Neurological and Perceptual-Motor Outcome at 5 - 6 Years of Age in Children with Neonatal Encephalopathy: Relationship with Neonatal Brain MRI

 

 Buy Article Permissions and Reprints

Abstract

Objective

The aims of this study were 1) to determine the incidence of minor neurological dysfunction and perceptual-motor difficulties in children aged 5œ - 6œ, who had been born full-term but presented with neonatal encephalopathy (NE) and low Apgar scores and 2) to examine the relationships between the presence/absence of these difficulties with neonatal brain MRI.

Participants and Methods

Sixty-eight full-term infants with one minute Apgar scores less than or equal to 5 and neurological abnormalities during the first 48 hours after birth were included in the study. All children had a neonatal MRI brain scan. Surviving infants were assessed between the age of 5 and 6 years using the Touwen Examination, the Movement ABC and the WPPSI-R.

Results

Fifteen of the 68 infants (22 %) died in the neonatal period. Of the 53 surviving infants, 19 (36 %) had cerebral palsy. The remaining 34 were considered normal at 2 years of age but, when assessed at school age, 8 (15 %) had minor neurological dysfunction and/or perceptual-motor difficulties, 1 (2 %) had only cognitive impairment and 25 (47 %) were normal. The outcome largely reflected the pattern of lesions on brain imaging. While 83 % of those with a normal outcome had normal scans or minimal white matter lesions, 80 % of those with minor neurological dysfunction and/or perceptual-motor difficulties had mild or moderate basal ganglia or more marked white matter lesions.

Conclusion

Continued surveillance is recommended for children with apparently normal outcome at two years of age after NE, particularly when abnormalities are detected on brain MRI.

References

• 1 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington; American Psychiatric Association 1994
  Google Scholar
• 2 Casey B M, McIntire D D, Leveno K J. The continuing value of the Apgar score for the assessment of newborn infants.  N Engl J Med. 2001;  344 467-471
  CrossrefPubMedGoogle Scholar
• 3 Croce R V, Horvat M, McCarthy E. Reliability and concurrent validity of the movement assessment battery for children.  Percep Motor Skills. 2001;  93 275-280
  PubMedGoogle Scholar
• 4 Gadian G, Aicardi J, Watkins K E, Porter D A, Mishkin M, Vargha-Khadem F. Developmental amnesia associated with early hypoxic-ischemic injury.  Brain. 2000;  123 499-507
  CrossrefPubMedGoogle Scholar
• 5 Gillberg (Ed) C. Clincial Child Neuropsychiatry. 2nd ed. Cambridge; Cambridge University Press 2000
  Google Scholar
• 6 Hellgren L, Gillberg I C, Bagenholm A, Gillberg C. Children with deficits in attention, motor control and perception (DAMP) almost grown up: psychiatric and personality disorders at age 16 years.  J Child Psychol Psychiat. ;  35 1255-1271
  PubMedGoogle Scholar
• 7 Henderson S E, Barnett A L. The classification of specific motor coordination disorders in children: some problems to be solved.  Hum Movement Sci. 1998;  17 449-469
  CrossrefPubMedGoogle Scholar
• 8 Henderson S E, Henderson L. Towards an understanding of developmental coordination disorder.  Adap Phys Activ Quar. 2002;  19 12-31
  PubMedGoogle Scholar
• 9 Henderson S E, Sugden D A. The Movement Assessment Battery for Children. Kent; The Psychological Corporation 1992
  Google Scholar
• 10 Jongmans M, Mercuri E, de Vries L, Dubowitz L, Henderson S E. Minor neurological signs and perceptual-motor difficulties in prematurely born children.  Arch Dis Child. 1997;  76 F9-F14
  PubMedGoogle Scholar
• 11 Kakebeeke T H, Jongmans M J, Dubowitz L MS, Schoemaker M M, Henderson S E. Some aspects of the reliability of Touwens' Examination of the child with minor neurological dysfunction.  Dev Med Child Neurol. 1993;  35 1097-1105
  PubMedGoogle Scholar
• 12 Kaplan B J, Wilson B N, Dewey D, Crawford S G. DCD may not be a discrete disorder.  Hum Movement Sci. 1998;  17 471-490
  CrossrefPubMedGoogle Scholar
• 13 Levene M I, Sands C, Grindulis H, Moore J R. Comparison of two methods of predicting outcome in perinatal asphyxia.  Lancet. 1986;  1 67-69
  PubMedGoogle Scholar
• 14 Losse A, Henderson S E, Elliman D, Hall D B, Knight E, Jongmans M. Clumsiness in children - do they grow out of it? A 10-year follow-up study.  Dev Med Child Neurol. 1991;  33 55-68
  CrossrefPubMedGoogle Scholar
• 15 Mercuri E, Ricci D, Cowan F, Lessing D, Frisone M F, Haataja J. Head growth in infants with hypoxic-ischaemic encephalopathy: correlation with neonatal magnetic resonance imaging.  Pediatrics. 2000;  106 235-43
  CrossrefPubMedGoogle Scholar
• 16 Mercuri E, Rutherford M, Barnett A, Foglia C, Haataja L, Counsell S. et al . MRI lesions and infants with neonatal encephalopathy. Is the Apgar score predictive?.  Neuropediatrics. 2002;  33 150-156
  Article in Thieme ConnectPubMedGoogle Scholar
• 17 Moster D, Lie R T, Markestad T. Joint association of Apgar scores and early neonatal symptoms with minor disabilities at school age.  Arch Dis Fetal Neonatal Ed. 2002;  86 F16-F21
  PubMedGoogle Scholar
• 18 Rands C E, Rose A S, Marlow N, Draper E S. Cognitive impairment in 6 - 8 year old children following neonatal encephalopathy.  Abstract Arch Dis Child. 2001;  84 A16-A17
  PubMedGoogle Scholar
• 19 Robertson C M, Finer N N, Grace M G. School performance of survivors of neonatal encephalopathy associated with birth asphyxia at term.  J Pediatr. 1989;  114 753-760
  CrossrefPubMedGoogle Scholar
• 20 Sarnat H B, Sarnat M S. Neonatal encephalopathy following fetal distress.  Arch Neurol. 1976;  33 696-705
  CrossrefPubMedGoogle Scholar
• 21 Touwen B CL. Examination of the Child with Minor Neurological Dysfunction. 2nd ed. Clinics in Developmental Medicine, No. 71. London; S. I. M. P. 1971
  Google Scholar
• 22 Wechsler D. Wechsler Preschool and Primary Scale of Intelligence - Revised. Kent; The Psychological Corporation 1990
  Google Scholar

Eugenio Mercuri

Department of Paediatrics, Hammersmith Hospital

Du Cane Road

London W12 OHN

United Kingdom

Email: e.mercuri@ic.ac.uk