Long-Term Neurodevelopmental Outcomes in Neonates with Perinatal Asphyxia in a High-Resource Country: A Single-Center Retrospective Analysis

Background: Perinatal asphyxia is a critical condition resulting from various complications around birth. Despite advances in neonatal care reliable prediction of long-term neurodevelopmental outcomes remains challenging. Therefore, standardized clinical follow-up assessments are recommended to detect impairments early and provide optimal support. This study aimed to characterize five-year neurodevelopmental outcomes in children with history of perinatal asphyxia treated at a tertiary neonatal care center in Austria. Methods: This retrospective analysis included infants with perinatal asphyxia, defined as umbilical artery pH < 7.0, admitted to the neonatal intensive care unit in Graz, Austria, between January 2004 and September 2020. The primary outcome was neurodevelopmental status at five years of age. This was assessed by trained clinicians during routine follow-up examinations and classified as age-appropriate development or mild, moderate, or severe developmental delay. Where feasible, the intelligence quotient was additionally quantified by certified psychologists using the standardized Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Demographic characteristics, causes of asphyxia, neonatal clinical course and short-term outcomes were also assessed. Data were extracted from the local electronic patient documentation system and analyzed descriptively. Results: Of 139 eligible neonates, 25 (18%) died. Five-year follow-up data were available for 35 (31%) of the 114 survivors, their median gestational age was 36.6 (IQR 31.3–39.3) weeks; 16 (46%) were term infants and 19 (54%) preterm infants. Hypoxic-ischemic encephalopathy was diagnosed in 19 (54%) infants. 10 (29%) infants received therapeutic hypothermia, and 30 (86%) required invasive respiratory support. At five years, five (31%) term infants achieved age-appropriate development, while five (31%) had mild, three (19%) moderate, and three (19%) severe developmental delay. Among preterm infants, four (21%) showed age-appropriate development, whereas 10 (53%) had mild, three (16%) moderate, and two (11%) severe developmental delay. Conclusion: Developmental delay was common among both term and preterm infants assessed five years after perinatal asphyxia. However, the small cohort and incomplete follow-up limit the generalizability of these findings. Improved strategies for risk stratification, neuroprotective interventions and long-term developmental surveillance are warranted.