Socioemotional and Psychological Outcomes of Hypoxic-Ischemic Encephalopathy: A Systematic Review

Grace H. Kromm, BA; Hilary Patankar, BA; Shubang Nagalotimath, BA; Hilary Wong, MBChB, FRCPCH, PhD; Topun Austin, MBBS, MRCP (Paeds), PhD

Address correspondence to Topun Austin, MBBS, MRCP, PhD, NeoLab, Evelyn Perinatal Imaging Centre, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom. E-mail: ta338@cam.ac.uk

FUNDING: Grace Kromm is a PhD candidate funded by the Dr Herchel Smith Fellowship (Williams College, MA, USA). The NIHR Cambridge Biomedical Research Centre (BRC) is a partnership between Cambridge University Hospitals NHS Foundation Trust and the University of Cambridge, funded by the National Institute for Health Research (NIHR). Prof Topun Austin is supported by the NIHR Cambridge BRC and the NIHR Brain Injury MedTech Co-operative. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest relevant to this article to disclose.

Pediatrics e2023063399.

https://doi.org/10.1542/peds.2023-063399

BACKGROUND AND OBJECTIVES:

Therapeutic hypothermia has reduced the risk of death or major disability following perinatal hypoxic-ischemic encephalopathy (HIE); however, many children who experience perinatal HIE still go on to develop personal and behavioral challenges, which can be difficult for caregivers and a public health burden for society. Our objective with this review is to systematically identify and synthesize studies that evaluate associations between perinatal HIE and socioemotional or psychological outcomes.

METHODS:

We screened all search-returned journal articles from Cochrane Library, Embase, Medline, PsycINFO, Scopus, and Web of Science from data inception through February 1, 2023. Keywords related to HIE (eg, neonatal encephalopathy, neonatal brain injury) and outcomes (eg, social*, emotion*, behav* problem, psycholog*, psychiatr*) were searched with a predefined search string. We included all observational human studies reporting socioemotional or psychological sequelae of term HIE. Study data were recorded on standardized sheets, and the Newcastle-Ottawa Scale was adapted to assess study quality.

RESULTS:

We included 43 studies documenting 3244 HIE participants and 2132 comparison participants. We found statistically significant associations between HIE and social and emotional, behavioral, and psychological and psychiatric deficits throughout infancy, childhood, and adolescence (19 studies). The authors of the included studies also report nonsignificant findings (11 studies) and outcomes without statistical comparison (25 studies).

CONCLUSIONS:

Perinatal HIE may be a risk factor for a range of socioemotional and psychological challenges in the short- and long-term. Routine screening, early intervention, and follow-up support may be particularly beneficial to this population.