4-year PhD Studentship: Early predictors of cognition in children cooled for hypoxic-ischaemic encephalopathy

Each year, in the UK, 2-3/1000 newborn babies born at term (> 36 weeks gestation) undergo cooling therapy for Hypoxic Ischaemic Encephalopathy, (HIE) (brain damage due to birth asphyxia) to reduce disability.(1,2) Of the survivors of cooling therapy, 18-20% have cerebral palsy (CP) (3) and we showed that 30-40% have cognitive impairment at school-age even in the absence of CP.(4) Cognitive deficits in these children affect their educational attainment and future employability impacting the personal and national economy.(5) Early identification of risk of cognitive deficits and targeted early intervention (6) could improve the cognitive outcomes and later educational performance.

Whilst the risk of CP in children cooled for HIE can be re predicted using General Movement Assessment (GMA) at 1 week or 3 months after birth by classifying the spontaneous movements as normal or abnormal based on the presence of certain types of movements,(7) there are currently no early predictors of their future cognitive performance. In preterm infants (born < 37 weeks gestation), GMA and visual tracking at 3 and 4 months of age predicts cognitive performance at pre and early school-age, (8,9,10) however, their ability to predict cognitive performance in children cooled for HIE is unknown.

Aims and objectives

Hypothesis: In children who were cooled for HIE, GMA and Visual tracking parameters during infancy will predict cognitive scores at 2 years of age.

In children cooled for HIE,

1. To determine whether GMA at 1 week or 3 months after birth predict cognition at 2 years and 6-8 years of age.
2. To evaluate visual tracking data at 4 months and 9 months in infants cooled for HIE.
3. To determine the association between visual tracking parameters at 4 and 9 months of age and cognitive scores at 2 years of age.

Methodology

This proposal will include data analysis on a retrospective cohort and a prospective observational study. We have routinely collected GMA video recordings at 1 week and 3 months of age and cognitive assessments at 2 years (n=250 ) and at 6-8 years (n=50) in children cooled for HIE. After obtaining ethics approval, the student will be trained in scoring GMA as normal/abnormal and quantify motor optimality score and examine the association between the GMA and cognition. In a prospective cohort of infants cooled for HIE (n=30) and comparison cohort (n=20) matched for age and sex the student under supervision will develop the technique and acquire the visual tracking parameters at 4 and 9 months of age and GMA at 3 months. Student will learn administering the Bayley Scales of Infant and Toddler assessment at 2 years of age to assess cognition. Student will also gain experience in recruiting families to the study, handling infants, interacting with families and conducting statistical analyses. Student will have access to training courses including statistical analyses and academic writing from the Bristol Doctoral College.

How to apply for this project

This project will be based in Bristol Medical School - Translational Health Sciences in the Faculty of Health Sciences at the University of Bristol.

Please visit the Faculty of Health Sciences website for details of how to apply