Kim Annink

133 The papez circuit and school-age outcome in HIE Interestingly, FA values conducted with TBSS were only positively associated with PIQ and visual-spatial long-term memory. In the neonatal period, lower FA values in e.g. the posterior limb or the internal capsule and corpus callosum are known to be predictive for long-term outcome (29). Literature about FA values at school-age in children with a history of HIE following perinatal asphyxia is scarce. Laporta-Hoyos et al. found that FA values were related to IQ and executive functioning in adults with dyskinetic CP, but not in the controls (30). Attention and information processing were not associated with FA values in both groups (30). The authors concluded that FA values are only associated with cognition in the presence of severe brain injury (30). This might explain the absence of an association between FA and IQ and memory in our population, since brain injury at neonatal age and at 10 years of age was only mild to moderate. Our study also showed that, although therapeutic hypothermia has proven to be neuroprotective, neurodevelopmental problems at school-age are still prevalent. In the short-term, therapeutic hypothermia reduces death, epilepsy and CP in infants with HIE (6,31). In our cohort, CP was also less often diagnosed in the screened population that was cooled compared to the non-cooled cohort. However, the actual incidence of CP and death cannot be compared due to the study design. The comparisons between the HT and non-HT group should therefore be interpreted with caution, because this is not a randomized controlled trial. We noted that the lactate levels were higher and Apgar scores were lower in the HT group compared to the non-HT group which suggests that the HT group was more severely asphyxiated. Also, more brain injury at the age of 10 years was found in the HT group. This might explain the finding that therapeutic hypothermia was associated with a lower verbal long-term memory (immediate recall). Nevertheless, we were able to show that memory and cognitive problems can develop at school-age even in children who were treated with therapeutic hypothermia. Shankaran et al. described that the incidence of death and CP were lower in 6- to 7-year-old children with HIE that were cooled compared to controls, but cognitive, attention and visuospatial function did not significantly improve (32). The TOBY trial also revealed a better survival with an IQ above 85, but similar intelligence, memory, learning, sensorimotor and visuospatial processing between cooled and non-cooled children at 6-7 years of age (5). Furthermore, quality of life at 6-7 years of age was comparable in the cooled and non-cooled group (33). 6