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Neonatal hypoxic-ischaemic encephalopathy: Motor impairment beyond cerebral palsy
Gergo Erdi-Krausz1, Ruben Rocha2, Alice Brown1
1Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.
Insights
Children with neonatal hypoxic-ischaemic encephalopathy (HIE) without cerebral palsy (CP) often show minor neurological dysfunction (MND) and motor skill deficits. Inattention may impact motor performance, but early MRI and toddler assessments have limited predictive value.
Area of Science:
- Neurology
- Developmental Pediatrics
- Neuroscience
Background:
- Neonatal hypoxic-ischaemic encephalopathy (HIE) can impact long-term neurodevelopment.
- Limited research exists on neuromotor function in children with HIE but without cerebral palsy (CP).
Purpose of the Study:
- To investigate school-age neurological and neuromotor function in children with neonatal HIE without CP.
- To explore correlations between attention, neonatal MRI findings, and toddler-age neuromotor assessments with school-age outcomes.
Main Methods:
- Assessed 27 children with HIE (treated with hypothermia) and 20 controls at 5-7 years for Minor Neurological Dysfunction (MND), motor skills (MABC-2), cognition (WPPSI-IV), and attention (DuPaul ADHD Rating Scale).
- Extracted 24-month neurological and motor (Bayley-3) assessments from clinical records.
- Analyzed neonatal MRI for hypoxic-ischaemic injury.
Main Results:
- Children with HIE showed higher prevalence of MND (p=0.026) and poorer motor skills (MABC-2 total score p=0.006), with greater parental concern (p=0.011).
- HIE group exhibited higher inattention scores (p=0.032), correlating with lower MABC-2 performance (rs=-0.590, p=0.004).
- Neonatal MRI and toddler motor assessments showed limited predictive value for school-age MND or motor skills.
Conclusions:
- Children with neonatal HIE without CP treated with hypothermia may be at higher risk for MND and motor difficulties.
- Inattention may play a role in motor performance deficits.
- Neonatal MRI and early motor assessments have limited predictive capacity for long-term outcomes in this cohort, warranting further investigation in larger studies.
Background:
Research investigating neuromotor function in the absence of cerebral palsy (CP) for children who had neonatal HIE is limited.
Aims:
To investigate school-age neurological and neuromotor function, and correlations with attention, neonatal Magnetic Resonance Imaging (MRI), and neuromotor assessments at toddler age.
Methods:
Twenty-seven children with neonatal HIE without CP who underwent hypothermia treatment and a comparison group of 20 children were assessed at age 5-7 years for Minor Neurological Dysfunction (MND; simplified Touwen), motor skills (Movement Assessment Battery for Children-2; MABC-2), parental concern over motor function (MABC Checklist), general cognition (Wechsler Preschool and Primary Scale of Intelligence-IV, WPPSI), and attention (DuPaul ADHD Rating Scale). Neurological examination and motor development, using Bayley-3 scales, at age 24-months was extracted from the clinical database. Clinical neonatal MRI was assessed for hypoxic-ischaemic injury.
Results:
In the HIE group, MND was more prevalent (p = 0.026) and M-ABC performance (total score p = 0.006; balance subtest p = 0.008) was worse; parents were more concerned about children's motor function (p = 0.011). HIE group inattention scores were higher (p = 0.032), which correlated with lower MABC-2 scores (rs = -0.590, p = 0.004). Neurological examination at 24-months correlated with MND (rs = 0.437, p = 0.033); Bayley-3 motor scores did not correlate with M-ABC-2 scores (rs = 368, p = 0.133). Neonatal MRI findings were not associated with school-age MND (rs = 0.140, p = 0.523) or MABC-2 (rs = 0.300, p = 0.165).
Conclusions:
Children with neonatal HIE, without CP, treated with hypothermia may be more likely to develop MND and motor difficulties than typically developing peers. Inattention may contribute to motor performance. In the absence of CP, neonatal MRI and toddler age assessment of motor development have limited predictive value for school-age outcome. Since this was an exploratory study with a small sample size, findings should be confirmed by a definite larger study.
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