Aim: To explore the integrated cardiopulmonary, metabolic, and muscular response to incremental exercise in individuals with cerebral palsy (CP) compared with typically developing participants. Method: This was a prospective cross-sectional study. Sixteen (seven male) individuals with CP (classified in Gross Motor Function Classification System levels II-V) and 30 (15 male) typically developing participants performed a treadmill-based incremental submaximal test and an exercise test to task failure. Participants used running frames (CP) or performed traditional running (typically developing participants). Metabolic and cardiopulmonary parameters were measured during both tests. Electromyography of the vastus lateralis and gastrocnemius medialis was recorded during the test to task failure. Results: Compared with typically developing participants, individuals with CP showed decreased minute ventilation (p < 0.05), increased respiratory frequency at a comparable exercise intensity (p < 0.05), and an altered metabolic response, on the basis of the partial pressure of carbon dioxide (p < 0.05) and lactate levels (p < 0.001), during both tests. In addition, participants with CP exhibited a lower ventilatory efficiency during the test to task failure (p < 0.01). Electromyography analysis suggested peripheral skeletal muscle fatigue in the lower limbs (p < 0.05) in individuals with CP compared with typically developing participants. Interpretation: Individuals with CP have a disproportional ventilatory response to incremental exercise, not driven by metabolic perturbations. The increased breathing frequency resulted in high rate of perceived exertion and signs of peripheral muscle fatigue compared with typically developing participants. Our findings stress the importance of interventions focused on ventilatory function in individuals with CP.

PURPOSE:To investigate the experiences with a new child-centred approach to promote participation in local sport clubs for children with a physical disability. The approach was implemented through an outpatient clinic for sport advice and support (Esther Vergeer Foundation Clinic), embedded in all children's hospitals affiliated with University Medical Centres in the Netherlands. MATERIALS AND METHODS:Semi-structured individual interviews were conducted with 49 stakeholders: children (n = 9), their parents (n = 13), referring professionals (n = 8), sport club staff (n = 13), and Clinic counsellors (n = 6). Interviews were transcribed verbatim, and transcripts were analysed using inductive thematic analysis. RESULTS:Stakeholders reported mainly positive experiences. Five major themes emerged: (1) an individualised approach, (2) guidance throughout the process, (3) building networks with hospitals and sport clubs, (4) added value of the Clinic support compared with earlier attempts, and (5) added value of participation in a regular sport club. CONCLUSIONS:Effective support requires three key elements: an individualised approach, structured guidance for children and parents, and strong networks linking hospitals and sport clubs. Stakeholders emphasised that the Clinic's added value lies in addressing all these factors simultaneously and in developing expertise to match children with suitable sport opportunities.

PURPOSE:Frame Running is an adapted community-based exercise option for people with moderate-to-severe walking impairments. This mixed-methods study aimed to examine the feasibility of 1) community-based Frame Running by young people with moderate-to-severe walking impairments and 2) conducting future studies on the impact of Frame Running on functional mobility and cardiometabolic disease risk factors. MATERIALS AND METHODS:Weekly training sessions and data collection occurred in two sites. Quantitative data were collected at baseline, and after 12 (both sites) and 24 (one site) weeks of training, followed by interviews or focus groups. Consent and retention rates, attendance and outcome measure completion rates were calculated. Qualitative data were analysed abductively using concurrent inductive and deductive thematic content analysis. Data for the assessments at baseline, 12 and 24 weeks were available for 23, 15 and 5 participants respectively. RESULTS:Participants were aged 5-25 with most diagnosed with cerebral palsy (GMFCS II-IV). Consent, intervention drop-out and adherence rates were 55%, 17% and 83% respectively with no serious adverse events. Outcome measure completion rates ranged between 60% and 98%. Themes related to facilitators to participating in Frame Running were mostly identified in the personal and social domains with barriers more common in the environmental and policy domains. CONCLUSIONS:The study results support the existing evidence that Frame Running is a safe and acceptable community-based exercise option for those with moderate-to-severe walking impairments. Themes identified in personal, social, environmental and policy domains can guide the implementation of community-based Frame Running participation. Our feasibility data can inform the design of future definitive studies.

