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Neuropsychological outcome at age 5 following unilateral neonatal brain lesion. 1728

Retrospective studies of neonates who sustain unilateral brain lesions demonstrate small but persistent deficits contralateral to lesion side. Prospective studies have generally been constrained by small sample size, variability in age of lesion onset, and wide range of ages when outcome has been assessed. We report neuropsychological outcome at age five for 24 children who were ascertained in the neonatal period to have unilateral brain lesions (LL=12; RL=12). The sample is part of a cohort of 152 critically ill term neonates (> 2kg) who received routine neonatal neuroimaging (US/CT) following ECMO treatment for cardiorespiratory failure and were available for comprehensive neuropsychological evaluation at age 5. The lesion groups were comparable in terms of birthweight, GA, Apgar scores, neuroimaging severity score, ethnicity, maternal education, and age at test. One child (RL) had post-neonatal seizures. We compared performance on neuropsychological measures presumed subserved by the right hemisphere (e.g. visual/spatial, left-hand use) and left hemisphere (e.g. language, right-hand use). Data were converted to z-scores. The RL group showed a visual/spatial deficit relative to language, and the LL group showed the corresponding language deficit relative to visual/spatial skills. Verbal and visual memory scores were equivalent. One child in each group was left-hand dominant. Visual/motor tasks were poorer for the LL group, given the dominant hand was contralateral to the side of lesion. Overall, the effect was predictable for lesion side, although the effect size was small. Our data suggest residual effects at age five within the general pattern of recovery following lateralized neonatal brain injury. [Funded by NIH/NINDS]