Long-term outcome after neonatal parenchymatous brain lesions.

BACKGROUND

Although considered of high prognostic impact, knowledge on the long-term outcome after neonatal parenchymatous brain lesions (PBL) is limited.

PATIENTS: 29 children with either unilateral (n = 19) or bilateral (n = 10) hemorrhagic/ischemic PBL.

METHODS

The patients were reinvestigated at 9 9/12 +/- 3 4/12 years of age, using a standardized clinical investigation, the Beery-Buktenica Scales of Visuomotor Integration (VMI) and the Bruininks-Oseretzky Test of Motor Proficiency (BOT). The parents were questioned by means of a standardized questionnaire and the Child Behavior Checklist (CBCL).

RESULTS

90 % of the children showed cerebral palsy (including 12 with hemi- and 8 with tetraplegia). Only 11 % showed normal results on BOT and 39 % on VMI testing. 50 % were bed wetters. Six had required ventriculoperitoneal shunting and 11 were on long-term antiepileptic therapy. Herewith bilateral versus unilateral lesions and low 5-minute APGAR scores were associated with poorer outcome (Cox model and Kaplan-Meier analysis). During follow-up the impact of different disabilities changed. Despite the high rate of cerebral palsy, 71 % learned to walk unaided and 86 % to communicate with words. The last patient learned to walk at 7 years of age. Only one showed poor seizure control. No severe shunt-related complications occurred after 5 years of age. Social, cognitive and behavioral problems increased with age. Only 34 % could attend mainstream schools or kindergartens, and only 50 % displayed normal behavior according to CBCL data, with attention deficiency and social problems being the most important domains. In consequence, nearly all children required 24-hour supervision.

CONCLUSIONS

After birth, organic problems such as delayed motor development, epilepsy and ventriculoperitoneal shunting are of major importance for children with PBL. Although delayed, basic skills such as verbal communication are achieved by the majority of patients. In later childhood and adolescence, social, behavioral and cognitive problems increase. In the future, vast resources will be required to provide adequate education and carers as substitutes for elderly parents.