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Published on: October 28, 2022
Long-term motor development after hypothermia-treated hypoxic-ischaemic encephalopathy
Mimmi Eriksson Westblad1, Kristina Löwing2, Katarina Robertsson Grossmann3
1Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Stockholm, Sweden.
Insights
Therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy may lead to motor difficulties in a third of children by age 11. Continued monitoring into adolescence is recommended for these children.
Area of Science:
- Neonatal Neurology
- Pediatric Motor Development
- Neurodevelopmental Outcomes
Background:
- Neonatal hypoxic-ischaemic encephalopathy (HIE) is a serious condition requiring intervention.
- Therapeutic hypothermia (TH) is a standard treatment for HIE.
- Longitudinal data on motor development after TH for HIE is crucial for understanding long-term outcomes.
Purpose of the Study:
- To describe the longitudinal motor development in children treated with TH for HIE.
- To explore motor functioning in early adolescence among these children.
Main Methods:
- Prospective follow-up study of children treated with TH for HIE.
- Motor development assessed using Alberta Infant Motor Scale, Bayley Scales of Infant and Toddler Development-III, and Movement Assessment Battery for Children (MABC-2).
- Parental MABC-2 Checklist and WISC-V for general cognition were also utilized.
Main Results:
- At 11.1 years, 31% had MABC-2 scores indicating risk of motor difficulties, and 52% had parental scores indicating everyday motor challenges.
- Children at risk at 11.1 years showed significantly lower motor percentiles at 2.1 years.
- Longitudinal motor development showed a weak association with Full Scale IQ.
Conclusions:
- A third of survivors of TH-treated HIE, without moderate/severe cerebral palsy, exhibited motor difficulties by age 11.
- Motor difficulties appeared to increase over time.
- Children treated with TH for HIE warrant follow-up until at least middle school age.
Aims:
To describe longitudinal motor development in children treated with therapeutic- hypothermia (TH) due to neonatal hypoxic-ischaemic encephalopathy (HIE) and to explore motor functioning in early adolescence.
Material And Methods:
Children treated with TH due to HIE during 2007-2009, in Stockholm, participated in a prospective follow-up study. Motor development was assessed on four occasions, reported as percentiles and at mean ages. Alberta Infant Motor Scale was used at 0.35 years of age, Bayley Scales of Infant and Toddler Development-III at 2.1 years and Movement Assessment Battery for Children (MABC-2) at 7.3 and 11.1 years of age. MABC-2 Checklist was completed by parents at 7.3 and 11.1 years of age. General cognition was assessed using Wechsler Intelligence Scales for Children Fifth Edition (WISC-V).
Results:
Thirty-one percent (14/45) of the children had a motor score ≤ 15th percentile, indicating risk of motor difficulties at 11.1 years of age, and simultaneously the scores from parents of 52% (23/44), indicating risk of motor difficulties in the everyday context. These children had significantly lower motor percentile at 2.1 years of age, but within the normal range. Longitudinal motor development displayed a weak association with WISC-V Full Scale IQ (rs0.38, p = 0.013).
Conclusion:
Among survivors of hypothermia-treated HIE free of moderate/severe cerebral palsy, a third had MABC-2 scores indicating risk of motor difficulties at 11.1 years of age. As motor difficulties became more apparent over time, we suggest that children treated with TH due to neonatal HIE should be followed into at least middle school age.
