Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Neurodevelopmental outcomes after hypothermia therapy in the era of Bayley-III

Journal of Perinatology volume 34, pages 629–633 (2014)Cite this article

Subjects

Abstract

Objective:

Bayley-III scales are currently used to evaluate outcomes of term infants following hypothermia therapy, while all before reported outcomes in this population have used Bayley-II. Our objectives were to determine the incidence of abnormal neurodevelopmental outcomes using Bayley III and the predictive value of Magnetic resonance imaging (MRI) in infants who received systemic hypothermia.

Study Design:

We conducted a prospective cohort study of inborn infants who underwent hypothermia for moderate/severe neonatal encephalopathy from October 2005–November 2011.

Result:

Eighty newborns underwent hypothermia (incidence of 1/1000). Of the survivors, 89% had Bayley-III performed around 24 months of age. An abnormal outcome using Bayley-III <85 occurred in 50%, while Bayley III <70 occurred in 13%. MRI predicted Bayley III<85 with sensitivity of 73%, specificity of 84%, positive-predictive value of 84% and negative-predictive value of 74%.

Conclusion:

A Bayley-III 85 cutoff identifies a disability rate of 50%, and MRI was predictive of abnormal outcomes. Findings can be useful for counseling of families and planning of future studies using Bayley III.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Levene ML, Kornberg J, Williams TH . The incidence and severity of post-asphyxial encephalopathy in full-term infants. Early Hum Dev 1985; 11 (1): 21–26.

    Article  CAS  Google Scholar 

  2. Zhou WH, Cheng GQ, Shao XM, Liu XZ, Shan RB, Zhuang DY et al. Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China. J Pediatr 2010; 157 (3): 367–372. (e1–3).

    Article  Google Scholar 

  3. Simbruner G, Mittal RA, Rohlmann F, Muche R . Systemic hypothermia after neonatal encephalopathy: outcomes of neo.nEURO.network RCT. Pediatrics 2010; 126 (4): e771–e778.

    Article  Google Scholar 

  4. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353 (15): 1574–1584.

    Article  CAS  Google Scholar 

  5. Azzopardi D, Brocklehurst P, Edwards D, Halliday H, Levene M, Thoresen M et al. The TOBY Study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: a randomised controlled trial. BMC Pediatr 2008; 8: 17.

    Article  Google Scholar 

  6. Jacobs SE, Morley CJ, Inder TE, Stewart MJ, Smith KR, McNamara PJ et al. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med 2011; 165 (8): 692–700.

    Article  Google Scholar 

  7. Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005; 365 (9460): 663–670.

    Article  Google Scholar 

  8. Cotten CM, Shankaran S . Hypothermia for hypoxic-ischemic encephalopathy. Expert Rev Obstet Gynecol 2010; 5 (2): 227–239.

    Article  Google Scholar 

  9. Barks JDE . Technical aspects of starting a neonatal cooling program. Clin Perinatol 2008; 35 (4): 765–775.

    Article  Google Scholar 

  10. Barkovich AJ, Hajnal BL, Vigneron D, Sola A, Partridge JC, Allen F et al. Prediction of neuromotor outcome in perinatal asphyxia: evaluation of MR scoring systems. AJNR Am J Neuroradiol 1998; 19 (1): 143–149.

    CAS  Google Scholar 

  11. Higgins RD, Raju T, Edwards AD, Azzopardi DV, Bose CL, Clark RH et al. Hypothermia and other treatment options for neonatal encephalopathy: an executive summary of the Eunice Kennedy Shriver NICHD workshop. J Pediatr 2011; 159 (5): 851–858.

    Article  Google Scholar 

  12. 2006. BsoidNSTHA. Bayley scales of infant and toddler development. 3rd ed. Harcourt Assessment 2006.

