4.7 NEONATAL RESUSCITATION AND CHILDHOOD COGNITIVE OUTCOMES

D. E. Odd, A. Whitelaw, D. Gunnell, G. Lewis. University of Bristol, Bristol, UK

Background: Neonatal encephalopathy has been considered an essential marker for perinatal cerebral injury. However, milder insults may cause subtle defects in functioning. The evidence for the long-term impact of such milder insults is contentious. The aim is to determine whether infants receiving resuscitation after birth have reduced IQ scores in childhood.

Methods: The study is based on 11 513 term infants from the Avon Longitudinal Study of Parents and Children. Three groups were defined: infants who received resuscitation at birth but no further neonatal care (n  =  818); those receiving resuscitation who developed subsequent encephalopathy (n  =  63) and those not requiring resuscitation or further care (n  =  10 632). Cognition was assessed at 8 years with a low score defined as an IQ of <80. Results were adjusted for other covariates. Chained equations were used to impute missing values of covariates only.

Results: Resuscitated infants without encephalopathy had an increased risk of low global IQ (odds ratio (OR) 1.65 (1.13 to 2.41)) and some evidence for a low verbal IQ (OR 1.41 (0.89 to 2.22)). They had similar performance IQ to the reference group (OR 1.03 (0.75 to 1.42). Infants with encephalopathy had an increased risk of low global (OR 6.21 (1.59 to 24.33)) and performance (OR 4.60 (1.49 to 14.19)) IQ and weak evidence for an increased risk of a poor verbal IQ (OR 1.95 (0.23 to 16.36)).

Conclusions: Infants who received resuscitation had an increased risk of low IQ scores, even if they remained well in the neonatal period. These data are supportive of the “continuum of reproductive casualty” and support the association between mild fetal compromise and cognition.

4.8 EXTREMELY PRETERM CHILDREN AT 11 YEARS: HOW DO THEY FARE AT SCHOOL?

S. Johnson¹, D. Wolke², N. Marlow¹. ¹University …