Resuscitation at birth and cognition at 8 years of age: a cohort study

Background Mild cerebral injury might cause subtle defects in cognitive function that are only detectable as the child grows older. Our aim was to determine whether infants receiving resuscitation after birth, but with no symptoms of encephalopathy, have reduced intelligence quotient (IQ) scores in childhood. Methods Three groups of infants were selected from the Avon Longitudinal Study of Parents and Children: infants who were resuscitated at birth but were asymptomatic for encephalopathy and had no further neonatal care (n=815), those who were resuscitated and had neonatal care for symptoms of encephalopathy (n=58), and the reference group who were not resuscitated, were asymptomatic for encephalopathy, and had no further neonatal care (n=10609). Cognitive function was assessed at a mean age of 8.6 years (SD 0.33); a low IQ score was defined as less than 80. IQ scores were obtained for 5953 children with a shortened version of the Weschler intelligence scale for children (WISC-III), the remaining 5529 were non-responders. All children did not complete all parts of the test, and therefore multiplied IQ values comparable to the full-scale test were only available for 5887 children. Results were adjusted for clinical and social covariates. Chained equations were used to impute missing values of covariates. Findings In the main analysis at 8 years of age (n=5887), increased risk of a low IQ score was recorded in both resuscitated infants asymptomatic for encephalopathy (odds ratio 1.65 [95% Cl 1.13-2.43]) and those with symptoms of encephalopathy (6.22 [1.57-24.65]). However, the population of asymptomatic infants was larger than that of infants with encephalopathy, and therefore the population attributable risk fraction for an IQ score that might be attributable to the need for resuscitation at birth was 3.4% (95% CI 0.5-6.3) for asymptomatic infants and 1.2% (0.2-2.2) for those who developed encephalopathy. Interpretation Infants who were resuscitated had increased risk of a low IQ score, even if they remained healthy during the neonatal period. Resuscitated infants asymptomatic for encephalopathy might result in a larger proportion of adults with low IQs than do those who develop neurological symptoms consistent with encephalopathy.