  13. Sarnat HB, Sarnat MS . Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976; 33 (10): 696–705.

    Article  CAS  Google Scholar 

  14. Shankaran S, Barnes PD, Hintz SR, Laptook AR, Zaterka-Baxter KM, McDonald SA et al. Brain injury following trial of hypothermia for neonatal hypoxic-ischaemic encephalopathy. Arch Dis Child 2012;97: F398–F404.

    Article  Google Scholar 

  15. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B . Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39 (4): 214–223.

    Article  CAS  Google Scholar 

  16. Palisano RJ, Hanna SE, Rosenbaum PL, Russell DJ, Walter SD, Wood EP et al. Validation of a model of gross motor function for children with cerebral palsy. Phys Ther 2000; 80 (10): 974–985.

    CAS  Google Scholar 

  17. Jary S, Whitelaw A, Walloe L, Thoresen M . Comparison of Bayley-2 and Bayley-3 scores at 18 months in term infants following neonatal encephalopathy and therapeutic hypothermia. Dev Med Child Neurol 2013; 55: 1053–1059.

    Article  Google Scholar 

  18. Vohr BR, Stephens BE, Higgins RD, Bann CM, Hintz SR, Das A et al. Are outcomes of extremely preterm infants improving? Impact of Bayley assessment on outcomes. J Pediatr 2012; 161 (2): 222–228. (e3).

    Article  Google Scholar 

  19. Moore T, Johnson S, Haider S, Hennessy E, Marlow N . Relationship between test scores using the second and third editions of the Bayley Scales in extremely preterm children. J Pediatr. 2012; 160 (4): 553–558.

    Article  Google Scholar 

  20. Lowe JR, Erickson SJ, Schrader R, Duncan AF . Comparison of the Bayley II Mental Developmental Index and the Bayley III Cognitive Scale: are we measuring the same thing? Acta Paediatr 2012; 101 (2): e55–e58.

    Article  Google Scholar 

  21. Acton BV, Biggs WS, Creighton DE, Penner KA, Switzer HN, Thomas JH et al. Overestimating neurodevelopment using the Bayley-III after early complex cardiac surgery. Pediatrics 2011; 128 (4): e794–e800.

    Article  Google Scholar 

  22. Rutherford MA, Counsell SJ, Cowan FM, Azzopardi D, Edwards D, Renowden S et al. Magnetic resonance imaging patterns of brain injury following hypothermia in neonates with hypoxic ischemic encephalopathy. Pediatric Res 2004; 55 (4): 583a–583aa.

    Google Scholar 

  23. Rutherford M, Srinivasan L, Dyet L, Ward P, Allsop J, Counsell S et al. Magnetic resonance imaging in perinatal brain injury: clinical presentation, lesions and outcome. Pediatr Radiol 2006; 36 (7): 582–592.

    Article  Google Scholar 

  24. Rutherford M, Ramenghi LA, Edwards AD, Brocklehurst P, Halliday H, Levene M et al. Assessment of brain tissue injury after moderate hypothermia in neonates with hypoxic-ischaemic encephalopathy: a nested substudy of a randomised controlled trial. Lancet Neurol. 2010; 9 (1): 39–45.

    Article  Google Scholar 

Download references

Acknowledgements

Dr Chalak is supported by Grant K23HD069521-01A11 and Gerber Foundation grant.

Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas, Southwestern Medical Center, Dallas, TX, USA

    L F Chalak, T L DuPont, P J Sánchez, A Lucke & R J Heyne

  2. Department of Radiology, The University of Texas, Southwestern Medical Center, Dallas, TX, USA

    M C Morriss & N K Rollins

Authors
  1. L F Chalak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T L DuPont
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P J Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A Lucke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R J Heyne
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M C Morriss
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. N K Rollins
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L F Chalak.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chalak, L., DuPont, T., Sánchez, P. et al. Neurodevelopmental outcomes after hypothermia therapy in the era of Bayley-III. J Perinatol 34, 629–633 (2014). https://doi.org/10.1038/jp.2014.67

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2014.67

This article is cited by

Search

Advanced search

Quick links