Hypoxic ischemic encephalopathy associates in newborn medicine. Hypoxic ischemic encephalopathy an overview sciencedirect. Obstetric aspects of hypoxic ischemic encephalopathy. Hypoxic ischemic encephalopathy hie is injury to the brain because of a lack of oxygen. It is compounded by low blood flow to vital organs ischemia. Hypoxic ischemic encephalopathy and hypothermia hypoxic ischemic encephalopathy hie is defined as an acute brain injury diagnosed by clinical and laboratory findings. Management of infants with hypoxic ischaemic encephalopathy is largely supportive, but current studies indicate that. Infants with hie present with neurological symptoms, whose severity is classified based on the modified sarnat staging see table below. Perinatal asphyxia results in hypoxic injury to various organs including kidneys, lungs and liver but the most serious effects are seen on the central nervous system. What is hie hope for hie hypoxic ischemic encephalopathy.
Neonatal hypoxic ischemic encephalopathy hie presents a significant clinical burden with its high mortality and morbidity rates. Hie can occur before, during, or after the birth process, and can be caused by a variety of complications including, but not limited to, umbilical cord complications, placental or. Because of differences in brain maturity at time of insult, severity of hypotension, and duration. Hypoxicischemic encephalopathy due to fetal or neonatal. While hie is associated in most cases with oxygen deprivation in the neonate due to birth asphyxia, it can occur in all age groups, and is often a complication of cardiac arrest. Pathophysiology of perinatal hypoxicischemic encephalopathy. Hypoxic ischemic encephalopathy hie is defined as an abnormal neurologic state in the neonatal period arising as a result of a hypoxicischemic insult.
Early eeg grade and outcome at 5 years after mild neonatal. Hypoxicischemic encephalopathy hie is a clinically defined syndrome of disturbed neurologic function in the first day of life in an infant, manifested by difficulty with initiating and maintaining respiration, depression of tone and reflexes, sub normal level of consciousness and often seizures. Postresuscitation management of asphyxiated neonates. Despite advances in supportive care, no treatments for hie are available at presen. Wallace professor of neonatology university of vermont 19th international symposium on neonatology sao paulo, brazil. Hypoxicischemic encephalopathy and therapeutic hypothermia. Diffuse hypoxic ischemic brain injury in the neonate results in neonatal hypoxic ischemic encephalopathy hie.
Patton, md diffuse hypoxicischemic brain injury in the neonate results in neonatal hypoxicischemic encephalopathy hie. The longterm neurodevelopmental outcome for neonates who have suffered brain injury from a birth related hypoxicischemic insult is often poor. However, important developmental norms have to be taken into an account when describing the pathophysiology of perinatal hypoxic ischemic encephalopathy. Hypoxicischemic encephalopathy in the perinatal period is a common disorder that has an impact throughout the perinatal period in both the preterm and termborn infant. Hypoxic ischemic encephalopathy hie is defined as an abnormal neurologic state in the neonatal period arising as a. There are several causes of hie in newborns, including interrupted cir. The most common causes of oxygen deprivation to the brain are low levels of oxygen in the blood or a reduced flow of oxygen to the brain. Diffuse hypoxicischemic brain injury in the neonate results in neonatal. Optimise electrolyte and fluid balance, correct coagulopathy with ffp, cryoprecipitate and platelets as appropriate. Neonatal hypoxic ischemic encephalopathy hie remains a leading cause of newborn death and longterm neurodisability.
