title: Cognitive outcomes after neonatal encephalopathy.
abstract: OBJECTIVE
  To describe the spectrum of cognitive outcomes of children with and without cerebral palsy (CP) after neonatal encephalopathy, evaluate the prognostic value of early developmental testing and report on school services and additional therapies.
  
  
  METHODS
  The participants of this study are the school-aged survivors of the National Institute of Child Health and Human Development Neonatal Research Network randomized controlled trial of whole-body hypothermia. Children underwent neurologic examinations and neurodevelopmental and cognitive testing with the Bayley Scales of Infant Development-II at 18 to 22 months and the Wechsler intelligence scales and the Neuropsychological Assessment-Developmental Neuropsychological Assessment at 6 to 7 years. Parents were interviewed about functional status and receipt of school and support services. We explored predictors of cognitive outcome by using multiple regression models.
  
  
  RESULTS
  Subnormal IQ scores were identified in more than a quarter of the children: 96% of survivors with CP had an IQ <70, 9% of children without CP had an IQ <70, and 31% had an IQ of 70 to 84. Children with a mental developmental index <70 at 18 months had, on average, an adjusted IQ at 6 to 7 years that was 42 points lower than that of those with a mental developmental index >84 (95% confidence interval, -49.3 to -35.0; P < .001). Twenty percent of children with normal IQ and 28% of those with IQ scores of 70 to 84 received special educational support services or were held back ≥1 grade level.
  
  
  CONCLUSIONS
  Cognitive impairment remains an important concern for all children with neonatal encephalopathy.
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, Michigan; apappas@med.wayne.edu.
authors.forename: Athina
authors.initials: A
authors.lastname: Pappas
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, Michigan;
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.affiliation: Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina;
authors.forename: Scott A
authors.initials: SA
authors.lastname: McDonald
authors.affiliation: Department of Pediatrics, Women & Infant's Hospital, Brown University, Providence, Rhode Island;
authors.forename: Betty R
authors.initials: BR
authors.lastname: Vohr
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California;
authors.forename: Susan R
authors.initials: SR
authors.lastname: Hintz
authors.affiliation: Department of Pediatrics, Yale University, New Haven, Connecticut;
authors.forename: Richard A
authors.initials: RA
authors.lastname: Ehrenkranz
authors.affiliation: Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas;
authors.forename: Jon E
authors.initials: JE
authors.lastname: Tyson
authors.affiliation: Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio;
authors.forename: Kimberly
authors.initials: K
authors.lastname: Yolton
authors.affiliation: Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland; and.
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, Michigan;
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bara
authors.affiliation: Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland; and.
authors.forename: Jane
authors.initials: J
authors.lastname: Hammond
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D002648:Child; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000503:physiopathology*; D007361:Intelligence Tests; D008297:Male; D009483:Neuropsychological Tests; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: cognitive outcomes; hypoxic ischemic encephalopathy; neonatal encephalopathy