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Hypoxic Ischemic Encephalopathy (Perinatal Asphyxia) : Causes, Symptoms, Stages, & Treatment

Hypoxic Ischemic Encephalopathy (Perinatal Asphyxia) : Causes, Pathophysiology, Symptoms, Stages, Prognosis, Diagnosis, Radiology, Treatment, & PPT

Definition

  • Hypoxic ischemic encephalopathy (HIE) is an acute or subacute brain injury due to asphyxia.

Essential Criteria

1. Umbilical artery blood pH < 7.0 OR Base deficit > 12 mmol/l.

2. Total APGAR Score 0-3 at 5 min./ 10 min. of life.

3. CNS dysfunction

4. Evidence of multiorgan dysfunction

Neuropathology

Preterm

  • Periventricular leukomalacia (PVL) : Hallmark
  • Subcortical neuronal necrosis

Term

  • Cortical neuronal necrosis
  • Parasagittal injury
  • Basal ganglia & thalamus ⇒ Status marmoratus (Marbled appearance of brain)

Staging

Sarnat & Sarnat staging

ParameterStage 1Stage 2Stage 3
ConsciousnessIrritableLethargicComatose
PupilMydriasisMiosisUnequal or fixed pupil
Suck reflexStrongWeakAbsent
Moro reflexStrongWeakAbsent
SeizuresAbsentPresentAbsent
ANSSympathetic overactivityParasympathetic overactivityBoth are depressed
Duration< 24 hours48 hour to 2 weekWeeks to months
OutcomeFairIntermediatePoor

Investigation (Ix)

MRI Brain (Ix of choice)

Diffusion weighed images > T2 FLAIR > T1 weighed

Treatment

A. Supportive

  • Oxygen
  • IV fluids
  • Avoid hypo or hyperglycemia (Target random blood glucose : 75-100 mg/dl)
  • IV calcium gluconate

B. Neuroprotective

  • Selective neuronal cooling

33.5° C for minimum 6 hour, maximum 72 hour

↓ complication rate (by decreasing cerebral metabolic rate)

  • Alternative: Whole day hypothermia

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