Hypoxic ischeamic encephalopathy

Question 1

Hypoxic ischaemic encephalopathy

Answer 1

Neurological manifestations of perinatal hypoxic injury

Classified using Sarnat criteria

Question 2

Mild

Answer 2

Initial lethargy followed by period of hyper-alertness with irritability
Normal tone
No seizures
May be impaired feeding for 1-2 days
No focal signs
Good prognosis

Question 3

Moderate

Answer 3

Hypotonia with reduced movements and decreased conscious level
Seizures often seen
Variable prognosis

Question 4

Severe

Answer 4

Coma with absence of spontaneous movement
Absent reflexes
Seizures usually seen, may be frequent
Multiorgan failure often present
Morbidity and mortality high

Question 5

Phases of neuronal injury

Answer 5

2 phases:

1) Acute injury at time of event
2) Reperfusion injury (6-72 post insult)

Question 6

Management

Answer 6

Supportive care vital in minimising damage during reperfusion period
Total body cooling in mod-severe reduces neurodisability and improves outcomes in survivors but doesn’t reduce mortality (hypothermia for 72 hours followed by gradual warming)
EEG monitoring and MRI - prognosis/outcome prediction
Close supportive management: resp support; anticonvulsants; fluid restriction; circulatory support with inotropes if necessary