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School performance of survivors of neonatal encephalopathy associated with birth asphyxia at term
C M Robertson1, N N Finer, M G Grace
1Department of Pediatrics, University of Alberta, Edmonton, Canada.
Insights
Neonatal encephalopathy from birth asphyxia significantly impacts school performance in children. Moderate to severe cases show lasting cognitive and academic deficits, unlike mild cases.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Neonatalogy
Background:
- Neonatal encephalopathy (NE) following birth asphyxia is a critical condition in term infants.
- NE can lead to significant long-term neurological and developmental impairments.
- Understanding the long-term academic outcomes of NE is crucial for early intervention.
Purpose of the Study:
- To assess school performance at 8 years of age in children with a history of NE due to birth asphyxia.
- To compare academic outcomes between NE severity groups and a peer comparison group.
- To identify predictors of academic performance in children with NE.
Main Methods:
- School performance testing at 8 years in 145 children with NE and 155 controls.
- NE categorized as mild, moderate, or severe based on neonatal clinical presentation.
- Assessment included intellectual, visual-motor, vocabulary, and academic achievement scores.
Main Results:
- 13% mortality rate by 8 years; 16% incidence of impairment in survivors.
- Children with moderate or severe NE showed significantly lower intellectual, visual-motor, vocabulary, and academic scores (p < 0.01).
- Predictors of reading performance included NE category, birth weight for gestational age, native language, and maternal education (multiple R = 0.58).
Conclusions:
- Moderate and severe neonatal encephalopathy pose significant risks for physical, cognitive impairment, and reduced school performance.
- Even non-impaired survivors of moderate NE experienced greater academic delays compared to peers.
- Mild neonatal encephalopathy did not appear to affect school performance compared to controls.
Abstract:
School performance testing was completed at 8 years of age on 145 children who had had neonatal encephalopathy associated with birth asphyxia as term infants and on a comparison peer group of 155 children. The prospectively identified clinical categories of encephalopathy for the neonates were 56 mild (hyperalertness, hyperexcitability), 84 moderate (lethargy, hypotonia, suppressed primitive reflexes), and 5 severe (stupor, flaccidity, absent primitive reflexes). The mortality rate to 8 years of age was 13%. The incidence of impairment, which included cerebral palsy, blindness, cognitive delay, convulsive disorder, and severe hearing loss, was 16% among those assessed at 8 years (75% of survivors). Intellectual, visual-motor integration, and receptive vocabulary scores, as well as reading, spelling, and arithmetic grade levels for those with moderate or severe encephalopathy, were significantly below (p less than 0.01) those in the mild encephalopathy or peer comparison groups. Predictors of reading performance for the study group included category of encephalopathy, birth weight for gestational age, native language, and mother's educational level (multiple R = 0.58). Nonimpaired survivors of moderate encephalopathy were more likely to be more than one grade level delayed than were children from the peer group (reading 35% vs 15%, spelling 18% vs 8%, arithmetic 20% vs 12%, p less than 0.01). Thus children who had moderate and severe neonatal encephalopathy are at risk for physical and mental impairment and reduced school performance. Children with mild encephalopathy had school performance scores similar to those of their peers.