Purpose: To explore the influence of preterm birth on parental beliefs about gross motor development and parents' supportive role in infants' motor development. Methods: Prospective cohort study: Parents of infants born very preterm (VPT) (gestation ≤32 weeks, birth weight <1500 g, without perinatal complications) and parents of healthy infants born full-term (FT) completed the Parental Beliefs on Motor Development questionnaire. Results: Questionnaires from 37 parents of infants born VPT, aged 3.5 to 7.5 months (corrected), and 110 parents of infants born FT, aged 3.5 months, were analyzed. Parents of infants born VPT believed stimulating motor development to be more important than parents of infants born FT ( F = 5.22; P = .024; η p 2 = 0.035). Most parents of infants born VPT (82.4%) and FT (85.2%) acknowledged their role in supporting motor development. More parents of infants born VPT (41.2% vs 12.0%) believed they should follow their infant's natural developmental pace. Conclusion: Knowledge of parental beliefs and parents' supporting role in motor development is relevant for tailoring pediatric physiotherapists' interventions with families.

Purpose To provide an overview of outcome and complications of selective dorsal rhizotomy (SDR) and intrathecal baclofen pump implantation (ITB) for spasticity treatment in children with hereditary spastic paraplegia (HSP). Methods Retrospective study including children with HSP and SDR or ITB. Gross motor function measure (GMFM-66) scores and level of spasticity were assessed. Results Ten patients were included (most had mutations in ATL1 ( n = 4) or SPAST ( n = 3) genes). Four walked without and two with walking aids, four were non-walking children. Six patients underwent SDR, three patients ITB, and one both. Mean age at surgery was 8.9 ± 4.5 years with a mean follow-up of 3.4 ± 2.2 years. Five of the SDR patients were walking. Postoperatively spasticity in the legs was reduced in all patients. The change in GMFM-66 score was + 8.0 (0–19.7 min–max). The three ITB patients treated ( SPAST ( n = 2 ) and PNPLA6 ( n = 1 ) gene mutation) were children with a progressive disease course. No complications of surgery occurred. Conclusions SDR is a feasible treatment option in carefully selected children with HSP, especially in walking patients. The majority of patients benefit with respect to gross motor function, complication risk is low. ITB was used in children with severe and progressive disease.

Purpose The para-athletic sport Frame Running is developed for persons with neurological impairments causing severe limitations of walking ability. Participating in sports can contribute to a better quality of life (QoL). It is unknown if participation in Frame Running contributes to QoL in children with mobility limitations. This study aims to explore the changes in QoL in children and youth who started Frame Running. Materials and Methods We conducted a cross-sectional study amongst young Frame Running athletes with mobility limitations due to various underlying causes, aged 6–19 years, who are members of one of the Frame Running groups in the Netherlands. For 62 athletes, parents completed the Psychosocial Impact of Assistive Devices Scale (PIADS) questionnaire (subscales: competence, adaptability, and self-esteem). For six athletes, parents were interviewed to obtain more in-depth insight in the perceived changes in the QoL of their children. Results Parents (of 58% boys, mean age 12 years 4 months; SD 3 years 3 months; 52% supported walkers) reported a significant positive change on all three subscales of the PIADS questionnaire since their children started Frame Running. Most change was experienced in the items performance, the ability to participate, happiness and self-confidence. Quotes of the parents who were interviewed elucidated these changes. Conclusion Frame Running increased QoL in young athletes with a mobility limitation. Frame Running may therefore be advised for these children and youth to improve QoL.

Objective Frame Running (RaceRunning) allows people with moderate-to-severe mobility impairments to participate in physical activity using a 3-wheeled frame with a saddle and handlebars. The aim of this study was to investigate athlete-perceived impact of Frame Running on aspects of physical fitness, functional mobility and psychosocial outcomes. Design Survey. Participants Frame Running athletes aged 5 years and over. Methods A survey was distributed to athletes through their club or sports organization. Results The survey was completed by 115 athletes (53 females). Median age was 17 years (range 5–62 years) and 64 (57%) used a wheelchair or walker for distances over 50 m. Many felt that Frame Running stretched their muscles (n = 93, 87%) and increased their self-confidence (n = 63, 93%). Four (4%) reported extreme fatigue or sore muscles after training (n = 17, 15%). Of the 110 athletes who had been participating in Frame Running for over 3 months, 46 (47%) reported being less out of breath during mobility tasks and 66 (66%) felt they had improved their functional mobility. However, 7 (7%) reported increased muscle tightness and 4 (4%) reported a Frame Running-related injury lasting more than 4 weeks. Conclusion Frame Running is a safe physical activity with athlete-perceived benefits on physical fitness, functional mobility and psychosocial outcomes. LAY ABSTRACT Frame Running (RaceRunning) allows people with moderate-to-severe walking difficulties to walk or run independently using a 3-wheeled frame with a saddle and handlebars. In this study 115 Frame Running athletes living in the UK, Sweden or the Netherlands and aged 5 years or over (or their parents) completed a survey about taking part in Frame Running. More than half used a wheelchair or walker for distances over 50 m. Most felt that Frame Running stretched their muscles and increased their self-confidence. Four athletes perceived extreme fatigue and 17 reported sore muscles after training. Approximately half of the athletes reported that they were less out of breath during mobility tasks (walking, standing) and two thirds reported better functional mobility since they had started Frame Running. Injuries lasting more than 4 weeks were reported by 4 athletes. We conclude that Frame Running is a safe activity with the potential to improve physical fitness, functional mobility, and self-confidence.

