Pediatrics · 2 h ago
Half of assessed infants not cooled had sub-normative scores at age 2
In a prospective cohort of infants evaluated for therapeutic hypothermia (TH) but not meeting institutional eligibility criteria, 13 of 26 children assessed at 24 months had sub-normative scores in at least one Bayley-4 developmental domain. Higher postnatal base deficits and lactate levels were associated with sub-normative performance, although the small cohort limits interpretation.
- 13 of 26 assessed children scored below norm in at least one domain.
- Only one affected child had acute MRI-detected injury.
- Higher base deficits and lactate were associated with sub-normative scores.
- Small cohort and incomplete follow-up limit interpretation.
Therapeutic hypothermia is standard care for moderate-to-severe neonatal encephalopathy, but outcomes are less well defined for infants evaluated for cooling who do not meet eligibility criteria. In this prospective cohort, 39 infants with perinatal risk factors were enrolled; 26 completed Bayley-4 assessments at 24 months. Scores below 85 were classified as sub-normative.
Thirteen of the 26 assessed infants (50%) had sub-normative performance in at least one developmental domain. Only one of these 13 had acute brain injury detected on MRI. Compared with infants whose scores were in the average range, those with sub-normative performance had higher postnatal base deficits (10.1 vs 6 mmol/L; p=0.04) and lactate levels (9.4 vs 4.9 mmol/L; p=0.05). Less sleep–wake cycling on amplitude-integrated EEG was also observed as a trend (45% vs 83%; p=0.06).
The findings suggest that a normal acute MRI does not rule out later developmental vulnerability in this group and support longitudinal follow-up. However, results are based on 26 children with completed assessments, and the reported metabolic differences do not establish predictive thresholds or causality.
In practice
For infants evaluated for therapeutic hypothermia but not meeting local eligibility criteria, this small prospective cohort found sub-normative Bayley-4 performance in half of those assessed at 24 months, including children without acute MRI-detected injury. The results support attention to developmental follow-up in this population, but they do not establish an individual infant’s prognosis or validated risk thresholds. Only 26 of 39 enrolled infants completed assessment, and the observed associations with base deficit and lactate require confirmation.
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Pediatric Research: Neurodevelopmental outcomes of infants evaluated for but not treated with therapeutic hypothermia: a prospective cohort study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.