Skip to main content Accessibility help
×
Home
  • Print publication year: 2013
  • Online publication date: March 2013

16 - Neurological follow-up of infants treated with hypothermia

from Section 2 - Clinical neural rescue

Summary

Introduction

The theory, timelines, measures and services for the follow-up care of high-risk infants have been well described [1–3]. Amiel-Tison’s overview of the trajectory of child development after birth asphyxia in the term infant continues to give guidelines for the sequential diagnosis of abnormalities [4]. Although neural protection has been shown to lessen major disabilities among survivors [5], there is no indication that the approach to long-term follow-up should be altered. This chapter focuses on the neurological examination as a tool to assist and augment the neurodevelopmental and neurocognitive follow-up of neonates after hypothermia. Examples of assessment and rating tools are given. Many other measures would also be appropriate. Measures should be standardized for the population where the test is given and be the latest edition available. Where possible a comparison population should also be tested. Within each section, there is a discussion on early referral for intervention services to reduce adverse outcomes. The organization of this chapter is patterned after the timelines approach of Amiel-Tison [4] with less emphasis on individual disabilities than in other publications on outcome of term infants with perinatal asphyxia [6,7].

Defining the cohort

The focus of this book is on techniques to preserve neurological function in neonates compromised by perinatal asphyxia. By extension, follow-up should not only document outcomes but provide services to reduce the impact of the insult on limitations of function, activities and participation for each child [8]. Clarity of definition of diagnosis not only of the initial insult but of associated diagnoses will assist both outcomes research and service to the child and family [6]. For more than three decades the words hypoxic–ischaemic encephalopathy (HIE) in the term newborn suggested neonatal encephalopathy beginning within hours of intrapartum asphyxia where there was evidence of fetal distress (fetal heart rate abnormalities, meconium-stained amniotic fluid and depression at birth [4,6]. This definition did not preclude an earlier antepartum acute or chronic hypoxic event. However, reports generally excluded children with known chromosomal abnormalities, syndromes or malformations of the central nervous system and those with intracranial haemorrhage. In general, there has been little mention of excluding children from outcome studies after HIE who also had antenatal infections such as cytomegalovirus, or exposure to toxins such as maternally consumed illicit drugs. Such exclusions should be considered in the future.

