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The association between birth condition and neuropsychological functioning and educational attainment at school age: a cohort study
  1. David E Odd1,2,
  2. Andrew Whitelaw2,
  3. David Gunnell3,
  4. Glyn Lewis4
  1. 1Neonatal Unit, Southmead Hospital, Bristol, Avon, UK
  2. 2Clinical Science at North Bristol, University of Bristol, Bristol, Avon, UK
  3. 3Department of Social Medicine, University of Bristol, Bristol, Avon, UK
  4. 4Department of Community Medicine, University of Bristol, Bristol, Avon, UK
  1. Correspondence to David E Odd, Neonatal Unit, Southmead Hospital, Bristol BS10 5NB, UK; david.odd{at}


Objective Poor condition at birth may impact on IQ, although its effect on other measures of neurodevelopment is unclear. The authors' aim was to determine whether infants receiving resuscitation after birth have reduced scores in measures of attention, memory and language skills or the need for educational support at school even in the absence of clinical encephalopathy.

Methods Three groups of term infants were identified from the Avon longitudinal study of parents and children: infants resuscitated at birth but asymptomatic for encephalopathy (n=612), infants resuscitated who developed symptoms of encephalopathy (n=40) and the reference infants who were not resuscitated and had no further neonatal care (n=8080). Measures of attention, language, memory and the need for educational support were obtained for children between 8 years and 11 years. Test results (standardised to a mean of 100 and SD of 15) were adjusted for clinical and social covariates. Missing covariate data were imputed using chained equations.

Results Infants asymptomatic after resuscitation had similar scores to those not requiring resuscitation for all measures while infants who developed encephalopathy had lower working memory (−6.65 (−12.34 to −0.96)), reading accuracy (−7.95 (−13.28 to −2.63)) and comprehension (−9.32 (−14.47 to −4.17) scores and increased risk of receiving educational support (OR 6.24 (1.52 to 26.43)) than infants thought to be well at birth, although there was little evidence for an association after excluding infants who developed cerebral palsy.

Conclusions The authors found no evidence that infants who were resuscitated but remained well afterwards differed from those not requiring resuscitation in the aspects of neuropsychological functioning assessed in this study. Infants who developed neonatal encephalopathy had evidence of worse functioning, particularly in language skills and were more likely to receive educational support at school.

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  • Funding This research was funded by the Wellcome Trust fellowship award (077036) to DEO. Role of sponsor: The funding organisation did not participate in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review or approval of the manuscript.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the ethical approval for the study was obtained from the ALSPAC Law and Ethics Committee and the local research ethics committees.

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

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