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Long-Term Outcomes of Perinatal Hypoxia and Asphyxia at an Early School Age
Renata Dzikienė1, Saulius Lukoševičius2, Jūratė Laurynaitienė3
1Department of Neonatology, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
Insights
Children experiencing perinatal asphyxia without therapeutic hypothermia showed lower cognitive scores in early school years. Neuromotor function and quality of life remained comparable to healthy peers.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Pediatric neurology
Background:
- Long-term outcomes of perinatal asphyxia (PA) in school-aged children are not well-understood, especially when therapeutic hypothermia (TH) was not administered.
- Assessing early school-age outcomes in children with a history of perinatal hypoxia or asphyxia is crucial for understanding developmental trajectories.
- This study focuses on children who did not receive TH following birth complications.
Purpose of the Study:
- To evaluate the long-term neurological and cognitive outcomes at early school age in children who experienced perinatal hypoxia or asphyxia.
- To compare cognitive abilities, neuromotor function, and quality of life between children with a history of PA (without TH) and a healthy control group.
Main Methods:
- A case-control study involving 8-9-year-old children: 32 with a history of perinatal hypoxia/asphyxia (no TH) and 16 healthy controls.
- Neurological examinations, Gross Motor Function Classification System (GMFCS) for neuromotor function, Health Utilities Index (HUI) for quality of life, and Wechsler Intelligence Scale for Children (WISC) for intellectual abilities were employed.
Main Results:
- The case group exhibited significantly lower mean scores across all assessed cognitive domains, including full-scale IQ, verbal IQ, performance IQ, and various index scores (p = 0.002).
- No significant differences were observed in neurological examination findings, movement abilities (GMFCS), or health-related quality of life (HUI) between the groups.
- Cognitive scores in the case group were noted to be at a low average level.
Conclusions:
- Children with perinatal asphyxia who did not undergo therapeutic hypothermia and did not develop cerebral palsy showed significantly lower cognitive function at early school age.
- Despite cognitive deficits, neuromotor function and quality of life were not significantly different from healthy controls, suggesting targeted cognitive support may be beneficial.
- These findings highlight the importance of long-term neurodevelopmental monitoring for children with a history of perinatal asphyxia, even in the absence of overt motor impairments.
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.
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