Table 3.
Neurodevelopmental Outcomes using the Bayley Scales of Infant and Toddler Development (Bayley-III).
| a. Cohort Results | (n=43) |
|---|---|
| Age at evaluation, months | 19 [18–22] |
| Disability | 7 (16 %) |
| Mild | 4 (9%) |
| Moderate | 0 |
| Severe | 3 (7%) |
| Cognitive score | 95 [90 – 106] |
| ≥ 85 | 36 (84%) |
| 70–84 | 4 (9 %) |
| <70 | 3 (7%) |
| Language score | 89 [79 – 100] |
| ≥ 85 | 29 (67%) |
| 70–84 | 10 (23%) |
| <70 | 4 (10%) |
| Language subtypes: Receptive communication | 9 [7–10] |
| Expressive communication | 8 [7–10] |
| Motor score* | 100 [88 – 105] |
| ≥85 | 37 (86%) |
| 70–84 | 3 (7%) |
| <70 | 1 (2%) |
| Motor subtypes: Fine motor | 10 [9–12] |
| Gross motor | 9 [8–10] |
| Cerebral palsy | 1 (2%) |
| Autism | 2 (5%) |
| b. Selected Details of the Seven Mild HIE infants with disability at 18-22 months | |||||||
|---|---|---|---|---|---|---|---|
| Cases with disability | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Sarnat at admission – abnormal categories (mild=1, moderate=2 and severe=3) | score= 1 For all | Posture=1 Tone=2 Moro=2 | Posture= 1 and SA=2 | LOC=1 ANS=1, Tone Moro=2 | All categories= 1 but ANS=3 | Post=1 Tone=1, Suck=2 ANS=3 | Posture=1 Suck=1; Tone=2 ANS=3 |
| Total # of abnormal categories | 4 | 3 | 2 | 4 | 6 | 4 | 4 |
| Short-term outcomes aEEG at <9h days of age | CNV | CNV | CNV | CNV | CNV | CNV | CNV |
| Brain MRI at <30d of age | 2b | 0 | 0 | 2b | 1b | 0 | 0 |
| Neurological exam at discharge/transfer | All= 1 LOC, activity Tone ATNR | normal | normal | Tone =2b | Abnormal ATNR | Moro =1 | Tone =1 |
| Follow-up 18–22 months | |||||||
| Disability | Severe | Severe | Severe | Mild | Mild | Mild | Mild |
| Bayley III Score - Cognitive | <70 | 60 | <70 | 75 | 80 | 75 | 80 |
| Bayley III Score - Language | <70 | 56 | <47 | 79 | 74 | 97 | 91 |
| Bayley III Score - Motor | <70 | 58 | <70 | 88 | 82 | 107 | 88 |
| Cerebral Palsy* | Yes | No | No | No | No | No | No |
| GMFCS | 4a | 0 | 0 | 1 | 1 | 0 | 0 |
| Autism | - | Yes b | Yes b | - | - | - | - |
Disability at 18–22 months of age as defined by the NICHD Neonatal Research Network: a) Mild: cognitive score of 70–84 alone, or a cognitive score ≥ 85 and GMFCS Level 1 or 2, seizure disorder (without anti-epileptic medication), or hearing deficit with ability to follow commands without amplification; b) Moderate: cognitive score from 70–84 and GMFCS Level 2, active seizure disorder or hearing deficit; and c) Severe: cognitive score < 70, GMFCS Level 3–5, blindness, or hearing impairment. Results are expressed as n (%), mean ± standard deviation or median [IQR].
Two cases with autism were excluded from the motor scores due to inability to complete testing.
Sarnat at admission included 6 categories that could be scored as Normal 0, mild=1, moderate=2 or severe=3 (Table 1). SA, spontaneous activity; LOC, level of consciousness; ANS, autonomic nervous system (all abnormalities were need of intubation: score 3); aEEG, amplitude integrated electroencephalogram; CNV, continuous normal voltage; MRI, magnetic resonance image; GMFCS, Gross motor function classification score:
mixed cerebral palsy.
Both Cases with a diagnosis of autism were followed beyond 36 months to confirm the diagnosis.