To the Editor Finder et al1 demonstrate that cognitive scores of children with a history of mild hypoxic ischemic encephalopathy (HIE) were lower than contemporaneous control children and not different from survivors of moderate HIE treated with therapeutic hypothermia.1 The authors mention that neuroprotective treatments, such as therapeutic hypothermia, are often not offered to infants with mild HIE because of a perceived good prognosis, a concern that we share. We have shown2 that even among healthy preschool children, a history of variations in oxygenation levels at birth is associated with poorer cognitive flexibility. Moreover, we demonstrated that there are genetic individual differences in the susceptibility to the damaging effects of birth hypoxia on cognition, in which a polygenic risk score reflecting variations in the function of the dopamine transporter gene (DAT1) gene network in the prefrontal cortex predicts both impaired cognitive flexibility and lower gray-matter density in those affected by hypoxia.2 In the era of precision medicine, there is a need for controlled studies evaluating the potential effect of innovative genomic measures in contributing for the identification of children at high risk for long-term impaired executive functions when facing HIE and who will potentially benefit from early interventions such as therapeutic hypothermia.
Miguel PM, Silveira PP. Neonatal Hypoxia Ischemia and Individual Differences in Neurodevelopmental Outcomes. JAMA Pediatr. Published online May 04, 2020. doi:10.1001/jamapediatrics.2020.0537
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