Neuropsychological and educational problems at school age associated with neonatal encephalopathy
Neuropsychological and educational problems at school age associated with neonatal encephalopathy
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DOI：
10.1136/adc.2004.067520
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发表时间：
2005-09-01
影响因子：
4.4
通讯作者：
Draper, ES
中科院分区：
文献类型：
--
作者：
Marlow, N;Rose, AS;Draper, ES
目的：探讨新生儿脑病后的神经认知和行为结局。方法：采用Trent新生儿调查数据库对65例新生儿脑病患儿在7岁时进行随访。他们在学校接受了检查，主流学校的一名同学和一名儿科医生和一名心理学家对他们进行了检查。根据已发表的定义，新生儿脑病被分级为中度或重度。结果：15名儿童有严重残疾，均为脑性瘫痪；8名在特殊学校接受严重认知障碍(IQ<；55)。6%的中度脑病患者和42%的重度脑病患者存在残疾。在50名无运动障碍的儿童中，重度组的认知得分最低(与同龄人的平均智商差为11.3分(95%可信区间为-19.0至-3.6)，而中度组与同班同学的得分相近(平均差值为-1.7分(95%可信区间为-7.3至+3.9))。神经心理测试在所有领域都显示出类似的结果。特别是，重度组的记忆和注意力/执行功能受损。尽管中度组的表现差异相对较小，但在两个脑病组中，特殊教育需求被发现的频率更高，与国家课程完成目标的成就较低有关。解释：新生儿脑病后，在没有神经运动障碍的情况下，发现轻微的认知障碍。在更严重的临床病程后，更常见的是细微的损害。脑保护策略的研究需要长期的跟踪研究，以研究对认知结果的影响。
Background: Adverse cognitive and educational outcomes are often ascribed to perinatal hypoxia without good evidence.Objective: To investigate neurocognitive and behavioural outcomes after neonatal encephalopathy.Methods: Sixty five children with neonatal encephalopathy, identified using the Trent Neonatal Survey database for 1992-1994, were followed up at the age of 7 years. They were examined at school, with a classmate for those in mainstream school, by a paediatrician and a psychologist. Neonatal encephalopathy was graded as moderate or severe using published definitions.Findings: Fifteen children had major disability, all with cerebral palsy; eight were in special school with severe cognitive impairment (IQ < 55). Disability was present in 6% of the moderate and 42% of the severe encephalopathy group. Of the 50 children without motor disability, cognitive scores were lowest in the severe group (mean IQ difference from peers -11.3 points (95% confidence interval (CI) - 19.0 to -3.6) and with similar scores for the moderate group compared with classmates (mean difference -1.7 points (95% CI -7.3 to +3.9). Neuropsychological testing showed similar findings in all domains. In particular, memory and attention/executive functions were impaired in the severe group. Despite relatively small differences in performance of the moderate group, special educational needs were identified more often in both encephalopathy groups, associated with lower achievement on national curriculum attainment targets.Interpretation: After neonatal encephalopathy, subtle cognitive impairments are found in the absence of neuromotor impairment. Subtle impairments are found more commonly after a more severe clinical course. Studies of brain protection strategies require long term follow up to study effects on cognitive outcome.