Hypoxicischemic encephalopathy hie, is one of the most frequent and dramatic urgency found in neurological brain diseases of adults. Hypoxicischemic encephalopathy hie in neonates is often difficult to diagnose in real time at the bedside because of the variety of disorders that can cause neonatal seizures and other. Understanding pathophysiology of the brain damage is essential for the early detection of patients with high risk for. Recently, the neuroprotective therapy of hypothermia has emerged as the standard of care, and other complementary therapies are. Pathophysiology of hie brain injury 2 phases primary and secondary primary characterized by reductions in cerebral blood flow and oxygen substrates secondary involves continuation of the. It is very important to remember that hypoxicischemic encephalopathy hie occurs due to oxygen deprivation. Hypothermia is associated with decline in ce rebral metabolism and is the prime therapeutic intervention. Definition of hypoxic ischemic encephalopathy,causes of hypoxic ischemic encephalopathy,presentations of hypoxic ischemic encephalopathy,diagnosis of hypoxic ischemic encephalopathy,complications ischemic encephalopathy,management of. Despite advances in supportive care, no treatments for hie are available at present. When an infants brain is deprived of oxygen for more than a few minutes, longterm damage and lifelong disabilities may develop. The newborns body can compensate for brief periods of depleted oxygen, but if the asphyxia lasts too long, brain tissue is destroyed. Management of infants with hypoxicischaemic encephalopathy is largely supportive, but current studies indicate that. Hypoxicischemic encephalopathy is the most common cause of neonatal seizures in both fullterm and premature infants accounting for close to onehalf of the causes see chapters 16 and 18.
Hypoxic ischemic encephalopathy hie is a condition that occurs when the entire brain is deprived of an adequate oxygen supply, but the deprivation is not total. Perinatal hypoxicischemic encephalopathy hie is the leading cause of acute mortality and morbidity in newborns with an incidence of one to eight cases per term births. Hie hypoxicischaemic encephalopathy greater than hr heart rate ischaemic encephalopathy hie 3. Hypoxic ischemic encephalopathy hie refers to the cns dysfunction associated with pa, and is often the prime concern while managing asphyxiated neonate as it can kill the neonate, and carries a potential to cause serious longterm neuromotor sequelae among survivors. Hypoxic ischemic encephalopathy hie occurs in 1 to 8 per live births in developed countries. Encephalopathy due to hypoxic ischemic injury hypoxic ischemic encephalopathy hie is defined as brain injury caused by the combination of inadequate blood flow and oxygen delivery to the brain. The hie help center serves as an informational resource guide for families of children with hypoxicischemic encephalopathy hie. It is sponsored by abc law centers, a birth trauma law firm that has represented families of children with hie and other birth injuries for over 20 years. Until recently, management of a newborn with hie has consisted mainly of. Hypoxic ischemic encephalopathy, or hie, is a medical term that means brain injury resulting from too little blood flow or oxygen delivery to the brain. Encephalopathy due to hypoxicischemic injury hypoxicischemic encephalopathy hie is defined as brain injury caused by the combination of inadequate blood flow and oxygen delivery to the brain. The longterm neurodevelopmental outcome for neonates who have suffered brain injury from a birth related hypoxic ischemic insult is often poor. Sep 01, 2011 hypoxic ischemic encephalopathy hie is a serious birth complication affecting full term infants.
May 26, 2010 hypoxic ischemic encephalopathy is an important cause of permanent damage to cns cells that may result in neonatal death or be manifested later as cerebral palsy or mental deficiency nelson textbook of pediatrics 19 th ed. With hypoxic ischemic encephalopathy hie, the brain is deprived of oxygen, and brain cells are injured. Hypoxic ischemic encephalopathy childrens hospital colorado. Hypothermia in neonatal hypoxicischemic encephalopathy hie. Cell therapy for neonatal hypoxicischemic encephalopathy. Hie acute or subacute perinatal asphyxia evidenced by neurologic examination and laboratory data decreased fetal cerebral blood flow and or hypoxemia one of the primary causes of severe, long term neurological deficits incidence in the usa per births. Outcomes for moderate and severe hie are well understood and improve after therapeutic hypothermia. Hypoxicischemic encephalopathy is characterized by neuropathological and clinical features that constitute an important portion of neonatal neurology. Little is known about vitamin d status, immunomodulatory function, or effects of hypothermia on vitamin d binding protein dbp in neonatal hypoxicischemic encephalopathy hie. Hypoxicischaemic encephalopathy hie queensland health. Severity is graded using clinical and electroencephalographic signs. It causes 23% of global neonatal deaths, totaling 1 million annually.
