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School-age outcomes of children without cerebral palsy cooled for neonatal hypoxic–ischaemic encephalopathy in 2008–2010
  1. Richard Lee-Kelland1,
  2. Sally Jary1,
  3. James Tonks1,2,
  4. Frances M Cowan1,3,
  5. Marianne Thoresen1,4,
  6. Ela Chakkarapani1
  1. 1 Faculty of Health Sciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  2. 2 Department of Psychology, University of Exeter, Exeter, UK
  3. 3 Department of Paediatrics, Imperial College London, London, UK
  4. 4 Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Ela Chakkarapani, School of Clinical Sciences, University of Bristol, Bristol BS2 8EG, UK; Ela.Chakkarapani{at}


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.

  • hypoxic-ischaemic encephalopathy
  • therapeutic hypothermia
  • cognitive
  • motor
  • behavioural outcomes
  • school-age

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  • Contributors RL-K: contributed to the study design, recruited participants, conducted the study, collected and analysed the data, wrote the first draft of the manuscript and approved the final version as submitted. SJ: contributed to the study design, assisted with data collection, contributed to the revisions of the paper and approved the final manuscript as submitted. JT: contributed to the study design, performed psychometric assessments, collected data, contributed to revisions of the paper and approved the final manuscript as submitted. FMC: contributed to the study design, revised the paper and approved the final manuscript as submitted. MT: formed the newborn cohort, headed the steering group, obtained funding for part of the staff salaries, contributed to study design, revised the paper and approved the final manuscript as submitted. EC: conceptualised and designed the study, obtained funding for the study and part of the staff salaries, supervised analysis, drafted the second and further versions of the manuscript, completed revisions of the paper and approved the final manuscript as submitted.

  • Funding We are grateful to the following for support: research project support: The Baily Thomas Charitable Fund, Luton, UK, and The David Telling Charitable Trust, University Hospitals Bristol NHS Trust, Bristol, UK. Staff salary support: The Moulton Foundation, London, UK; The Baily Thomas Charitable Fund, Luton, UK; and a Charitable donation through SPARKS, London, UK.

  • Competing interests None declared.

  • Ethics approval The study has favourable ethical opinion from the NRES Committee South West-Frenchay and the Health Research Authority (15/SW/0148).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at The work has been presented in the Pediatric Academic Societies conference in San Francisco (2017) and the Neonatal Society Spring Meeting in London (2017).

  • Patient consent for publication Not required.

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