Sociodemographic Characteristics and Behavioral Outcomes in Infants With Hypoxic-Ischemic Encephalopathy Treated With...

In infants with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia, the frequency, characteristics, and social risk factors for atypical behavior are poorly understood.

Secondary analysis of the High-Dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) trial. Atypical behavior defined as >= one clinically significant behavior on the parent-reported Child Behavior Checklist (CBCL) at age two years. Logistic regression was used to evaluate the association between atypical behavior and sociodemographic, maternal, and infant factors.

Among 500 infants with HIE enrolled in the HEAL trial, 434 (87%) survived to age two and 408 (94% of survivors) had CBCL available. Atypical behavior was reported in 59 of 408 (14%), including autism spectrum (8%), withdrawn (6%), affective (4%), and attention (3%) problems. On univariate analysis, lower education attainment, non-English language preference, and parents identifying as Black were associated with increased atypical behavior's risk. On multivariate analysis, compared with infants of college graduate mothers, infants of mothers who did not graduate (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.6-18) or never attended (OR, 8.0; 95% CI, 2.5-25.9) college had higher odds of atypical behavior. The clinical severity of encephalopathy at birth, was not independently associated with atypical behavior's risk. Atypical behavior's frequency increased from 7% in infants without neurodevelopmental impairment (NDI) to 34% in infants with severe NDI (P < 0.01).

Among survivors of HIE, lower maternal educational attainment was associated with an increased risk of atypical behavior. These findings highlight the importance of addressing social drivers of health to optimize recovery following HIE.