Most follow-up care after neonatal hypoxic ischemic encephalopathy (HIE) has focused on motor outcomes, like cerebral palsy, epilepsy, and on some early childhood cognitive development. A new scoping review, published July 29, 2026 in the Journal of Perinatology, asks a different question: what happens to a child's emotional health after HIE — and are we watching closely enough for it?
The research team, based at the University of Wisconsin, set out to map what the existing science says about anxiety, depression, and related symptoms — grouped together as "internalizing" symptoms — in children and adolescents who survived neonatal HIE. Anxiety and depression can be easy to miss in young children because, unlike motor or learning delays, they don't always show up in a clinic visit.
This was a scoping review, not a new clinical trial. The team searched five major research databases for studies published through October 2024, screening 2,917 studies in total. Twelve studies met their criteria for inclusion. Most were conducted in Europe, and most relied on parents filling out standardized behavior checklists, most commonly the Child Behavior Checklist. Only one study used a structured clinical interview to check for an actual diagnosis rather than symptoms alone.
Nine of the 12 studies found that children with a history of HIE showed more anxiety, depression, or somatic symptoms than comparison groups — though four of those nine had mixed results, and three studies found no difference at all. A few patterns are worth naming directly:
This review cannot tell us how common anxiety or depression is in any individual child, or predict how a specific child will do. The 12 included studies used different tools, different age groups, and different ways of measuring symptoms, which is part of why the researchers could not combine the results into a single statistic.
Most studies also relied on parent report alone, which may miss what a child is actually experiencing internally. And this research cannot separate the effects of HIE itself from other factors that shape a child's mental health, including family circumstances and environment.
Right now, many HIE follow-up clinics stop seeing children around 2-3 years of age. This research points to a real gap: anxiety tends to emerge around early elementary school, and depression often doesn't show up until adolescence — well past the point when most children stop being followed. A child can look "fine" at a two-year checkup and still be at higher risk for anxiety or depression years later. That is not a reason for alarm. It is a reason to keep emotional health on the radar as your child grows, the same way you'd track a developmental milestone.
If you're parenting a child who experienced HIE, this may be a useful moment to ask your child's pediatrician or care team about routine mental health screening — not just at follow-up clinic visits, but as part of ongoing primary care, especially as your child enters school and the teen years.
We're tracking this area of research closely and will continue to bring family priorities — including longer-term emotional and mental health follow-up — into conversations with clinicians and researchers.
This study also points directly to why we are building the Hope for HIE Research Registry. The authors name several gaps that made it hard to draw firm conclusions: studies used different measurement tools, followed children for different lengths of time, and mostly stopped well before the ages when anxiety and depression tend to emerge.
A data set built on data that families themselves contribute, tracked over years rather than months, is one way to help close exactly that gap — giving researchers a larger, more consistent, longer-term picture than any single study has been able to gather on its own.
We'll be sharing more details on how to enroll in My HIE Journey, and the HIE research portal, later into 2026 to ensure we have the most complete, deidentifed data set of HIE patients anywhere always with privacy and family-centered experiences in mind.
Read the full study: Silent struggles of internalizing disorders in survivors of neonatal hypoxic ischemic encephalopathy: a scoping review, published in the Journal of Perinatology.
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