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School-age outcomes of children after perinatal brain injury: a systematic review and meta-analysis
Philippa Rees1, Caitriona Callan2, Karan Chadda3
1Population Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK p.rees@ucl.ac.uk.
Insights
Perinatal brain injury in children significantly increases risks for neurodevelopmental impairment, including cognitive and motor deficits. More research is needed to support affected children and families.
Area of Science:
- Neuroscience
- Pediatrics
- Developmental Biology
Background:
- Over 3000 children in England experience perinatal brain injury annually.
- Childhood outcomes for these infants remain largely unknown.
Approach:
- A systematic review and meta-analysis examined studies from 2000-2021.
- Focused on school-aged neurodevelopmental outcomes post-perinatal brain injury.
- Primary outcome: neurodevelopmental impairment after age 5.
Key Points:
- Infants with severe intraventricular hemorrhage face a threefold higher risk of neurodevelopmental impairment.
- Perinatal stroke is linked to hemiplegia, cognitive deficits, and poorer language skills.
- Neonatal meningitis and hypoxic-ischaemic encephalopathy also increase risks for impairment and special educational needs.
Conclusions:
- Limited comparative studies exist, with significant heterogeneity.
- Longitudinal population studies are crucial for better clinical support and targeted interventions.
Background:
Over 3000 children suffer a perinatal brain injury in England every year according to national surveillance. The childhood outcomes of infants with perinatal brain injury are however unknown.
Methods:
A systematic review and meta-analyses were undertaken of studies published between 2000 and September 2021 exploring school-aged neurodevelopmental outcomes of children after perinatal brain injury compared with those without perinatal brain injury. The primary outcome was neurodevelopmental impairment, which included cognitive, motor, speech and language, behavioural, hearing or visual impairment after 5 years of age.
Results:
This review included 42 studies. Preterm infants with intraventricular haemorrhage (IVH) grades 3-4 were found to have a threefold greater risk of moderate-to-severe neurodevelopmental impairment at school age OR 3.69 (95% CI 1.7 to 7.98) compared with preterm infants without IVH. Infants with perinatal stroke had an increased incidence of hemiplegia 61% (95% CI 39.2% to 82.9%) and an increased risk of cognitive impairment (difference in full scale IQ -24.2 (95% CI -30.73 to -17.67) . Perinatal stroke was also associated with poorer academic performance; and lower mean receptive -20.88 (95% CI -36.66 to -5.11) and expressive language scores -20.25 (95% CI -34.36 to -6.13) on the Clinical Evaluation of Language Fundamentals (CELF) assessment. Studies reported an increased risk of persisting neurodevelopmental impairment at school age after neonatal meningitis. Cognitive impairment and special educational needs were highlighted after moderate-to-severe hypoxic-ischaemic encephalopathy. However, there were limited comparative studies providing school-aged outcome data across neurodevelopmental domains and few provided adjusted data. Findings were further limited by the heterogeneity of studies.
Conclusions:
Longitudinal population studies exploring childhood outcomes after perinatal brain injury are urgently needed to better enable clinicians to prepare affected families, and to facilitate targeted developmental support to help affected children reach their full potential.
