Hypoxic Ischaemic encephalopathy

Question 1

Hypoxic ischaemic encephalopathy why occurs

Answer 1

Hypoxia during birth

Question 2

What events can lead to HIE?

Answer 2

Perinatal/intrapartum hypoxia
Intrapartum period
Acidosis (pH<7)
Umbilical artery blood gas
poor Apgar scores
Features of mild mod or severe HIE
Evidence of multi organ failure

Question 3

What is considered in the Apgar score?

Answer 3

Appearance - skin colour
Pulse - HR
Grimace - reflex irritability
Activity - muscle tone
Respiration - breathing rate and effort

Question 4

What is 0 to 2 in the apgar scale for appearance?

Answer 4

Bluish-gray or pale all over
Normal colour - hands and feet bluish
Normal colour - all over - hands and feet are pink

Question 5

Pulse/HR on Apgar scoring 0-2

Answer 5

0 - Absent
1 - Slow or irregular breathing, weak cry
2- normal rate and effort, good cry

Question 6

Grimace/reflex irritability r score 0-2

Answer 6

0 - absent (no response to stimulation)
1 - Facial movement only (grimace) with stimulation
2 - pulls away, sneezes, coughs or cries with stimulation

Question 7

Activity/muscle tone apgar score 0-2

Answer 7

0 - no movement, floppy
1 - arms and legs flexed with little movement
2 - active spontaneous movement

Question 8

Respiration (breathing rate and effort) 0-2 on apgar score

Answer 8

0 - absent
1- slow irregualr breathing, weak cry
2 - normal rate and effort, good cry

Question 9

Respiration (breathing rate and effort) 0-2 on apgar score

Answer 9

0 - absent
1- slow irregualr breathing, weak cry
2 - normal rate and effort, good cry

Question 10

Causes of HIE

Answer 10

Maternal shock
Intrapartum haemorrhage
Prolapsed cord, compression of cord during birth
Nuchal cord - wrapped around neck of baby

Question 11

What staging is used for HIE?

Answer 11

Sarnat staging

Question 12

Features of mild HIE?

Answer 12

Poor feeding, generally irritability and hyper alert
Resolves within 24 hours
Normal prognosis

Question 13

Moderate HIE staging

Answer 13

Poor feeding, lethargic, hypotonic and seizrures
Can take weeks to resolve
Up to 40% develop cerebral palsy

Question 14

Severe HIE features

Answer 14

Reduced consciousness, apnoea, flaccid and reduced or absent reflexes
Up to 50% mortality
Up to 90% develop CP

Question 15

Management of HIE

Answer 15

Neonatology specialists
Supportive care - noenatal resuss
Ogoing optimal ventilation, circulatory support, nutirition, acid base balance and treatment of seizures

Question 16

What can help protect the brain from hypoxic injury in HIE?

Answer 16

Therapeutic hypothermia

Question 17

What is therapeutic hypothermia?

Answer 17

Coolin babies core temperatire between 33-34 degrees for 72 hours, then gradually warmed back to naturak temperatures over 6 hours
neonatal ICU
Measures with rectal probe

Question 18

What is teh intention of therapeutic hypothermia?

Answer 18

Reduce inflammation and neurone loss after acute hypoxic inkiry
Reduces risk of CP, developmentak delay, learning disability, blindness and death

Question 19

What is teh intention of therapeutic hypothermia?

Answer 19

Reduce inflammation and neurone loss after acute hypoxic inkiry
Reduces risk of CP, developmentak delay, learning disability, blindness and death