Neurodevelopmental outcomes after hypothermia therapy in the era of Bayley-III.

Perinatal hypoxic-ischemic encephalopathy (HIE) remains a frequent cause of cerebral palsy, mental retardation, learning disability, and epilepsy. (1) Hypothermia therapy for moderate to severe HIE has reduced significantly death or disability at 18 to 24 months of age.(2–7) Bayley-Scales of Infant and Toddler Development, 2nd edition (Bayley-II) and brain magnetic resonance imaging (MRI), have mostly been utilized for assessing, predicting, and counseling about neurodevelopmental outcomes in these infants.(8–10) The need for standardized assessment of outcomes among survivors of HIE who underwent hypothermia as part of clinical care has been cited as a critical need area by the National Institute of Child Health and Human Development (NICHD). (11) Published clinical neuro-protection trials have used the Bayley-II score of <70 as part of the criteria for moderate and/or severe disability. (2–7)In 2006, the Bayley-II was restructured in a new standardized third edition (Bayley-III) to provide distinct scores for cognitive, expressive and receptive language, fine and gross motor function, as well as updated normative data for the general population(12). Neonatal follow-up programs including ours have recently incorporated the new Bayley-III as the standard for developmental assessments. The objectives of this study were to 1) assess the neurodevelopmental outcomes of cooled infants using the new Bayley-III scales, and 2) determine the incidence of each of moderate (70–84) vs. severe (<70) developmental delays and the MRI predictive values of Bayley-III outcomes in a 6 year prospective inborn cohort delivered at Parkland Memorial Hospital (PMH), Dallas, TX.