European Journal of Pediatrics

, Volume 166, Issue 7, pp 645-654

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review

  • Mariëlle van HandelAffiliated withDepartment of Neonatology, University Medical Center Utrecht (Wilhelmina Children’s Hospital) Email author 
  • , Hanna SwaabAffiliated withDepartment of Clinical Child and Adolescent Studies, Leiden University
  • , Linda S. de VriesAffiliated withDepartment of Neonatology, University Medical Center Utrecht (Wilhelmina Children’s Hospital)
  • , Marian J. JongmansAffiliated withDepartment of Neonatology, University Medical Center Utrecht (Wilhelmina Children’s Hospital)Department of General and Special Education, University of Utrecht


Neonatal encephalopathy (NE) following perinatal asphyxia (PA) is considered an important cause of later neurodevelopmental impairment in infants born at term. This review discusses long-term consequences for general cognitive functioning, educational achievement, neuropsychological functioning and behavior. In all areas reviewed, the outcome of children with mild NE is consistently positive and the outcome of children with severe NE consistently negative. However, children with moderate NE form a more heterogeneous group with respect to outcome. On average, intelligence scores are below those of children with mild NE and age-matched peers, but within the normal range. With respect to educational achievement, difficulties have been found in the domains reading, spelling and arithmetic/mathematics. So far, studies of neuropsychological functioning have yielded ambiguous results in children with moderate NE. A few studies suggest elevated rates of hyperactivity in children with moderate NE and autism in children with moderate and severe NE. Conclusion: Behavioral monitoring is required for all children with NE. In addition, systematic, detailed neuropsychological examination is needed especially for children with moderate NE.


Asphyxia neonatorum Hypoxia, brain Hypoxia-ischemia, brain Neuropsychology Behavioral problems