Cognitive outcome and its neural correlates after cardiorespiratory arrest in childhood

Abstract

Hypoxia-ischaemia (HI) can result in structural brain abnormalities, which in turn can lead to behavioural deficits in various cognitive and motor domains, in both adult and paediatric populations. Cardiorespiratory arrest (CA) is a major cause of hypoxia-ischaemia in adults, but it is relatively rare in infants and children. While the effects of adult CA on brain and cognition have been widely studied, to date, there are no studies examining the neurodevelopmental outcome of children who suffered CA early in life. Here, we studied the long-term outcome of 28 children who suffered CA during infancy or childhood (i.e., before age 16). They were compared to a group of control participants (n = 28) matched for age, gender and socio-economic status. The patient group had impairments in the domains of memory, language and academic attainment (measured using standardised tests; impairment defined as a score > 1.5 standard deviations below the control group mean). Individual scores within the impaired range were most commonly found within the memory domain (79%), followed by attainment (50%), and language (36%). The patient group also had reduced whole brain grey matter volume, and reduced volume and fractional anisotropy of the white matter. In addition, lower performance on memory tests was correlated with bilaterally reduced volume of the hippocampi, thalami, and striatum, while lower attainment scores were correlated with bilateral reduction of fractional anisotropy in the superior cerebellar peduncle, the main output tract of the cerebellum. We conclude that patients who suffered early CA are at risk of developing specific cognitive deficits associated with structural brain abnormalities.