Introduction: Brain abnormalities in cerebral palsy (CP) are known to relate to motor outcome; however, their association with cognitive functioning is less clear. Aim of the study: 1) To investigate the prognostic value of brain abnormalities for cognitive functioning; 2) To explore the added value of prognostic variables across ICF domains: motor function, epilepsy, gestational age, birthweight and educational level of the parents. Methods: We retrospectively analyzed brain MRI scans of 75 children with CP (GMFCS level I-V, 36% born preterm), as part of a longitudinal study. MRI classification: qualitative classification of brain ab-normality pattern and semi-quantitative grading of the extent of damage. Cognitive functioning, measured as non-verbal intelligent quotient (IQ), was dichotomized into 'impaired cognition' (IQ < 70) and 'normal' (IQ > 70). Multivariable logistic regression produced odds ratios (OR) with 95% confidence interval (C.I.) of risk factors for impaired cognition. Results: Overall, 27% of the tested participants had a non-verbal IQ below 70 and 36% of the participants was classified as 'having impaired cognition'. At a young age, a higher degree of white matter damage (OR 1.6, 95% C.I. 0.97-2.67) anda more severe GMFCS level (OR 3.2, 95% C.I. 1.70-5.98) are risk factors for impaired cognition at school-age (4-7 years of age). This model correctly predicts 89% of the cases. Brain damage alone predicts the presence of impaired cognition in 71% of the cases. Interpretation: Brain MRI characteristics and GMFCS level at a young age can each help identify children with CP at risk for impaired cognition at school age and together have a strong predictive value. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of European Paediatric Neurology Society. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Aim To evaluate parental mental health monitoring during follow-up care for very preterm (VPT) infants, describe symptoms of anxiety and depression and risk factors for mothers and fathers at 1 and 12 months of corrected age. Methods Parents completed the Hospital Anxiety and Depression Scale (HADS). Psychological symptoms and risk factors were analysed within and between mothers and fathers. Results In 4 years, the monitoring reached 1260 (48%) families. Of these, 693 mothers and 340 fathers (300 couples) completed the HADS twice. At 1 month, 22% and 15% of the mothers and 10% and 9% of the fathers, respectively, reported elevated symptoms of anxiety and depression. At 12 months, these rates were significantly reduced to 14% and 9% for mothers and 5% and 4% for fathers respectively. Within couples, anxiety and depression were positively associated. At 12 months, in 20% of the couples, one or both parents reported elevated symptoms. Risk factors were length of hospital stay, migration background, educational level and employment status. Conclusion The mental health of parents of VPT infants improved, but elevated symptoms were still observed in 17% of included families after one year. Acknowledging and remediating parental mental health remain essential during follow-up care.

