and developmental pediatrics
Background:
- Birth resuscitation may lead to subtle cognitive deficits detectable later in childhood.
- The long-term cognitive effects of resuscitation in infants without apparent neurological symptoms are not fully understood.
Purpose of the Study:
- To investigate if infants requiring resuscitation at birth but remaining asymptomatic for encephalopathy exhibit reduced intelligence quotient (IQ) scores in childhood.
Main Methods:
- A cohort study of 10,609 infants from the Avon Longitudinal Study of Parents and Children was conducted.
- Three groups were analyzed: resuscitated asymptomatic infants (n=815), resuscitated encephalopathic infants (n=58), and a non-resuscitated reference group (n=10,609).
- Cognitive function, specifically IQ, was assessed at a mean age of 8.6 years using a shortened Weschler intelligence scale for children (WISC-III).
Main Results:
- Resuscitated infants, both asymptomatic (OR 1.65) and those with encephalopathy (OR 6.22), showed an increased risk of low IQ scores (<80) at age 8.
- The population attributable risk fraction for low IQ due to resuscitation was higher in asymptomatic infants (3.4%) compared to those with encephalopathy (1.2%).
Conclusions:
- Neonatal resuscitation is associated with an increased risk of lower IQ scores in childhood, irrespective of initial neurological symptoms.
- Asymptomatic infants who undergo resuscitation may contribute a larger proportion to the population with low IQs than those who develop overt encephalopathy.
Background:
Mild cerebral injury might cause subtle defects in cognitive function that are only detectable as the child grows older. Our aim was to determine whether infants receiving resuscitation after birth, but with no symptoms of encephalopathy, have reduced intelligence quotient (IQ) scores in childhood.
Methods:
Three groups of infants were selected from the Avon Longitudinal Study of Parents and Children: infants who were resuscitated at birth but were asymptomatic for encephalopathy and had no further neonatal care (n=815), those who were resuscitated and had neonatal care for symptoms of encephalopathy (n=58), and the reference group who were not resuscitated, were asymptomatic for encephalopathy, and had no further neonatal care (n=10 609). Cognitive function was assessed at a mean age of 8.6 years (SD 0.33); a low IQ score was defined as less than 80. IQ scores were obtained for 5953 children with a shortened version of the Weschler intelligence scale for children (WISC-III), the remaining 5529 were non-responders. All children did not complete all parts of the test, and therefore multiplied IQ values comparable to the full-scale test were only available for 5887 children. Results were adjusted for clinical and social covariates. Chained equations were used to impute missing values of covariates.
Findings:
In the main analysis at 8 years of age (n=5887), increased risk of a low IQ score was recorded in both resuscitated infants asymptomatic for encephalopathy (odds ratio 1.65 [95% CI 1.13-2.43]) and those with symptoms of encephalopathy (6.22 [1.57-24.65]). However, the population of asymptomatic infants was larger than that of infants with encephalopathy, and therefore the population attributable risk fraction for an IQ score that might be attributable to the need for resuscitation at birth was 3.4% (95% CI 0.5-6.3) for asymptomatic infants and 1.2% (0.2-2.2) for those who developed encephalopathy.
Interpretation:
Infants who were resuscitated had increased risk of a low IQ score, even if they remained healthy during the neonatal period. Resuscitated infants asymptomatic for encephalopathy might result in a larger proportion of adults with low IQs than do those who develop neurological symptoms consistent with encephalopathy.
Funding:
Wellcome Trust.
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