MRI , Child Opportunity Index, and 4‐year cognitive outcome after neonatal encephalopathy

Aim To evaluate the association of neonatal magnetic resonance imaging (MRI) and Child Opportunity Index (COI) with 4‐year cognitive outcomes after neonatal encephalopathy. Method This was a cross‐sectional analysis of 4‐year outcomes (interquartile range [IQR] = 48–52 months) in a single‐center prospective cohort of term neonatal encephalopathy (1993–2017). Therapeutic hypothermia began in 2007. Watershed and basal ganglia/thalamus injury was scored on day‐4 MRI (IQR = 3–6) by a blinded pediatric neuroradiologist. Zip code at birth determined the COI composite and subscores (0–100). The primary outcome was 4‐year full‐scale, verbal, and performance IQ on the Wechsler Preschool & Primary Scale of Intelligence, Third Edition. Results Among 149 children (77 males, 72 females) with neonatal encephalopathy, the median full‐scale 4‐year IQ was 101 (IQR = 81–112), verbal IQ was 97 (IQR = 79–112), and performance IQ was 100 (IQR = 84–112). Basal ganglia/thalamus injury was associated with lower full‐scale, verbal, and performance IQ, adjusting for therapeutic hypothermia and birth characteristics. An increasing composite COI was associated with higher full‐scale and verbal IQ adjusting for MRI injury, therapeutic hypothermia, and birth characteristics. Every 10‐point increase in COI was independently associated with a 2‐point increase in full‐scale IQ (95% confidence interval [CI] = 0.8–3.2, p = 0.002) and 2.6‐point increase in verbal IQ (95% CI = 1.3–3.8, p < 0.001). Interpretation Neighborhood‐level social drivers of health are associated with cognition after neonatal encephalopathy, regardless of MRI findings. These data highlight modifiable opportunities after hospital discharge.