Neurological and perceptual-motor outcome at 5-6 years of age in children with neonatal encephalopathy: Relationship with neonatal brain MRI

Objective: The aims of this study were 1) to determine the incidence of minor neurological dysfunction and perceptual-motor difficulties in children aged 51/2 - 61/2, who had been born fullterm but presented with neonatal encephalopathy (NE) and low Apgar scores and 2) to examine the relationships between the presence/absence of these difficulties with neonatal brain MRI. Participants and Methods: Sixty-eight full-term infants with one minute Apgar scores less than or equal to 5 and neurological abnormalities during the first 48 hours after birth were included in the study. All children had a neonatal MRI brain scan. Surviving infants were assessed between the age of 5 and 6 years using the Touwen Examination, the Movement ABC and the WPPSI-R. Results: Fifteen of the 68 infants (22%) died in the neonatal period. Of the 53 surviving infants, 19 (36%) had cerebral palsy. The remaining 34 were considered normal at 2 years of age but, when assessed at school age, 8 (15%) had minor neurological dysfunction and/or perceptual-motor difficulties, 1 (2%) had only cognitive impairment and 25 (47%) were normal. The outcome largely reflected the pattern of lesions on brain imaging. While 83% of those with a normal outcome had normal scans or minimal white matter lesions, 80% of those with minor neurological dysfunction and/or perceptual-motor difficulties had mild or moderate basal ganglia or more marked white matter lesions. Conclusion: Continued surveillance is recommended for children with apparently normal outcome at two years of age after NE, particularly when abnormalities are detected on brain MRI.