Geheugen en gedrag op de schoolleeftijd van voldragen kinderen met een geschiedenis van perinatale asfyxie: correlatie met vroege en late MRI bevindingen
01 / 2004 - 02 / 2008
Rudolf Magnus Institute
- Aims: To reveal the association between brain lesions identified with MRI in the neonatal period and MRI abnormalities identified in middle childhood. Secondly, by examining in detail the cognitive and behavioral functioning of children with perinatal asphyxia, we will increase our understanding of the range of possible cognitive and/or behavioral problems present in these children at school age. - Summary: Perinatal asphyxia, resulting in neonatal encephalopathy (NE) is a worldwide problem with a prevalence of 2-10/1000 liveborn full-term infants. For those with a moderate or severe NE, there is a considerable risk of cerebral palsy or death. Infants with mild or moderate NE are at risk for more subtle problems like motor coordination problems, cognitive or behavioral problems. We hypothesize that full-term infants who suffer NE are at risk of developing cerebral palsy. In addition, these children are at greater risk of developing concomitant cognitive and/or behavioral problems. To evaluate these hypotheses we assess children born between 1994 and 1998, previously cared for in the neonatal intensive care unit of the WKZ, again during middle childhood. These children all had neonatal MRIs and were seen till the age of 18 months, looking at neurological function and early cognition. At the age of 8 to 10 years, we assess motor coordination and use standardized tests to evaluate cognitive (in particular memory and attention) and behavioral functioning. We also perform another MRI, including 3D volumetric studies, which will enable us to correlate neonatal abnormalities with changes seen at the age of 8 to 10 years. Furthermore, volumes of the hippocampus are measured, an area sensitive to acute neonatal hypoxia and known to be of importance for memory functions. Other areas like the frontal lobes and the striate are also measured, as these areas have been associated with attention deficit disorders. For comparison, a group of typically developing children who did not have perinatal problems participates. We expect to find a prevalence of approximately 15-20% of CP among survivors with moderate and severe NE and a higher prevalence of motor coordination disorders and mild cognitive and/or behavioral problems in those with mild and moderate NE. We expect that the abnormalities seen in MRI in the neonatal period will have changed but will still be recognizable at the age of 8 to 10 years. We also expect to find reduced volumes of certain brain areas and expect that these will be associated with memory and behavioral problems.