Behavioral and neurodevelopmental outcome of children after maternal allopurinol administration during suspected fetal hypoxia: 5-year follow up of the ALLO-trial

Job Klumper, Joepe J Kaandorp, Ewoud Schuit, Floris Groenendaal, Corine Koopman-Esseboom, Eduard J H Mulder, Frank Van Bel, Manon J N L Benders, Ben W J Mol, Ruurd M van Elburg, Arend F Bos, Jan B Derks, ALLO-trial study group, Job Klumper, Joepe J Kaandorp, Ewoud Schuit, Floris Groenendaal, Corine Koopman-Esseboom, Eduard J H Mulder, Frank Van Bel, Manon J N L Benders, Ben W J Mol, Ruurd M van Elburg, Arend F Bos, Jan B Derks, ALLO-trial study group

Abstract

Objective: To evaluate the long-term neurodevelopmental and behavioral outcome of antenatal allopurinol treatment during suspected fetal hypoxia.

Study design: We studied children born from women who participated in a randomized double-blind placebo controlled multicenter study (ALLO-trial). Labouring women in whom the fetus was suspected to have fetal hypoxia were randomly allocated to receive allopurinol or placebo. At 5 years of age, the children were assessed with 2 parent reported questionnaires, the Ages and Stages Questionnaire (ASQ) and the Child Behavior Checklist (CBCL). A child was marked abnormal for ASQ if it scored below 2 standard deviation under the normative mean of a reference population in at least one domain. For CBCL, a score above the cut-off value (95th percentile for narrowband scale, 85th percentile for broadband scale) in at least one scale was marked as abnormal.

Results: We obtained data from 138 out of the original 222 mildly asphyxiated children included in the ALLO-trial (response rate 62%, allopurinol n = 73, placebo n = 65). At 5 years of age, the number of children that scored abnormal on the ASQ were 11 (15.1%) in the allopurinol group versus 11 (9.2%) in the placebo group (relative risk (RR) 1.64, 95% confidence interval (CI): 0.64 to 4.17, p = 0.30). On CBCL 21 children (30.4%) scored abnormal in de allopurinol group versus 12 children (20.0%) in the placebo group (RR 1.52, 95% CI: 0.82 to 2.83, p = 0.18).

Conclusion: We found no proof that allopurinol administered to labouring women with suspected fetal hypoxia improved long-term developmental and behavioral outcome. These findings are limited due to the fact that the study was potentially underpowered.

Trial registration: NCT00189007 Dutch Trial Register NTR1383.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. CONSORT flow diagram of the…
Fig 1. CONSORT flow diagram of the ALLO-trial and its follow-up.
ALLO-trial: Antenatal allopurinol trial for reduction of birth asphyxia induced brain damage. ASQ: Ages and Stages Questionnaire, CBCL: Child Behavior Checklist.

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