Everyday life in early adolescence after hypothermia-treated neonatal hypoxic-ischaemic encephalopathy

<p dir="ltr"><b>Title</b>: Everyday life in early adolescence after therapeutic hypothermia following neonatal hypoxic-ischaemic encephalopathy: Motor development, executive functions, health-related quality of life, self-esteem, and physical activity. <br><br><b>Background</b>: Therapeutic hypothermia (TH) is the standard treatment for moderate to severe neonatal hypoxic-ischaemic encephalopathy (HIE). While early developmental outcomes are well documented, knowledge about long- term outcomes into early adolescence, especially in adolescents without severe cerebral palsy is limited.</p><p dir="ltr"><br><b>Aims</b>: To investigate long-term outcomes in early adolescents treated with TH for neonatal HIE, focusing on motor development, executive functions (EF), health-related quality of life (HRQOL), self-esteem, and physical activity (PA).<br><br></p><p dir="ltr"><b>Methods</b>: A regional cohort of 45 early adolescents, (mean age of 11 years) treated with TH following neonatal HIE between 2007 and 2009 in the Stockholm region, was followed prospectively from infancy to early adolescence. Motor development was assessed at four time points, at a mean age of 4 months, 2 years, 7 and 11 years, using age-appropriate standardised tools: Alberta Infant Motor Scale, Bayley Scales of Infants and Toddler Development, Third Edition, and Movement Assessment Battery of Children, Second Edition (MABC-2). Executive functions (EFs) were evaluated using a combination of standardised tools, including Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V), the Behavior Rating Inventory of Executive Function, Second Edition, and the Five to Fifteen Revised Questionnaire. Health-related quality of life (HRQOL) assessed with the Pediatric Quality of Life Inventory 4.0, Self-esteem with, I Think I Am-2 (ITIA-2). Physical activity (PA) was device-based measured using accelerometers and through self-reported questionnaire.</p><p dir="ltr"><b>Result</b>: At 11 years, 69% of the participants scored above the 15th percentile on the MABC-2 test, indicating no motor difficulties. Thirty-one percent of the participants scored below the 15th percentile on MABC-2 indicating motor difficulties. Motor capacity was associated with weaker EFs, especially in processing speed, working memory, flexibility, and impulse control. Everyday motor challenges were reported by parents in 52%. No significant differences were found between the participants' self-reported and the parental proxy- reported HRQOL. Self-esteem was generally high, even among the participants with motor difficulties. Forty-one percent met the WHO recommendation of 60 minutes of moderate-to-vigorous physical activity per day. However, the participants with motor difficulties engaged in significantly less MVPA than peers without motor difficulties. The total participation in organised PA was high (73%). However, screen time was frequently above recommended levels, with 46% of the participants spending 2-3 hours per day.</p><p dir="ltr"><b>Conclusions</b>: Most children treated with TH following neonatal HIE show favourable outcomes when reaching early adolescence, including high self- esteem, strong participation in organised PA, and generally positive HRQOL. However, a notable proportion still experience motor and executive function challenges, along with lower PA levels. These findings underscore the need for a multidimensional and multiprofessional approach that integrates clinical assessments with parental insights, to enable early identification of those at risk and ensure timely interventions.</p><h3>List of scientific papers</h3><p dir="ltr">I. <b>Eriksson Westblad M,</b> Löwing K, Grossmann KR, Blennow M, Lindström K. Long-term motor development after hypothermia- treated hypoxic-ischaemic encephalopathy. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society. 2023;47:110-7. <a href="https://doi.org/10.1016/j.ejpn.2023.10.003" rel="noreferrer" target="_blank">https://doi.org/10.1016/j.ejpn.2023.10.003</a></p><p dir="ltr">II. <b>Eriksson Westblad M,</b> Löwing K, Robertsson Grossmann K, Andersson C, Blennow M, Lindström K. Motor activities and executive functions in early adolescence after hypothermia- treated neonatal hypoxic-ischemic encephalopathy. Applied neuropsychology Child. 2025:1-9. <a href="https://doi.org/10.1080/21622965.2025.2463498" rel="noreferrer" target="_blank">https://doi.org/10.1080/21622965.2025.2463498</a></p><p dir="ltr">III. <b>Eriksson Westblad M*</b>, Kokkonen Nassef S*, Blennow M, Jirwe M, Lindstrom K. Motor performance, health-related quality of life and self-esteem in early adolescence after neonatal therapeutic hypothermia. Acta Paediatr. 2025. Epub ahead of print. *Shared first authorship. <a href="https://doi.org/10.1111/apa.70170" rel="noreferrer" target="_blank">https://doi.org/10.1111/apa.70170</a></p><p dir="ltr">IV. <b>Mimmi Eriksson Westblad</b>, David Moulaee Conradsson, Ulrika Einarsson, Katarina Lindström. Physical Activity in Early Adolescence after Hypothermia-Treated Neonatal Hypoxic-Ischaemic Encephalopathy. [Manuscript]</p>