Developmental outcomes in infants treated with therapeutic hypothermia before and during the COVID-19 pandemic.

BACKGROUND

Infants with hypoxic ischemic encephalopathy (HIE) are at high-risk for adverse neurodevelopmental outcomes, which may be further impacted by disruptions to social and healthcare systems such as during the COVID-19 pandemic. This study aimed to compare outcomes of infants with HIE born before versus during the pandemic.

METHODOLOGY: We retrospectively compared neurodevelopmental outcomes in infants with HIE born pre-pandemic (10/2017-12/2019) versus during the pandemic (03/2020-09/2021), using the Bayley Scales of Infant Development-4 at 12 and 18-24 months.

RESULTS

Among 73 infants studied, no differences were found in the baseline characteristics of two groups. Infants born during the pandemic (n = 40) had lower language scores at 12 months than pre-pandemic infants (n = 33) (mean 93.3 vs 99.4; p = 0.042). More pandemic cohort infants showed poorer gross motor development at 12 (40.6% vs 9.1%; p = 0.014) and 18-24 months (45.5% vs 18.5%; p = 0.035). The gap in language performance between infants with low versus high family-social risk widened during the pandemic.

CONCLUSIONS

Infants with HIE born during the pandemic showed temporarily reduced language and consistently lower motor performance compared to pre-pandemic peers. This may reflect reduced access to therapies and increased family distress, underscoring the need to build resilient, equitable follow-up support systems for vulnerable children during periods of heightened environmental stress.

IMPACT: This study suggests a potential impact of the pandemic-related healthcare and social disruptions on neurodevelopmental outcomes of high-risk neonates. Infants with neonatal encephalopathy born during the pandemic had worse language and gross motor outcomes, despite similar baseline characteristics to those born pre-pandemic. The widening language gap among infants from higher family-social risk backgrounds highlights possible inequities during the pandemic. The study emphasizes the importance of maintaining accessible, equitable early intervention and follow-up services during periods of societal stress, informing future healthcare system preparedness and policy planning.