Ischemic hypoxic encephalopathy is often s een in emergency departments and can have a disastrous prognosis. Presence of hypotonia in either meets the criteria. Pdf hypoxicischemic encephalopathy hie occurs in 1 to 8 per live births in developed countries. Histologic examination reveals severe hypoxicischemic neuronal change. Other terms used for hie include birth asphyxia, perinatal asphyxia, and neonatal encephalopathy. As a general rule, the potential for neurologic recovery is greater with tbi compared with hie. Severe acute hypoxic ischemic neuronal change in the basal ganglia is noted. Hypoxic ischemic encephalopathy hie is a neonatal brain injury caused by oxygen deprivation or reduced blood flow to the brain. Hypoxicischaemic encephalopathy hie flowchart version. Hypoxicischemic encephalopathy, or hie, is the brain injury caused by oxygen deprivation to the brain, also commonly known as intrapartum asphyxia. Diffuse hypoxicischemic brain injury in the neonate results in neonatal hypoxicischemic encephalopathy hie. Hypoxic ischemic encephalopathy hie is defined as an abnormal neurologic state in the neonatal period arising as a result of a hypoxic ischemic insult. Hypoxicischemic encephalopathy is an important cause of permanent damage to cns cells that may result in neonatal death or be manifested later as cerebral palsy or mental deficiency nelson textbook of pediatrics 19 th ed. Hypoxicischemic encephalopathy hie is a type of newborn brain damage caused by oxygen deprivation and limited blood flow.
However, important developmental norms have to be taken into an account when describing the pathophysiology of perinatal hypoxicischemic encephalopathy. The queensland clinical guideline hypoxic ischaemic encephalopathy hie is the primary reference for this package. Preventing hypoxicischemic encephalopathy hie an ounce of prevention is worth a pound of cure. Hypoxic ischaemic encephalopathy refer to online version, destroy printed copies after use page 3 of 27. The queensland clinical guideline hypoxicischaemic encephalopathy hie is the primary reference for this package. Hypoxicischemic encephalopathy is the major cause of encephalopathy in the neonatal period and represents a major cause of mortality and longterm morbidity in affected infants.
This condition is also called neonatal encephalopathy. Hypoxicischemic encephalopathy hie is a severe central nervous system injury in neonates secondary to perinatal asphyxia. Perinatal hypoxic ischemic encephalopathy hie is the leading cause of acute mortality and morbidity in newborns with an incidence of one to eight cases per term births. Twentyfive percent of surviving children, are left with significant longterm neurologic disability, 1 placing hie in the top 10 diseases with the. We connect to support families, educate the greater community and generate awareness of hie. Hypoxic ischemic encephalopathy in the perinatal period is a common disorder that has an impact throughout the perinatal period in both the preterm and termborn infant.
Definition of hypoxic ischemic encephalopathy,causes of hypoxic ischemic encephalopathy,presentations of hypoxic ischemic encephalopathy,diagnosis of hypoxic ischemic encephalopathy,complications ischemic encephalopathy,management of hypoxic ischemic encephalopathy. Neonatal encephalopathy can result from a wide variety of conditions. The majority of the underlying pathologic events of hie are a result. Understanding pathophysiology of the brain damage is essential for the early detection of patients with high risk for hie and development of strategies for their treatments. Hypoxic ischemic encephalopathy is the major cause of encephalopathy in the neonatal period and represents a major cause of mortality and longterm morbidity in affected infants.
