Neurological and perceptual-motor outcome at 5 - 6 years of age in children with neonatal encephalopathy: relationship with neonatal brain MRI.
OBJECTIVE
The aims of this study were 1) to determine the incidence of minor neurological dysfunction and perceptual-motor difficulties in children aged 5-1/2 -- 6-1/2, 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.


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.


CONCLUSIONS
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.
Barnett
A
A
Department of Paediatrics, Imperial College School of Medicine, Hammersmith Campus, London, United Kingdom.
Mercuri
E
E
Rutherford
M
M
Haataja
L
L
Frisone
M F
MF
Henderson
S
S
Cowan
F
F
Dubowitz
L
L
D000367:Age Factors; D001034:Apgar Score; D001927:Brain Diseases / Q000150:complications* / Q000151:congenital* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D016472:Motor Neuron Disease / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D009422:Nervous System Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D017063:Outcome Assessment, Health Care; D010465:Perception / Q000502:physiology*; D011446:Prospective Studies