Background: Children born very preterm are at risk for cognitive deficits and motor impairment. Enhanced protein intake immediately after very preterm birth has been associated with favorable growth and improved neurodevelopment. It is unknown whether increased protein intake after discharge from the hospital affects long-term neurodevelopment. Objective: The primary objective was to assess neurodevelopment from infancy to 8 years in pretermborn children who received either protein-enriched formula (PDF), standard term formula (TF), or human milk (HM) after discharge. The secondary objective was to assess the correlation between outcomes obtained at 24 months corrected age (CA) and at 8 years. Methods: This RCT included 152 children born very preterm (gestational age <= 32 weeks) and/or with a very low birth weight (<= 1500 g) of whom 102 were randomly assigned to receive PDF (n = 54) or TF (n = 48) from term age to 6 months CA. A control group of infants fed HM (n = 50) was also included. Neurodevelopmental outcomes were assessed at 24 months CA (cognitive and motor functioning; n = 123) and at 8 years (estimated Full Scale Intelligence Quotient, visual-motor skills, verbal memory, attention, and motor functioning; n = 76). Results: The PDF and TF groups were not significantly different in neurodevelopmental outcomes. The HM group had a better cognitive score compared with the PDF group: at 24 months CA 92.9 +/- 12.5 vs. 105.2 +/- 18.6, P < 0.001 and at 8 years 98.1 +/- 11.3 vs. 105.8 +/- 9.1, P = 0.017 (P = 0.002 and P = 0.080, respectively, after adjustment for parental educational level). Correlations between outcomes at 24 months CA and 8 years were weak: r = 0.35 and r = 0.37 for cognitive and motor outcomes, respectively. Conclusions: PDF did not improve long-term neurodevelopmental outcomes as compared with TF. However, these results should be interpreted with caution considering the substantial attrition at follow-up. Furthermore, the correlation between outcomes at different ages was weak, emphasizing the need for long-term follow-up of nutritional intervention studies in preterm-born children. (C) 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

OBJECTIVE:To identify factors associated with long-term improvement in gait in children after selective dorsal rhizotomy (SDR).DESIGN:Retrospective cohort study.SETTING:University medical center.PARTICIPANTS:Children (N=36) (age 4-13y) with spastic diplegia of Gross Motor Function Classification System (GMFCS) level I (n=14), II (n=15), and III (n=7) were included retrospectively from the database of our hospital. Children underwent SDR between January 1999 and May 2011. Patients were included if they received clinical gait analysis before and 5 years post-SDR, age >4 years at time of SDR and if brain magnetic resonance imaging (MRI) scan was available.INTERVENTION:Selective dorsal rhizotomy.MAIN OUTCOME MEASURES:Overall gait quality was assessed with Edinburgh visual gait score (EVGS), before and 5 years after SDR. In addition, knee and ankle angles at initial contact and midstance were evaluated. To identify predictors for gait improvement, several factors were evaluated including functional mobility level GMFCS, presence of white matter abnormalities on brain MRI, and selective motor control during gait (synergy analysis).RESULTS:Overall gait quality improved after SDR, with a large variation between patients. Multiple linear regression analysis revealed that worse score on EVGS and better GMFCS were independently related to gait improvement. Gait improved more in children with GMFCS I and II compared to III. No differences were observed between children with or without white matter abnormalities on brain MRI. Selective motor control during gait was predictive for improvement of knee angle at initial contact and midstance, but not for EVGS.CONCLUSION:Functional mobility level and baseline gait quality are both important factors to predict gait outcomes after SDR. If candidates are well selected, SDR can be a successful intervention to improve gait both in children with brain MRI abnormalities as well as other causes of spastic diplegia.

Background Increasing numbers of preterm-born children survive nowadays, and improving long-term health and neurodevelopment is becoming more important. Early-life growth has been linked to neurodevelopmental outcomes. We aimed to study whether this association has changed with time. Methods We studied two cohorts of preterm-born children (gestational age ≤32 weeks and/or birth weight ≤1500 g) from 1983 ( n = 708) and 2003–2006 ( n = 138), respectively. We distinguished four early-life growth patterns at 3 months corrected age: appropriate for gestational age (AGA) with or without growth restriction (AGA GR+/AGA GR−), and small for gestational age (SGA) with or without catch-up growth (SGA CUG+/SGA CUG−). Intelligence quotient (IQ), neuromotor function, and behavior were assessed at ages 19 and 8 years, respectively, for the cohorts. Results In the 2003–2006 cohort, less children had early-life GR. In both cohorts, SGA CUG− subjects had unfavorable growth trajectories and neurodevelopmental outcomes (IQ β −6.5, 95% confidence interval (CI) −9.8; −3.2, P < 0.001; neuromotor score β −1.9%, 95% CI −3.2; −0.6, P = 0.005), while SGA CUG+ subjects were comparable to adequately grown subjects. Conclusion Although the incidence of adverse growth patterns decreased between the cohorts, possibly indicating improvements in care over time, the impact of these growth patterns on neurodevelopmental outcomes was not significantly different. Achieving adequate early-life growth may be crucial for improving neurodevelopmental outcomes, especially for preterms born SGA.

