Prospective research in infants with mild encephalopathy identified in the first six hours of life: neurodevelopmental outcomes at 18-22 months

Lina F Chalak, Kim-Anh Nguyen, Chatchay Prempunpong, Roy Heyne, Sudhin Thayyil, Seetha Shankaran, Abbot R Laptook, Nancy Rollins, Athina Pappas, Louise Koclas, Birju Shah, Paolo Montaldo, Benyachalee Techasaensiri, Pablo J Sánchez, Guilherme Sant'Anna, Lina F Chalak, Kim-Anh Nguyen, Chatchay Prempunpong, Roy Heyne, Sudhin Thayyil, Seetha Shankaran, Abbot R Laptook, Nancy Rollins, Athina Pappas, Louise Koclas, Birju Shah, Paolo Montaldo, Benyachalee Techasaensiri, Pablo J Sánchez, Guilherme Sant'Anna

Abstract

Background: Studies of early childhood outcomes of mild hypoxic-ischemic encephalopathy (HIE) identified in the first 6 h of life are lacking.

Objective: To evaluate neurodevelopmental outcomes at 18-22 months of PRIME study.

Study design: Multicenter, prospective study of mild HIE defined as ≥1 abnormality using the modified Sarnat within 6 h of birth and not meeting cooling criteria. Primary outcome was disability with mild: Bayley III cognitive 70-84 or ≥85 and either Gross Motor Function Classification System (GMFCS) 1 or 2, seizures, or hearing deficit; moderate: cognitive 70-84 and either GMFCS 2, seizures, or hearing deficit; severe: cognitive <70, GMFCS 3-5.

Results: Of the 63 infants enrolled, 51 (81%) were evaluated at 19 ± 2 months and 43 (68%) completed Bayley III. Of the 43 infants, 7 (16%) were diagnosed with disability, including 1 cerebral palsy and 2 autism. Bayley scores < 85 in either cognition, motor, or language were detected in 17 (40%): 14 (32%) language, 7 (16%) cognitive, and 6 (14%) motor domain. Infants with disability had more abnormalities on discharge examination and brain MRI, with longer hospital stay (p < 0.001).

Conclusions: In this contemporary untreated cohort of mild HIE, disability occurred in 16% of infants at 18-22 months.

Conflict of interest statement

Conflict of interest: The authors all have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1.
Figure 1.
Flowchart of infants enrolled in PRIME. 5 Infants had incomplete Bayley evaluations and 12 (19%) infants were completely lost to follow up.
Figure 2.
Figure 2.
Evolution of neonatal examination among infants with mild HIE with (2a) and without disability at 18–22 months (2b). The % of infants with Sarnat abnormalities is plotted on the y axis, while serial exams are plotted on x axis: in the first 6 hours, at 24 hours and at discharge.

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