Hypoxicanoxic brain injury can result from insufficient cerebral blood flow, reduced oxygen availability, reduced oxygen carriage by blood, or metabolic interference with the use of available oxygen commichau, 2006. Hope for hie hypoxic ischemic encephalopathy is a worldwide organization of families whose children have been affected by hypoxic ischemic encephalopathy hie which also called neonatal encephalopathy, neonatal asphyxia, birth asphyxia, birth injury, neonatal depression. Hypoxic ischemic encephalopathy hie is a serious birth complication affecting full term infants. Hypoxic anoxic brain injury can result from insufficient cerebral blood flow, reduced oxygen availability, reduced oxygen carriage by blood, or metabolic interference with the use of available oxygen commichau, 2006. Hypoxicischemic encephalopathy hie occurs in 1 to 8 per live births in developed countries. Terminology it is important to remember that neonatal encephalopathy may result from a variety of. Severe acute hypoxicischemic neuronal change in the basal ganglia is noted. Historically, the clinician has had little to offer neonates with hie other than systemic supportive care. Hypoxicischemic encephalopathy hie is generally diagnosed by a physician once signs of oxygen deprivation birth asphyxia become evident. Hypoxic ischemic encephalopathy hie is the most important reason for morbidity and mortality in termborn infants. Vitamin d insufficiency in neonatal hypoxicischemic. Abnormal magnetic resonance signal in the internal capsule predicts poor neurodevelopmental outcome in infants with hypoxicischemic encephalopathy. Histologic examination reveals severe hypoxic ischemic neuronal change, characterized by the presence of pyknotic and.
Neonatal hypoxic ischemic encephalopathy hie is the result of a global hypoxic ischemic brain injury in a term neonate, usually after asphyxia. This is a pdf file of an unedited manuscript that has been. The majority of the underlying pathologic events of hie are a result of impaired cerebral blood flow and oxygen delivery to the brain with resulting primary and secondary energy failure. Hypoxicischaemic encephalopathy hie c linical guideline education presentation e16. Hypoxic ischaemic encephalopathy hie page 4 of 5 neonatal guideline other intensive care management. Encephalopathy is an acute intrapartum event sufficient to cause neuronal injury evidenced by. Hypoxic ischaemic encephalopathy hie c linical guideline education presentation e16. Hypoxicischaemic encephalopathy hie queensland clinical guideline. Checklist for therapeutic hypothermia cooling if baby has a perinatal event andor acidosis and meets the criteria below, therapeutic hypothermia may be indicated. Hypoxic ischemic encephalopathy hie is the indirect consequence of systemic asphyxia. Neonatal encephalopathy due to hypoxiaischemia occurs in 1 to 6 per. Postresuscitation management of asphyxiated neonate.
Xenon ventilation during therapeutic hypothermia in neonatal encephalopathy. Hypoxic ischemic encephalopathy clinical pathway sickkids. Mar 15, 2010 neonatal hypoxicischemic encephalopathy hie is a common cause of longterm neurological disability in children. The diagnosis is typically based on a combination of medical history, physical and neurological exams, laboratory results, and neuroimaging. Hypoxicischemic encephalopathy hie or birth asphyxia is responsible for some, but not all, cases of neonatal encephalopathy.
Hypoxic ischemic encephalopathy hie birth injury guide. This can happen in a variety of ways prior to birth, during the birth process, after birth, and during childhood. Delineate the pathophysiology of brain injury from hypoxicischemic. The term hypoxic ischemic encephalopathy hie, intrapartum hypoxiaischemia, or perinatal asphyxia describes a lack of oxygen and damage to cells within the brain as a result of restricted blood flow and occurs in approximately four out of every 1,000 births. Hypoxic ischemic encephalopathynewborn lahey health. This is a neurovascular and neurometabolic syndrome, caused by a shortage of supply of oxygen and glucose or their metabolism in the brain. Hypoxic ischemic encephalopathy hie is a serious birth. Neonatal hypoxicischemic encephalopathy hie is a common cause of longterm neurological disability in children. Because of differences in brain maturity at time of insult, severity of hypotension, and duration of insult, there are four distinct patterns of brain injury. Hie is a brain dysfunction caused by a lack of oxygen at birth, causing damage to the brain and other organs.
990 1590 347 1567 137 883 1392 799 1428 1541 395 1186 421 85 43 759 86 1108 250 1379 43 1423 925 868 1288 193 1218 818 742 1181 14 442 1180