Clinical Research Article | Published:

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

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.

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Acknowledgements

We thank Beverley Adams-Huet (UT Southwestern) for help in statistical analysis and the following individuals for help in patient enrollment and follow-up: Jarred Garfinkle and Rose Boyle (McGill), Imran Mir (UT Southwestern), Vaneet Kalra and Sanjay Chawla (Wayne State). L.C. is supported by NIH Grant K23HD069521 and 1R01NS102617-01.

Author contributions

All authors contributed to the conception or design of the work, data collection, and approval of the version to be published and agree to be accountable for all aspects of the work. Specifically: L.C.—conception or design of the work, drafting the first draft article, central interpretation of aEEG recordings, data collection, critical revision, final approval of the version to be published, and agrees to be accountable for all aspects of the work. K.-A.N.—conception or design of the work, data collection, final approval of the version to be published, and agrees to be accountable for all aspects of the work. C.P.—conception or design of the work, data collection, critical revision of the article, final approval of the version, and agrees to be accountable for all aspects of the work. R.H.—outcome data collection and analysis, critical revision of the article, final approval of the version to be published, and agrees to be accountable for all aspects of the work. N.R.—MRI central blinded reader and MRI data analysis, critical revision of the article, final approval of the version to be published, and agrees to be accountable for all aspects. S.T.—design of the work data collection, critical revision of the article, final approval of the version to be published, and agrees to be accountable for all aspects of work. A.P.—design of the work, central interpretation of aEEG recordings, data collection, critical revision of the article, final approval of the version to be published, and agrees to be accountable for all aspects of the work. B.S.—data collection, critical revision of the article, final approval of version to be published, and agrees to be accountable for all aspects of work. L.K.—data regarding outcomes, critical revision of the article, final approval of version to be published, and agrees to be accountable for all aspects of work. P.J.S.—conception or design of the work, critical revision of the article, final approval of the version to be published, and agrees to be accountable for all aspects of the work. S.S.—conception or design of the work data collection, critical revision of the article, final approval of the version to be published, and accountable for all aspects of the work. P.M.—data collection, critical revision of the article, final approval of version to be published, and agrees to be accountable for all aspects of work. B.T.—data collection, critical revision of the article, final approval of version to be published, and agrees to be accountable for all aspects of work. A.L.—conception or design of the work, data collection, critical revision of the article, final approval of version to be published, and agrees to be accountable for all aspects of work. G.S.—conception or design of the work, data collection, critical revision of the article, final approval of the version to be published, and agrees to be accountable for all aspects of the work.

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Competing interests

The authors declare no competing interests.

Correspondence to Lina F Chalak.

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