1 - Unidade Funcional de Neonatologia, Área de Pediatria, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.
2 - Faculdade de Educação, Universidade de Aveiro, Aveiro, Portugal.
3 - Centro de Reabilitação de Paralisia Cerebral Calouste Gulbenkian de Lisboa, Santa Casa de Misericórdia de Lisboa, Lisboa.
4 - Serviço de Neonatologia, Departamento de Pediatria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal.
5 - Sociedade Portuguesa de Pediatria do Neurodesenvolvimento, Portugal.
6 - Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal.
- 35th EACD Annual Meeting - Ljubljana, Slovenia.
Introduction. Induced hypothermia (IH) reduces the occurrence of death or cerebral palsy (CP) among term neonates with moderate-to-severe hypoxic-ischemic encephalopathy (HIE). Is the severity of CP among survivors of HIE after IH similar to their counterparts not submitted to IH?
Patients and Methods. The Portuguese Surveillance of Cerebral Palsy registers 5-year-old children with CP, born since 2001. A partner of Surveillance of Cerebral Palsy in Europe, both share methodology. We retrieved clinic, imagiologic (main MRI finding) and function scores data from children born in Portugal between 2007 and 2013, ≥36 weeks gestation, admitted to neonatal care; we excluded: TORCH infection, brain malformation, syndrome causing neurologic compromise, and postneonatal CP. On a post-hoc analysis, children with MRI classified as C3-MCA infarction, C4-Normal or C5-Miscellanea were excluded. We compared 5-year-old survivors of HIE whereas submitted or not to IH, using Chi-square or fisher-exact tests.
Results. Children submitted to IH more often had predominant grey matter lesion (87%vs.70.5%; p=0.055), especially basal ganglia lesions (72%vs.48%; p=0.041). Dyskinetic:spastic CP ratio was 48.5%:48.5% if submitted to IH vs. 31%:69% if not (p=0.040). Those submitted to IH had worse function scores (BFMF IV-V 71%vs.42%, p=0.020; GMFCS IV-V 71% vs. 42%, p=0.016; speech intelligibility Viking IV 73%vs 60%, p=0.031; IQ<50 70% vs. 48.5%, p=0.037) and tended to epilepsy (69%vs.51.5%; p=0.080).
Conclusion. Children with CP, born at term, with HIE, if having been on IH, seem to have higher odds for predominantly dyskinetic CP, basal ganglia lesion, their function scores being lower and more likely to suffer epilepsy.
Relevance for users and families. These data provide novel, useful information to complement the already known data provided by clinical trials and effectiveness studies on the ability of IH to prevent death or CP after HIE, characterizing the clinical and functional severity of CP at age 5 years-old among survivors of HIE after IH, compared with counterparts with CP not submitted to IH. It may be used to inform on prognosis and for anticipating intervention needs.
Palavras Chave: cerebral palsy, children, hypoxic-ischemic encephalopaty, induced hypothermia, severity