Towards a biopsychosocial understanding of neurodevelopmental outcomes in children with hypoxic-ischemic encephalopathy: A mixed-methods study

Abstract

Objective Children with hypoxic-ischemic encephalopathy (HIE) are at high risk of neurodevelopmental delay despite the widespread adoption of therapeutic hypothermia. Thus, consideration of both biological and psychosocial factors is warranted to better predict outcomes. We examined the associations between various child neurodevelopmental outcomes and potentially influential factors such as brain imaging, parent mental health, previous intervention, and social risk. Qualitative themes in the parent experience were also identified from free-text questionnaire responses. Methods: Parents of 54 children with HIE (ages 6 months–6.5 years) completed questionnaires capturing sociodemographic factors, qualitative perceptions of clinical outcome, parent mental health, and ratings of child adaptive and psychosocial functioning. Neurodevelopmental assessment scores at 18 and 36 months were extracted retrospectively from the medical chart for a subset of children. Results: Linear regression analyses showed significant associations between poorer parent mental health and child psychosocial and language outcomes. In multivariable analyses, social risk served as a significant predictor of 18 and 36 month cognitive and language functioning. Qualitative analyses of parents’ written reflections revealed themes of hopefulness and ongoing concern. Conclusion: In children with HIE, social context and parent mental health are strong contributing factors in the pathway of neurodevelopmental outcomes.