MABC Article Summary
Reference: Erdi-Krausz G, Rocha R, Brown A, et al. Neonatal hypoxic-ischaemic encephalopathy: Motor impairment beyond cerebral palsy. Eur J Paediatr Neurol. 2021;35:74-81. doi:10.1016/j.ejpn.2021.10.005
Purpose: Neonatal hypoxic-ischemic encephalopathy (HIE) is a condition that is caused by lack of blood flow to the brain around birth. One of the intervention approaches to this condition is therapeutic hypothermia (TH). Even with this (TH) intervention, some of these children will go on to receive a diagnosis of cerebral palsy (CP). However, there are some children with neonatal HIE who do not receive a CP diagnosis. There is a lack of information regarding physical and cognitive outcomes in children who had neonatal HIE but did not receive a formal diagnosis of CP. Therefore, the purpose of this study was to look at motor, neurologic, and cognitive ability in school aged children who had neonatal HIE but no diagnosis of CP.
Study population: This study included 47 subjects between the ages of 5-7. Twenty-seven of these were children who had a diagnosis of neonatal HIE and had TH intervention but no diagnosis of CP. The remaining twenty children were controls.
Methods: Between the ages of 5-7, the children engaged in several assessments to assess motor, cognitive, and neurologic ability and impairments. The Touwen exam evaluated reflexes, posture and tone, balance, and nerve function of the face and eyes and was used to assess minor neurologic dysfunction. To assess motor function, the movement assessment battery for children was used (MABC-2). The MABC-2 examines three categories: dexterity, aiming and catching, and balance. They asked the parents to report the impact of motor impairments on the daily life of the child via the Peds Quality of Life inventory. Cognition was assessed via the Weschler Preschool and Primary Scale of Intelligence (WPPSI) and attention was assessed via the DuPaul ADHD rating scale. For the children who had neonatal HIE, they had neurologic and developmental records on file at two years of age and those were used to compare to their current data. T-tests, Mann-Whitney U test, and Chi-square tests were used for data analysis.
Outcome measures: The MABC-2, Touwen exam, DuPaul ADHD scale, Welsch Preschool and Primary scale of Intelligence
Interventions: No interventions were provided.
Results: Roughly 1/5 of the children in the HIE group had MND compared to all of the control group having normal neurologic exams. Children in the HIE group had significantly lower MABC-2 scores than the control group. Dexterity and balance scales of the MABC-2 were significantly lower for the HIE group and there was no difference in the aiming and catching scale. There were no significant differences in WPPSI scores. The HIE group had significantly higher scores on the ADHD rating scale.
Major Strength and limitations: I thought this was a strong study. The study design was comprehensive and captured multiple aspects of the children they were studying. The study was not intervention based and thus only captured data. I agree with their statement that future studies should incorporate a multiple regression if possible. This study did have a few limitations including a small sample size, a convenience-based sample, and a statistically significant difference in age between groups.
Overall conclusion: This study concluded that approximately 20% of children who don’t have a diagnosis of CP but had neonatal HIE with TH intervention had significant motor difficulties at the age of 5-7. The HIE group scored significantly lower than their controls on the MABC-2. This was most noted in the dexterity and balance categories of the MABC-2. In addition to the objective differences in MABC-2 scores, parents of kids with HIE reported that their motor difficulties had a significant impact on their child’s daily life. When the HIE group was compared to their previous self, it was found that motor ability at age 2 was not a good predictor of their motor ability at school age. This is significant because it highlights the need for continued follow-up. The early assessments given to these children may not be able to accurately predict long term consequences and implications of their motor, cognitive, and neurologic abilities.
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Great synopsis of the article! The importance of early intervention on children with a CP diagnosis is critical for their prognosis, as we learned in Dr. Dibiasio’s lectures. I think that despite the small sample size, this study’s goal of identifying certain diagnoses is an important step towards creating more successful treatment plans. Considering that dexterity was lower for children in the HIE group (according to the MABC-2), incorporating fine motor activities in their therapeutic sessions (stacking blocks, putting caps on markers, etc) would be a great way to try and improve this. I also personally haven’t heard of the outcome measures used in this study, so it was interesting to see why they used these certain ones for these populations.