(47) Internalizing Disorders in Survivors of Neonatal Hypoxic Ischemic Encephalopathy: Scoping Review

Background: Internalizing disorders in children and adolescents encompass a range of emotional and psychological conditions, including anxiety, depression, and somatic symptom disorders. Early identification and intervention are crucial, as untreated internalizing disorders can increase risk of long-term mental health challenges, including the development of chronic mood and anxiety disorders in adulthood. Hypoxic-ischemic encephalopathy (HIE), a condition resulting from oxygen deprivation and reduced blood flow to the brain during the perinatal period, has been associated with an increased risk for internalizing disorders in childhood and adolescence. Children with HIE may have higher rates of anxiety, depression, and somatization. This relationship may be mediated by early disruptions in neurodevelopmental pathways involved in emotion processing.

Objectives: The intent of this scoping review is to comprehensively summarize existing literature on internalizing disorders in children with HIE, examining assessment methods, psychological outcomes, and influencing factors. This review also aims to identify gaps and inconsistencies in current diagnostic approaches to inform future studies and promote standardized practices.

Design/Methods: This review followed PRISMA-ScR guidelines. Only articles published in peer-reviewed journals between 2000-2024 that reported internalizing symptoms (e.g., depression, anxiety or somatizations) in children with a history of HIE were included. Cochrane Library, Scopus, EMBASE, PubMed, and APA PsycINFO using relevant search terms were searched. Newcastle-Ottawa Assessment Scale to assess study bias was used.

Results: A total of 2,917 studies were reviewed with twelve meeting inclusion criteria. Our review revealed variability in internalizing symptoms reported in survivors of neonatal HIE, but nine of the 12 studies revealed survivors of neonatal HIE had higher internalizing symptoms. Qualitatively, there appeared to be no relationship between internalizing symptoms and other variables including measurement method, therapeutic hypothermia utilization, use of control groups, age of the sample, or risk of bias.

Conclusions: This review revealed a strong association between internalizing symptoms and HIE and high variability in methods, measurements, and results among the related literature. Future research should prioritize standardized assessment tools and longitudinal designs to help clarify developmental trajectories of these individuals.