The relationship between neonatal encephalopathy and maternal postpartum depression.

PURPOSE: Neonatal hypoxic-ischemic encephalopathy (HIE) is a type of brain injury resulting from insufficient oxygen and blood supply. The standard treatment for HIE is therapeutic hypothermia, which involves a 72-hour period of hypothermia, during which time the infant is isolated from his/her parents. The primary objective of this study was to assess the effects of the diagnosis of neonatal encephalopathy and subsequent separation on rates of maternal postpartum depression (PPD) as compared to other hospitalized infants.

MATERIALS AND METHODS: Case-control analysis of newborns admitted to the NICU from 2015-2018. Maternal PPD symptoms were determined by the Edinburgh Postnatal Depression Scale (EPDS). Demographics, diagnoses, and outcomes were abstracted from clinical records. Associations between EPDS scores and HIE diagnosis and severity, insurance type, marital status, markers of overall illness severity, and the need for neonatal transport were evaluated. The Student's t test and Fisher's exact test were used to compare differences in continuous and categorical variables, respectively. A multiple regression model was used to adjust for markers of illness severity.

RESULTS: The study found no association between EPDS scores and marital status, overall illness severity, or the need for transport. A trend toward higher EPDS scores was noted in mothers of infants with HIE versus other admission diagnoses (21 versus 10%, p = 0.09). A similar trend was seen in mothers of infants with severe versus moderate encephalopathy (30 versus 7%, p = 0.12). Mothers of infants with no insurance (20%) or Medicaid (16%) had higher rates of PPD than those with private (6%) or military insurance (6%) (p = 0.02).

CONCLUSION: Mothers of infants with HIE are at high risk for PPD, which may be in part related to therapeutic hypothermia interfering with maternal-infant bonding. These findings support the need for continued universal depression screening with investigation of new methods to reduce stress and improve the bonding experience during and after therapeutic hypothermia.