Observational studyBMJ paediatrics open2026
High levels of parenting stress and trauma despite age-appropriate developmental outcomes following perinatal asphyxia: a cross-sectional observational study.
Observational study in BMJ paediatrics open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
objectiveTo examine the association of perinatal asphyxia across mild to moderate hypoxic-ischaemic encephalopathy (HIE) severity levels and therapeutic hypothermia (TH) with child developmental outcomes and parenting stress and to explore parental trauma and psychosocial support.
designMulticentre, cross-sectional, comparative observational study.
settingTwo university medical centres in Germany.
participantsParents of children aged 1-5.5 years with a history of perinatal asphyxia treated with TH (n=58) or without TH (n=77), and unexposed control children (n=179). OUTCOME MEASURES: Parents completed the Ages & Stages Questionnaire, Third Edition, and the Parenting Stress Index (PSI) for the primary outcome, and reported on birth-related trauma, psychosocial support and family planning decisions as exploratory secondary outcomes.
resultsMost children showed age-appropriate developmental outcomes across all groups. In contrast, parents in both asphyxia groups reported elevated stress levels, with higher PSI scores in the TH group, particularly in the health, competence and attachment domains. Postnatal trauma was highly prevalent, affecting 88% of parents in the TH group, 73% in the non-TH group and 15% in controls. Psychosocial support was perceived as sufficient by only 20% of parents in the non-TH group, compared with 39% in the TH group. Birth-related trauma was a significant predictor of parental stress.
conclusionsDespite mostly age-appropriate development on screening, parental stress and trauma were highly prevalent regardless of HIE severity, and psychosocial support was markedly insufficient, particularly for families whose infants did not receive TH. These findings highlight the need for structured, accessible psychosocial support for all patient-families affected by perinatal asphyxia.
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