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.

Keywords:

• Hypoxic-ischemic encephalopathy
• neurodevelopmental outcomes
• mixed methods
• early brain injury
• parent experiences

Acknowledgments

We would like to thank Samantha Roberts and Meghan Ford for their assistance with collecting and managing data. We are also grateful to Dr. Linh Ly, Ranit Beck and the other members of the Neonatal Neurodevelopmental Follow-Up Clinic at The Hospital for Sick Children for their help with recruiting families for this study. Most importantly, we express our gratitude to the families who participated in this study, whose perspectives and experiences continue to inspire our work.

Disclosure statement

The authors have no conflicts of interest to disclose.

Funding

This work is supported by the Medical Psychiatry Alliance, a collaborative health partnership of the University of Toronto, the Centre for Addiction and Mental Health, the Hospital for Sick Children, Trillium Health Partners, the Ontario Ministry of Health and Long-Term Care, and an anonymous donor.