Neuropsychological consequences at young adult age after cardio-pulmonary resuscitation at birth or being born small-for-gestational age

Abstract

The main objective of this thesis was to investigate whether infants resuscitated at birth because of presumed birth asphyxia or born small-for-gestational age without evidence of neurodevelopmental deviations in early childhood, may express cognitive deficits in adulthood when the demands of cognitive and social adaptation increase. Methods: A long-term follow-up was carried out in a group of young adults (n=70), 19-28 years of age, born at Sahlgrens Hospital, Göteborg between 1969 and 1978, requiring cardio-pulmonary resuscitation at birth with a mild or moderate clinical course or born small-for-gestational age (SGA). During the same time period a group of control subjects with an uncomplicated birth were studied. Most children were full-term. All subjects were without signs of neurological impairments or developmental deviations at 18 months of age. A questionnaire about educational achievements, current social situation and self-estimation of health was sent to the young adults in the clinical groups and the control group. A blinded comprehensive neuropsychological and neurolinguistic assessment of main aspects of cognitive functions was performed in a representative part of the young adults in the clinical groups and the control group (n=61) who had answered the questionnaire. Results: The clinical groups could not be separated from the controls in terms of educational achievements or social adjustment. No major differences were found between the resuscitated groups and controls in intelligence quotients or other cognitive abilities. However, the results indicate a tendency towards minor deficits in verbal ability in the mild resuscitated group as compared to controls. The SGA group demonstrated a significantly reduced intelligence level and had lower performances on all sub-tests in the neuropsychological assessment as compared to the controls. The young adults in the clinical groups displayed significantly reduced attention functions as compared to the controls. These differences were most obvious in auditory attention functions but also demonstrated in visual attention. The SGA group was most affected in their attention functions followed by the moderate, mild and control group. Conclusions: An acute episode of birth asphyxia that requires resuscitation may result in neurological and/or developmental impairment, which can be diagnosed before 18 months of age. Resuscitated children who then appear healthy have a high probability of normal future development. When their verbal abilities and attention functions are placed under special stress some weakness may become apparent. On the other hand, neonates who are born SGA with indication of asymmetric growth retardation may run a completely uneventful neonatal course but at adult age demonstrate multiple minor deficiencies in various aspects of their cognitive and attentive abilities. It appears that the intrauterine condition that places the fetus at disadvantage have long-term effects.