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
| Parameter | Stage 1 | Stage 2 | Stage 3 |
| Consciousness | Irritable | Lethargic | Comatose |
| Pupil | Mydriasis | Miosis | Unequal or fixed pupil |
| Suck reflex | Strong | Weak | Absent |
| Moro reflex | Strong | Weak | Absent |
| Seizures | Absent | Present | Absent |
| ANS | Sympathetic overactivity | Parasympathetic overactivity | Both are depressed |
| Duration | < 24 hours | 48 hour to 2 week | Weeks to months |
| Outcome | Fair | Intermediate | Poor |
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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