Motor performance and cognitive correlates in children cooled for neonatal encephalopathy without cerebral palsy at school age

Abstract

Aim: To investigate whether motor performance in school-age children without cerebral palsy (CP), cooled for neonatal encephalopathy, is associated with perinatal factors and 18month developmental scores and to explore relationships between school-age motor and cognitive performance.Methods: Motor and cognitive performance was assessed in 29 previously cooled children at six to eight years using the Movement Assessment Battery for Children-2 (MABC-2) and the Wechsler Intelligence Scale for Children (WISC-IV). Associations between MABC-2 scores less than/equal (≤) 15th centile and perinatal factors, social/family background, 18month Bayley-III scores and WISC-IV scores were explored.Results: Eleven of the 29 (38%) children had MABC-2 scores ≤15th centile including 7 (24%) ≤5th centile. No significant perinatal or socio-economic risk factors were identified. Motor scores <85 at 18 months failed to identify children with MABC-2 scores ≤15th centile. MABC-2 scores ≤15th centile were associated with lower Full Scale IQ (p = 0.045), Working Memory (p = 0.03) and Perceptual Reasoning (p = 0.005) scores at six to eight years and receiving greater support in school (p = 0.01).Conclusion: A third of cooled children without CP had MABC-2 scores indicating motor impairment at school age that was not identified at 18 months by Bayley-III. Most children with low MABC scores needed support at school. Sub-optimal MABC-2 scores indicate need for detailed school-age cognitive evaluation.

Disrupted brain connectivity in children treated with therapeutic hypothermia for neonatal encephalopathy

“…TH reduces the chance of death and disability at 18 months ( Jacobs et al, 2013 ), reduces likelihood and severity of CP ( Jary et al, 2015 ) and increases the incidence of survival with an IQ > 85 ( Azzopardi et al, 2014 ). However, recent studies have shown that children aged 6–8 years, who underwent TH at birth for NE and did not develop CP, perform worse in motor and cognitive tests than controls ( Jary et al, 2019 , Lee-Kelland et al, 2020 ) and have attention difficulties, slower reaction times and reduced visuo-spatial processing abilities ( Tonks et al, 2019 ). These motor and cognitive deficits are not predicted by 18-month developmental scores ( Azzopardi et al, 2014 , Jary et al, 2019 ).…”

An Age-Specific Atlas for Delineation of White Matter Pathways in Children Aged 6-8 Years

“…Many of these regions were also shown to have reduced FA in the CoolMRI cases, indicating that the early structural alterations resulting from the brain injury cause lasting changes to white matter development. These results also provide evidence for an underlying white matter deficit which manifests as neuropsychological differences seen at school-age (Jary et al, 2019;Lee-Kelland et al, 2020;Tonks et al, 2019).…”

“…As a demonstration, we then investigate tract-level differences in children treated with therapeutic hypothermia (TH) for neonatal encephalopathy (NE) at birth, compared with healthy controls, and compare results obtained using the age-specific atlas to those from the JHU atlas. The children who had TH, do not have CP and are in mainstream education still exhibit significantly reduced performance on cognitive tests (Jary et al, 2019;Lee-Kelland et al, 2020) and have slower reaction times and reduced visuo-spatial processing abilities (Tonks et al, 2019), compared to the typically developing controls.…”

Cognitive and behavioural outcomes: are they impaired in children without cerebral palsy following neonatal hypoxic‐ischaemic encephalopathy?

“…These cognitive impairments are reflected by the significantly higher need for additional support at school in the case group . Case children with lower cognitive scores had lower motor performance scores on movement assessment battery for children—second edition . Furthermore, school‐aged children cooled for HIE and did not have CP have lower attention and visuospatial function compared to age, sex and social class matched controls …”