Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review

Neonatal encephalopathy (NE) following perinatal asphyxia (PA) is considered an important cause of later neurodevelopmental impairment in infants born at term. This review discusses long-term consequences for general cognitive functioning, educational achievement, neuropsychological functioning and behavior. In all areas reviewed, the outcome of children with mild NE is consistently positive and the outcome of children with severe NE consistently negative. However, children with moderate NE form a more heterogeneous group with respect to outcome. On average, intelligence scores are below those of children with mild NE and age-matched peers, but within the normal range. With respect to educational achievement, difficulties have been found in the domains reading, spelling and arithmetic/mathematics. So far, studies of neuropsychological functioning have yielded ambiguous results in children with moderate NE. A few studies suggest elevated rates of hyperactivity in children with moderate NE and autism in children with moderate and severe NE. Conclusion: Behavioral monitoring is required for all children with NE. In addition, systematic, detailed neuropsychological examination is needed especially for children with moderate NE

Do antiepileptic drugs differ in suppressing interictal epileptiform activity in children?

Antiepileptic drugs may suppress interictal epileptiform activity in addition to suppressing seizures, although the comparative rates of suppression of interictal epileptiform activity for phenobarbital (PHB), carbamazepine (CBZ), and valproate (VPA) in children are unknown. Electroencephalogram (EEG) pairs were identified in which the first tracing illustrated interictal epileptiform activity before antiepileptic drug treatment; the rate of clearance of such activity in the subsequent tracing was assessed according to the drug introduced. EEG pairs (n = 213) were identified for CBZ, PHB, and VPA. Overall suppression rates of epileptiform activity in the second EEG were 12/55 (22%) for PHB, 27/81 (33%) for CBZ, and 35/77 (46%) for VPA (P = 0.005 for VPA vs PHB). When suppression rates were assessed comparing sleep-state pairs, suppression rates were 24/80 (30%) for PHB, 51/129 (40%) for CBZ, and 60/120 (50%) for VPA (P = 0.005 for PHB vs VPA). A subanalysis for focal discharges yielded suppression rates of 10/43 (23%) for PHB, 19/60 (32%) for CBZ, and 8/19 (42%) for VPA; for generalized discharges, 2/12 (17%) for PHB, 8/21 (38%) for CBZ, and 27/58 (47%) for VPA. VPA, and to a lesser extent CBZ, appeared superior to PHB in suppressing interictal epileptiform activity, including both focal and generalized epileptiform activity. (C) 2001 by Elsevier Science Inc. All rights reserved

Late-preterms: A group of infants at risk for cognitive developmental delay. Systematic review and description of evaluation tools

Children born at 34-36 weeks' gestation are defined as late-preterms (LP); they are considered as being at risk for adverse cognitive outcomes compared to infants born at term. We performed an extensive search and systematic review of English language articles on the cognitive development of LP from the first year of life to school age, published between January 2006 and June 2013. General cognitive outcome, specific neuropsychological abilities and school performances were investigated. We selected the studies that had used standardized instruments for the evaluation. Nineteen studies were reviewed; eleven were on pre-school children and eight on school-age children. The results suggest that pre-school LP children reach a lower general cognitive level than term children, and perform worse when specific neuropsychological abilities are measured. At school age LP still reach a lower cognitive level and have more academic difficulties in comparison to term infants. The reasons for the lower cognitive performances of LP might be related to prematurity itself, but also to the causes of the preterm birth

Prognostic value of the cerebral function monitor (CFM) and of the eeg in term newborns with hypoxic-ischemic encephalopaty

The prognostic value of the neonatal EEG has been well established, while the role of the neonatal CFM in predicting neurological outcome is more controversial. The aim of the study was to compare the prognostic value of the conventional EEG with CFM trace in 35 term newborns with HIE. The recordings were made with a CFM for a period of at least 48 hours during the first days of life; repeated EEG recordings were also performed during the first week and severity of EEG and CFM abnormalities was graded using a score. Survivors were followed until 1 year of age, by repeated standardized neurological examinations. There were no significant differences between early EEG and CFM in predicting neurological outcome, but the conventional EEG recorded at the end of the first week of life prooved to be the more valuable tool in predicting prognosis for infants with HIE. Our results support the hypothesis that HIE prognosis is well valued by simultaneous recording of CFM trace and repeated EEG