<scp>MRI</scp> , Child Opportunity Index, and 4‐year cognitive outcome after neonatal encephalopathy

AIM: To evaluate the association of neonatal magnetic resonance imaging (MRI) and Child Opportunity Index (COI) with 4-year cognitive outcomes after neonatal encephalopathy. METHOD: This was a cross-sectional analysis of 4-year outcomes (interquartile range [IQR] = 48-52 months) in a single-center prospective cohort of term neonatal encephalopathy (1993-2017). Therapeutic hypothermia began in 2007. Watershed and basal ganglia/thalamus injury was scored on day-4 MRI (IQR = 3-6) by a blinded pediatric neuroradiologist. Zip code at birth determined the COI composite and subscores (0-100). The primary outcome was 4-year full-scale, verbal, and performance IQ on the Wechsler Preschool & Primary Scale of Intelligence, Third Edition. RESULTS: Among 149 children (77 males, 72 females) with neonatal encephalopathy, the median full-scale 4-year IQ was 101 (IQR = 81-112), verbal IQ was 97 (IQR = 79-112), and performance IQ was 100 (IQR = 84-112). Basal ganglia/thalamus injury was associated with lower full-scale, verbal, and performance IQ, adjusting for therapeutic hypothermia and birth characteristics. An increasing composite COI was associated with higher full-scale and verbal IQ adjusting for MRI injury, therapeutic hypothermia, and birth characteristics. Every 10-point increase in COI was independently associated with a 2-point increase in full-scale IQ (95% confidence interval [CI] = 0.8-3.2, p = 0.002) and 2.6-point increase in verbal IQ (95% CI = 1.3-3.8, p < 0.001). INTERPRETATION: Neighborhood-level social drivers of health are associated with cognition after neonatal encephalopathy, regardless of MRI findings. These data highlight modifiable opportunities after hospital discharge.