Background: Short-term benefit on gait of selective dorsal rhizotomy (SDR) surgery, which relieves spasticity of the lower extremities has been demonstrated in children with cerebral palsy (CP). However very little is known of the evolution of gait when patients become adolescents and young adults. Research question: How does the gait pattern evolve in adolescents and young adults who underwent SDR during childhood? Methods: A longitudinal study was performed including 19 ambulant patients with spastic diplegia due to CP or other causes (mean age at SDR: 6.6 +/- 1.6 years) who were assessed four times: pre-SDR, 2 years post- SDR, 5 years post-SDR and at least 10 years post-SDR. From 2D video recordings, Edinburgh Visual Gait Score and lower limb joint kinematic parameters were calculated. Results: Our data show that the improvement in the gait pattern obtained short-term after SDR continues during into adolescence and adulthood. Ten years after SDR all patients improved compared to baseline. Considering the lower limb joint kinematics, most notable improvements were found at knee and ankle joints. Compared to the evaluation before SDR, the range of motion of the knee increased: the knee was more extended at initial contact and knee flexion in midswing improved. Excessive ankle plantar flexion was reduced during the entire gait cycle. Only minor changes were found at hip and pelvis. Eight patients underwent additional orthopaedic surgery in the years after SDR, and the present findings should be considered as a combination of SDR, development and additional treatment. Significance: We demonstrate lasting improvement of gait quality in ambulant patients with spastic diplegia who underwent SDR during childhood when they become adolescents and young adults.

We recently showed a beneficial effect of selective dorsal rhizotomy (SDR) on daily care and comfort in nonwalking children with severe bilateral spasticity. However, despite careful selection, some patients showed dystonia after the intervention, in which cases caregivers tended to be less satisfied with the result. The aim of this study is to identify risk factors for dystonia after SDR in children and adolescents with severe bilateral spasticity (GMFCS levels IV/V). Clinical and MRI risk factors for dystonia after SDR were studied in our cohort of 24 patients. Patients with clinical evidence of dystonia and brain MRI showing basal ganglia abnormalities were excluded for SDR. Nine of 24 patients (38%) showed some degree of dystonia after SDR. There was a significant association between the cause of spasticity and dystonia after SDR; in six (67%) patients with a congenital disorder, dystonia was present versus three (20%) with an acquired disorder (Chi-squared test: C(1)=5.23, p=0.02). This study allows more optimal selection of patients that may benefit from SDR. Patients with an acquired cause of spasticity, when selected carefully on clinical examination and MRI, rarely show dystonia after SDR. However, patients with an underlying congenital disorder have a considerable risk of dystonia after SDR.

Purpose: To study the effectiveness of cognitive orientation to daily occupational performance (CO-OP) to teach motor skills to youth with intellectual disabilities. Methods: Six youth aged 12 to 19 years participated in this study. A multiple baseline design was employed to evaluate distance and time cycled, and a pre-post-follow-up design was used to evaluate the effect on cycling skills mastered, cycling performance, and parent satisfaction. Results: At follow-up, 5 of the 6 youth rode their 2-wheeled bicycles over 100 m in their communities (range, 103-1400 m) and demonstrated improved cycling skills and parent satisfaction. Conclusions: The skills acquired by youth with Down syndrome using a CO-OP approach exceeded what has been reported in the literature. CO-OP offers a promising alternative to existing approaches for teaching 2-wheeled cycling to youth with Down syndrome.

Objective To evaluate the feasibility and potential efficacy of an age-appropriate additional parenting intervention for very preterm born toddlers.Study design In a randomized controlled pilot study, 60 of 94 eligible very preterm born children who had received a responsive parenting intervention in their first year were randomized to usual care or the additional intervention, consisting of 4-6 home visits between 18 and 22 months' corrected gestational age (CA). Parents were supported to responsively interact during increasingly complex daily activities and play. Parental satisfaction with the intervention was evaluated with a questionnaire. At baseline and 24 months CA, parents completed the Infant Toddler Social and Emotional Assessment, the Ages and Stages Questionnaire, and the Dutch Schlichting Lexilist for receptive language. At 24 months CA, motor, and cognitive development was measured by the Bayley Scales of Infant and Toddler Development, Third Edition Dutch version, and parent-child interaction was evaluated by the Emotional Availability Scales.Results Parental compliance and satisfaction with the intervention was high. Effect sizes (after correction for baseline variables) were small for internalizing and competence behavior, receptive language, and problem solving; medium for cognitive development and parent-child interaction; and large for externalizing and dysregulation behavior and motor development.Conclusion After a postdischarge intervention during the first year, an additional responsive parenting support at toddler-age is feasible and associated with positive outcomes in a broad array of parental and child outcome measures.

