Hypoxic Ischaemic Encephalopathy *

Question 1

Define HIE?

Answer 1

HIE is the acute or subacute brain injury due to asphyxia

The neonatal condition (0.5-1 in 1,000 live births)

Cerebral palsy is the post-neonatal condition (i.e. Severe HIE that is not treated)

Question 2

Aetiology of HIE?

Answer 2

Placental abruption
Interruption of umbilical blood flow
Inadequate maternal placental perfusion
Compromised foetus (IUGR)
Failure to breath at birth

Question 3

Signs and Symptoms of HIE?

Answer 3

Mild = infant irritable, responds excessively to stimulation, staring eyes, hyperventilation, hypertonia

§ Complete recovery can be expected

o Moderate = abnormalities of movement, hypotonic, cannot feed, has seizures

§ If fully resolved by 2 weeks of age, there is a good long-term prognosis

§ If persistent past 2 weeks, bad prognosis

o Severe = no normal movements or response to pain, tone in limbs fluctuates hypo- to hyper-tonic, seizures prolonged and refractory to treatment, multi-organ failure may be present

§ 30-40% mortality

§ Over 80% have neurodisability (if not cooled) à cerebral palsy

Question 4

How to Manage HIE?

Answer 4

Respiratory support

Anticonvulsants - treat seizures

Fluid restrictions to aid renal impairment

Inotropes - to treat hypertension

Electrolytes and glucose

Question 5

Define Cerebral Palsy?

Answer 5

Abnormality of movement and posture, causing activity limitation attributed to non-progressive disturbances that occurred in the developing foetal or infant brain

Question 6

Aetiology of CP?

Answer 6

80% antenatal:
Vascular occlusion
Structural maldevelopment

Genetic syndromes
Congenital infection

10% HIE during delivery

10% postnatal

Question 7

Risk factors of CP?

Answer 7

Antenatal: preterm birth, chorioamnionitis, maternal infection

o Perinatal: LBW, HIE, neonatal sepsis

o Postnatal: meningitis

Question 8

Signs of CP?

Answer 8

delayed milestones

abnormal limb or trunk posture and tone - stiff legs, hypotonia, spasticity, fisted hands, round back,

feeding difficulties

abnormal gait

Question 9

Subclasses of CP?

Answer 9

Spasticity - 90% - damage to UMN - presents early, can be unilateral, bi/quadilateral, diplegia (legs more affected

Dyskinetic - involuntary uncontrolled - damage to basal ganglia

Ataxic - damage to cerebellum - hypotonia, delayed development

Question 10

Investigations for CP?

Answer 10

History
Developmental progress
Clinical exam
Cranial Ultrasound

Follow up MDT with members: : paediatrician, nurse, physiotherapist, OT, SALT, dietetics, psychology

Question 11

How to manage?

Answer 11

Walking: children who can sit by age 2 years are likely to be able to walk unaided by 6 years old

§ Speech: 50% have difficulties with communication, 33% have difficulties with speech and language

§ Life Expectancy: the more severe the CP the greater the likelihood of reduced life expectancy

§ Support:

· SCOPE disability charity