Maayke Hunfeld

203 Neuropsychological outcome Introduction Yearly, 9 out of 100.000 children in the Netherlands experience an Out-of-Hospital Cardiac Arrest (OHCA) (1) . In contrast to adults, non-cardiac causes are the most prevalent causes of OHCA (2-4) . The overall survival rate of OHCA children is low; approximately 90-92% die pre-hospital or during hospital admission (5, 6) . In our previous observational cohort study, 56% of the children who achieved return of circulation (ROC) died after PICU admission. Death was mainly due to withdrawal of life sustaining therapies based on poor neurological prognosis (67%) or brain death (29%) (7). In a recent study including 1980 children with OHCA, 125 of 162 survivors (77%) had a favorable outcome at discharge expressed in a good pediatric cerebral performance category (PCPC) (6) . PCPC is often used as an outcome measure in studies describing neurological outcome after paediatric OHCA (8, 9) . However, PCPC is a crude outcome on a scale ranging from 1 to 6 (normal; mild, moderate or severe disability; comatose; dead) (supplementary file 1). It is unknown whether PCPC at discharge reflects daily function at longer term and if it appropriately reflects the level of neuropsychological functioning. Neuropsychological deficits are expected as sequelae in children after cardiac arrest (CA), due to ischaemic changes in the brain during and around CA. Identification of cognitive deficits is of paramount importance as these deficits may delay or even prevent the development of academic and social skills, causing long- term restrictions in activities and participation in daily life. This phenomenon is known as growing into deficit (10) . Little is known about long-termneuropsychological functioning inOHCA survivors (11, 12) . In a cross-sectional cohort of in-and-out of hospital CA survivors (median follow- up interval 5.6 years), lower scores were found for intelligence and visual memory, compared with the general population (11) . In the THAPCA trial, 85 parents of OHCA children reported, during a single interview by phone at 1-year follow-up, neurocognitive problems in their children such as problems in adaptive behaviour, communication, daily living and motor skills (12) . In this same study, most children displayed significant deficits in intelligence domains of neuropsychological tests. Since 2012, our hospital provides a standardised multidisciplinary follow-up program for paediatric OHCA survivors with structured and repeated outpatient clinic visits including functional and neuropsychological assessments. Within this context 1) we investigated functional and neuropsychological outcomes 3-6 and 24 months after paediatric OHCA and, 2). explored whether PCPC scores were associated with intellectual functioning in paediatric OHCA survivors. 7