Background: In non-walking children with severe spasticity, daily care can be difficult and many patients suffer from pain. Selective dorsal rhizotomy (SDR) reduces spasticity in the legs, and therefore has the potential to improve daily care and comfort.Aim: To examine effects of SDR on daily care and comfort in non-walking children with severe spasticity due to different underlying neurological conditions.Methods: Medical history, changes in daily care and comfort and satisfaction with outcome were assessed retrospectively in non-walking children who underwent SDR in our center, with a mean follow-up of 1y 7m (range 11m-4y 3m). All eligible patients (n = 24, years 2009 2014) were included.Results: Mean age at SDR was 12y 4m (SD 4y 3m, range 2y 8m-19y 3m). Associated orthopaedic problems were frequent. Seven patients underwent scoliosis correction in the same session. Most improvements were reported in dressing (n = 16), washing (n = 12) and comfort (n = 10). Median score for satisfaction was 7 on a scale of 10 (range 1-9). SDR resulted in reduction of spasticity in leg muscles. In nine patients dystonia was recorded post-operatively, mainly in children with congenital malformations and syndromes.Interpretation: SDR is a single event intervention that can improve daily care and comfort in non-walking children with severe spasticity, and can safely be combined with scoliosis correction. Despite the improvements, satisfaction is variable. Careful attention is necessary for risk factors for dystonia, which may be unmasked after SDR. (C) 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Selective dorsal rhizotomy (SDR) surgery is a well-established treatment for ambulatory children with bilateral spastic paresis and is performed to eliminate spasticity and improve walking. The objective of this case report is to describe sudden falls as a persistent complication of SDR. The authors report on 3 patients with bilateral spastic paresis, aged 12, 6, and 7 years at the time of surgery. The percentage of transected dorsal rootlets was around 40% at the L2-S1 levels. Sudden falls were reported with a frequency of several a day, continuing for years after SDR. The falls were often triggered by performing dual tasks as well as occurring in the transition from sitting to standing, during running, after strenuous exercise, or following a fright. Patients also had residual hyperesthesia and dysesthesia of the foot sole. The authors hypothesize that the sudden falls are caused by a muscle inhibition reflex of the muscles in the legs, as an abnormal reaction to a sensory stimulus that is perceived with increased intensity by a patient with hyperesthesia. A favorable effect of gabapentin medication supports this hypothesis.

Introduction: Therapeutic hypothermia improves outcome after perinatal asphyxia. The Ages and Stages Questionnaire is a screening tool to detect neurodevelopmental delay. In this study we examined the outcome of patients with perinatal asphyxia (defined as Apgar score <5 at 10 min, or continued need for resuscitation, or pH < 7.00 in umbilical cord or within one hour after birth) with and without therapeutic hypothermia treatment at the age of four years.Methods: Cohort study of patients with perinatal asphyxia admitted to the Neonatal Intensive Care Units of the VU University Medical Center, Amsterdam and the Wilhelmina Children's Hospital, Utrecht in the year 2008. Parents were asked to fill out the 48 months Ages and Stages Questionnaire (ASQ). In Wilhelmina Children's Hospital treatment with therapeutic hypothermia was implemented in 2008, in the VU University Medical Center in 2009, providing a historical cohort.Results/Discussion: Twenty-three questionnaires were evaluated. Response rate of questionnaires for the VU Medical Center was 63% (n = 10) and Wilhelmina's Childrens Hospital 93% (n = 13). No significant differences were found in the mean scores between both groups. However, the untreated group scored more frequently under the -2 SD threshold. In the fine motor skills domain the difference was statistically significant (p = 0.031). In the treated group no patients developed cerebral palsy and in the untreated group two patients developed cerebral palsy.Conclusion: In this study patients treated with hypothermia tend to have a better neuro-developmental outcome. No significant differences were found between the two groups, apart from the fine motor skills. (C) 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.