References
Cioni, G, Mercuri, E, editors. Neurological assessment in the first two years of life: instruments for the follow-up of high-risk newborns. Clinics in developmental medicine No. 176. London: MacKeith Press; 2007.
The American Academy of Pediatrics. Follow-up care of high-risk infants. Pediatrics 2004;114:1377–97.
Taeusch, HW, Vogman, MW, editors. Follow-up management of the high-risk infant. Boston: Little, Brown and Company; 1987.
Amiel-Tison, C, Ellison, P. Birth asphyxia in the fullterm newborn: early assessment and outcome. Dev Med Child Neurol 1986;28:671–82.
Edwards, AD, Brocklehurst, P, Gunn, AJ, et al. Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischemic encephalopathy: Synthesis and met-analysis of trial data. BMJ 2010;340:c363.
Robertson, CMT. Long-term follow-up of term infants with perinatal asphyxia. In: Stevenson, BK, Benitz, WE, Sunshine, P, editors. Fetal and neonatal brain injury: mechanisms, management and the risk of practice. 3rd edition. Cambridge: Cambridge University Press; 2003. p. 829–58.
Miller, SP, Latal, B. Neurocognitive outcomes of term infants with perinatal asphyxia. In: Stevenson, BK, Benitz, WE, Sunshine, P, Heintz, SR, Druzin, ML, editors. Fetal and neonatal brain injury, 4th edition. Cambridge: Cambridge University Press; 2009. p. 574–83.
Simeonsson, RJ, Leonardi, M, Lollar, D, et al. Applying the International Classification of Functioning, Disability and Health (ICF) to measure childhood disability. Disabil Rehabil 2003;25:602–10.
Pin, TW, Eldridge, B, Galea, MP. A review of developmental outcomes of term infants with post-asphyxia neonatal encephalopathy. Eur J Paed Neurol 2009;13:224–34.
American College of Obstetricians and Gynecologists. Neonatal encephalopathy and cerebral palsy: Executive Summary. Obstet Gynecol 2004;103:780–81.
Hallberg, B, Grossman, NK, Bartocci, M, Blennow, M. The prognostic value of early aEEG in asphyxiated infants undergoing systemic hypothermia treatment. Acta Paediatr 2010;99:531–36.
Sarnat, HB, Sarnat, MSNeonatal encephalopathy following fetal distress: A clinical and electrocephalographic study. Arch Neurol 1976;33:696–705.
Volpe, JJ. Hypoxic-ischemic encephalopathy: clinical aspects. In: Neurology of the newborn. 5th edition. Philadelphia: Sanders Elsevier; 2008. p. 400–80.
Gunn, AJ, Wyatt, JS, Whitelaw, A, et al. Therapeutic hypothermia changes the prognostic value of clinical evaluation of neonatal encephalopathy. J Pediatr 2008;152:55–8.
Volpe, JJ. Neurological examination: normal and abnormal features. In: Neurology of the newborn. 5th edition. Philadelphia: Sanders Elsevier; 2008. p. 121–53.
American Academy of Pediatrics Joint Committee on Infant Hearing. 2007 Position statement: principles and guidelines for early hearing protection and intervention programs. Pediatrics 2007;120:898–921.
Schwarz, SM, Corredor, J, Fisher-Medina, J, Cohen, J, Rabinowitz, S. Diagnosis and treatment of feeding disorders in children with developmental disabilities. Pediatrics 2001;108:671–6.
Miller, SP, Ramaswamy, V, Michelson, D, et al. Patterns of brain injury in term neonatal encephalopathy. J Pediatr 2005;146:453–60.
Prechlt, HFR, Ferrari, F, Cioni, G. Predictive value of general movement in asphyxiated full term infants. Early Hum Dev 1993;35:91–120.
Cordes, I, Roland, EH, Lupton, BA, Hill, A. Early prediction of the development of microcephaly after hypoxic-ischemic encephalopathy in the full term newborn. Pediatrics 1994;93:703–7.
Thomasgard, M, Metz, WP. Parent-child relationship disorders: what do the Child Vulnerability Scale and the Parent Protection Scale measure?Clin Pediatr 1999;38:347–56.
Romeo, DMM, Cioni, M, Scoto, M, et al. Neuromotor development of infants with cerebral palsy investigated by Hammersmith Infant Neurological Examination during the first year of age. Eur J Pediatr Neurol 2008;12:24–31.
Piper, MC, Darrah, J. Motor assessment of the developing infant. Philadelphia: WB Saunders Co; 1994.
Bayley, N. Manual for the Bayley Scales of Infant and Toddler Development. 3rd edition. San Antonio, TX: The Psychological Corporation; 2006.
Rosenbaum, P, Panif, N, Leviton, A, Rosenstein, M, Max, M. A report: the definition and classification of cerebral palsy, April 2006. In: The definition and classification of cerebral palsy. Dev Med Child Neurol 2007;49(Suppl 109):1–43.
Rosenbaum, P, Walter, S, Hanna, S, et al. Prognosis for gross motor function in cerebral palsy: creation of motor developmental curves. JAMA 2002;288:1357–63.
Eliasson, A-C, Krumlinde-Sundholm, L, Rösbald, B, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol 2006;48:549–54.
Sakzewski, L, Ziviani, J, Boyd, R. Systematic review and meta-analyses of therapeutic management of upper-limb dysfunction in children with congenital hemiplegia. Pediatrics 2009;123:e1111–22.
Coker, P, Labkicher, C, Harris, L, Snape, J. The effects of constraint-induced movement therapy for a child of less than a year of age. Neurorehabilitation 2009;24:199–208.
Clowry, GJ. The dependence of spinal cord development on cortical spinal input and its significance in understanding and treating spastic cerebral palsy. Neural Sci Behav Rev 2007;31:1114–24.
Rona, S, Gold, JT. Nonoperative management of spasticity in children. Childs Nerv Syst 2007;23:943–56.
Delgado, MR, Hirtz, D, Aisen, M, et al. Practice parameter: pharmacological treatment of spasticity in children and adolescence with cerebral palsy (an evidenced based review): Report on the quality standard subcommittee of the American Academy of Neurology and the Practice Subcommittee of the Child Neurology Society. Neurology 2010;74:336–43.
Heinen, F, Desloovere, K, Schroeder, AS, et al. The updated European consensus 2009 on the use of botulism toxin for children with cerebral palsy. Eur J Pediatr Neurol 2010;14:45–66.
Novacheck, TF, Gage, JR. Orthopedic management of spasticity in cerebral palsy. Childs Nerv Syst 2007;23:1015–31.
Australasian Academy of Cerebral Palsy and Developmental Medicine. Consensus Statement on Hip Surveillance for Children with Cerebral Palsy. Australian Standard of Care. 2008. (Accessed, July 7, 2010.)
Harrison, PL, Oakland, T. Manual for the adaptive behavior assessment system. 2nd edition. San Antonio, TX: The Psychological Corporation; 2003.
Henderson, SE, Sugden, DA, Barnett, AL. Movement assessment battery for children, 2nd edition. London: Harcourt Assessment; 2007.
Wechsler, D. Manual for the preschool and primary scale of intelligence. 3rd edition. San Antonio, TX: The Psychological Corporation; 2002.
American Association for Intellectual and Developmental Disabilities. Definition, classification and systems of support. 11th edition. Washington, DC: American Association for Intellectual and Developmental Disabilies; 2010.
Reynolds, CR, Kamphaus, RW. Manual for the behaviour assessment system for children. 2nd edition. Circle Pines, MN: American Guidance Services, Inc; 2004.
The Psychological Corporation. Clinical evaluation of language fundamentals, preschool. 2nd edition. San Antonio, TX: The Psychological Corporation; 2004.
Varni, JW, Seid, M, Kurtin, PS. The Peds QL 4.0: reliability and validity of pediatric quality of life inventory version 4.0 generic core scales in healthy and patient populations. Med Care 2001;30:800–12.
Marlow, N, Rose, AS, Rans, CE, Diaper, ESNeuropsychological and educational problems at school age associated with neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2005;90:F380–7.
Wechsler, D. Manual of the intelligence scale for children. 4th edition. San Antonio, TX: The Psychological Corporation; 2004.
Wechsler, D. Manual for the Wechsler individual achievement test. 2nd edition. San Antonio, TX: The Psychological Corporation; 2001.
Korkman, M, Kirk, U, Kemp, S. Clinical and interpretative manual for the NEPSY-II. 2nd edition. San Antonio, TX: The Psychological Corporation; 2007.
Gioia, GA, Isquith, PK, Guy, SC, Kentworthy, L. Behaviour rating inventory of executive function. Lutz, FL: Psychological Assessment Resources, Inc; 2001.
Goodman, R, Ford, T, Simmonds, H, Gratward, R, Meltzer, H. Using Strengths and Difficulties Questionnaire (SDQ): to screen for child psychiatric disorders in a community sample. Br J Psychiatry 2000;177:534–9.