School-age outcomes of children without cerebral palsy cooled for neonatal hypoxic-ischaemic encephalopathy in 2008-2010
School-age outcomes of children without cerebral palsy cooled for neonatal hypoxic-ischaemic encephalopathy in 2008-2010
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DOI：
10.1136/archdischild-2018-316509
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发表时间：
2020-01-01
影响因子：
4.4
通讯作者：
Chakkarapani, Ela
中科院分区：
文献类型：
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作者：
Lee-Kelland, Richard;Jary, Sally;Chakkarapani, Ela
目的 由于低温治疗成为新生儿缺氧缺血性脑病 (HIE) 的标准护理，18 个月评估时死亡或残疾的婴儿比临床试验中的婴儿更少。然而，缺乏对明显未受影响的儿童的长期随访。我们调查了没有脑瘫 (CP) 的幸存者的认知、运动和行为表现，并与 6-8 岁匹配的非 HIE 对照组儿童进行比较。设计病例对照研究。参与者有 29 名无脑瘫 (CP) 的病例，在 2008-2010 年进行冷却，以及 20 名年龄匹配、性别匹配和社会阶层匹配的足月出生对照。测量韦氏儿童智力量表，英国第四版，运动评估儿童电池，第二版 (MABC-2) 和优势与困难问卷。 结果 与对照组相比，病例的平均 (SD) 满量程智商 (91 [10.37] vs105 [13.41]；平均差 (MD)：-13.62，95% CI -20.53 至 -6.71）和 MABC-2 总分 (7.9) 显着降低[3.26]vs10.2[2.86]；MD：-2.12，95% CI -3.93 至 -0.3）。病例和对照组之间言语理解（-8.8，95% CI -14.25至-3.34）、知觉推理（-13.9，95% CI-20.78至-7.09）、工作记忆（-8.2，95% CI-16.29至-0.17）、处理速度（-11.6，95% CI-20.69）的平均差异显着至-2.47）、瞄准和接球（-1.6，95% CI-3.26 至-0.10）以及手动灵巧度（-2.8，95% CI-4.64 至-0.85）。与对照组相比，病例组的中位数 (IQR) 总数（12 [6.5-13.5] vs 6 [2.25-10]，p = 0.005）和情绪行为困难（2 [1-4.5] vs 0.5 [0-2.75]，p = 0.03）显着更高，并且更多病例儿童在学校需要额外支持（34% vs 5%，p = 0.02）。 结论 学龄儿童没有因 HIE 进行 CP 冷却的人仍然比同龄人的认知和运动表现下降，并且情绪困难更多，这有力地支持了学龄评估的必要性。
Objective Since therapeutic hypothermia became standard care for neonatal hypoxic-ischaemic encephalopathy (HIE), even fewer infants die or have disability at 18-month assessment than in the clinical trials. However, longer term follow-up of apparently unimpaired children is lacking. We investigated the cognitive, motor and behavioural performances of survivors without cerebral palsy (CP) cooled for HIE, in comparison with matched non-HIE control children at 6-8 years.Design Case-control study.Participants 29 case children without CP, cooled in 2008-2010 and 20 age-matched, sex-matched and social class-matched term-born controls.Measures Wechsler Intelligence Scales for Children, Fourth UK Edition, Movement Assessment Battery for Children, Second Edition (MABC-2) and Strengths and Difficulties Questionnaire.Results Cases compared with controls had significantly lower mean (SD) full-scale IQ (91 [10.37]vs105[13.41]; mean difference (MD): -13.62, 95% CI -20.53 to -6.71) and total MABC-2 scores (7.9 [3.26]vs10.2[2.86]; MD: -2.12, 95% CI -3.93 to -0.3). Mean differences were significant between cases and controls for verbal comprehension (-8.8, 95% CI -14.25 to -3.34), perceptual reasoning (-13.9, 95% CI-20.78 to -7.09), working memory (-8.2, 95% CI-16.29 to -0.17), processing speed (-11.6, 95% CI-20.69 to -2.47), aiming and catching (-1.6, 95% CI-3.26 to -0.10) and manual dexterity (-2.8, 95% CI-4.64 to -0.85). The case group reported significantly higher median (IQR) total (12 [6.5-13.5] vs 6 [2.25-10], p=0.005) and emotional behavioural difficulties (2 [1-4.5] vs 0.5 [0-2.75], p=0.03) and more case children needed extra support in school (34%vs5%, p=0.02) than the control group.Conclusions School-age children without CP cooled for HIE still have reduced cognitive and motor performance and more emotional difficulties than their peers, strongly supporting the need for school-age assessments.