Functional status at 18 months of age as a predictor of childhood disability after neonatal hypoxic-ischemic encephalopathy

Aim: In children with neonatal hypoxic-ischemic encephalopathy (HIE), we examined the association between 18-month functional status by parental report and disability at 6-7 years. Method: Prospective observational study involving participants in the NICHD randomized controlled trial of hypothermia for HIE. Parent questionnaires-Functional Status-II (FS-II), Impact on Family (IOF) and Family Resource Scale (FRS) at 18 months were correlated with 6- to 7-year developmental assessments. Disability at 6-7 years was defined as IQ < 70, gross motor functional classification scale level III-V, bilateral blindness, deafness, or epilepsy. Results: Rates of severe HIE (32 vs. 15%), public insurance (73% vs. 47%) and IOF scales were higher and mean (SD) FS-II independence (I) {54 (SD 35) vs. 98 (SD 8)} and general health (GH) {87 (SD 14) vs. 98 (SD 6)} scores were significantly lower in children with disability (n=37) at 6-7 years, compared to those (n=74) without disability. FS-II I scores were significantly associated with disability (OR 0.92; 95% CI 0.87-0.97; p=0.003). On path analysis, severe HIE, greater IOF and public insurance were associated with poorer 18-month FS-II I scores, which, in turn, were associated with disability at 6 to 7 years. Interpretation: Poor independent functioning by parental report at 18 months in children with HIE was associated with childhood disability. What this paper adds: Children with a history of neonatal hypoxic-ischemic encephalopathy (HIE) and moderate/severe disability at age 6 to 7 have lower functional status scores by parental report at 18 months.Severe HIE and greater impact on the family are significantly associated with lower functional status scores at 18 months.Lower independent functioning scores at 18 months are associated with childhood disability. This article is commented on by Colditz on page 1033 of this issue.