Placental findings are not associated with neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy - an 11-year single-center experience.

OBJECTIVES: Although neonates with moderate to severe hypoxic ischemic encephalopathy (HIE) receive therapeutic hypothermia (TH), 40-50% die or have significant neurological disability. The aim of this study is to analyse the association of placental pathology and neurodevelopmental outcome in cooled neonates with HIE at 18-24 months of age. METHODS: Retrospective analysis of prospectively collected data on 120 neonates registered in the Swiss National Asphyxia and Cooling Register born between 2007 and 2017. This descriptive study examines the frequency and range of pathologic findings in placentas of neonates with HIE. Placenta pathology was available of 69/120 neonates, whose results are summarized as placental findings. As neonates with HIE staged Sarnat score 1 (21/69) did not routinely undergo follow-up assessments and of six neonates staged Sarnat Score 2/3 no follow-up assessments were available, 42/48 (88%) neonates remain to assess the association between placental findings and outcome. RESULTS: Of the 42/48 (88%) neonates with available follow up 29% (12/42) neonates died. Major placenta abnormalities occurred in 48% (20/42). Major placenta abnormality was neither associated with outcome at 18-24 months of age (OR 1.75 [95% CI 0.50-6.36, p=0.381]), nor with death by 2 years of age (OR 1.96 [95% CI 0.53-7.78, p=0.320]). CONCLUSIONS: In this study cohort there could not be shown an association between the placenta findings and the neurodevelopmental outcome at 18-24 months of age.

Very preterm adolescents show impaired performance with increasing demands in executive function tasks.

BACKGROUND: Very preterm birth is often associated with executive function deficits later in life. The transition to adolescence increases personal autonomy, independence and, in parallel, the demands placed on executive functions at home and in school. AIM: To assess the impact of increasing demands on executive function performance in very preterm children and adolescents with normal intellectual and motor functions. METHODS: Forty-one very preterm children and adolescents with normal intellectual and motor functions and 43 healthy term-born peers were assessed at a mean age of 13.0 years (SD: 1.9; range: 10.0-16.9). A comprehensive battery of performance-based executive function measures with different demand levels as well as a parent-rating questionnaire evaluating executive functions relevant for everyday life was applied. Standardized mean differences between groups of d ≥ .41 were regarded as clinically relevant. RESULTS: No group differences were found at the lowest demand levels of working memory (d=.09), planning (d=-.01), cognitive flexibility (d=-.21) and verbal fluency (d=-.14) tasks, but very preterm participants scored significantly below their term-born peers in the most demanding levels (d=-.50, -.59, -.43 and -.55, respectively). These differences were clinically relevant. Executive functions relevant for everyday life were strongly impaired in very preterm participants, e.g., global executive composite (d=-.66). CONCLUSION: Very preterm children and adolescents with normal intellectual and motor functions are at high risk for executive function deficits that may only become apparent with increasing demands, potentially leading to academic and other deficits.