# Beyond cognition: psychopathological sequelae of neonatal hypoxic-ischemic encephalopathy

## TL;DR

Children with neonatal brain injury show more psychopathological symptoms like anxiety and somatic complaints compared to healthy peers, even without major impairments.

## Contribution

This study is the first to systematically investigate psychopathological vulnerability in children with neonatal HIE during the prepuberal period.

## Key findings

- HIE children showed significantly more internalizing and somatic complaints than controls.
- T scores on the CBCL differed significantly between HIE and control groups for most subscales.
- Age interacted with group differences in variables distinguishing HIE children from controls.

## Abstract

Since the introduction of therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE), mortality and severe morbidity have been reduced, but follow-up studies have shown a high incidence of neuropsychological impairments. By contrast, the possibility of psychopathological vulnerability in children with HIE has not been clearly addressed. Our study aims to investigate the presence of psychopathological symptoms by comparing in the prepuberal period a sample of children with a history of neonatal HIE to a control group.

This is an observational cohort study with cross-sectional outcome assessment, where 76 HIE children (mean age 7.2 ± 1.84 years, range 5–12 years, 53.5% males) and 76 controls (mean age 7.8 ± 2.25 years, range 5–12 years, 51% males) were recruited. Exclusion criteria were the presence of major impairments. Parents completed the Child Behavior Checklist (CBCL) questionnaire. HIE group and controls have been compared, and the roles of age and sex have been evaluated.

A significantly higher percentage of psychopathological symptoms, in particular internalizing (p =.048) and somatic complaints (p <.001), in HIE children compared to peers have been found. The T scores of HIE and controls differed significantly for all CBCL subscales except for externalizing problems. An interaction between age and group in the variables strongly distinguishing HIE and controls has been found.

Neurobiology of neonatal HIE may determine a vulnerability to developing psychopathological symptoms. Great attention should be paid to internalizing problems, given the risk of underestimating them in children and their potential to be precursors of most invalidating disorders at higher ages, such as depression.

The online version contains supplementary material available at 10.1186/s13052-025-02062-z.