Neonatal Encephalopathy

Question 1

Causes of NE

Answer 1

HIE 
Perinatal stroke 
IVH 
Metabolic disorders 
Withdrawal from maternal drugs 
Genetic - PWS 
Structural brain abnormalities

Question 2

Insult mid gestation

Answer 2

periventricular white matter most susceptible to ischaemia - periventricular leukomalacia
increases risk for IVH
results in spastic diplegia

Question 3

insult at term

Answer 3

due to partial asphyxial insult
- parasagittal watershed area - results in behavioural problems, language delays, cognitive deficits, possible epilepsy, severe motor impairment uncommon

due to acute total asphyxia

• deep grey matter injury (basal ganglia and thalamus) and peri-rolandic cortex (pre-central gyrus, post central gyrus, paracentral lobule) injury
• results in movement disorders (dystonia/chorea/athetosis) & spastic quadriplegia & cognitive impairment - may have associated epilepsy

Question 4

Therapeutic Hypothermia

Answer 4

must be started within 6 hours of birth
whole-body cooling and selective head cooling have similar safety and effectiveness
duration 72 hours
core t 33.5-34.5
improves surgical and outcome at 18 months age
not been studied in prem < 36w and severely growth restricted < 1800g

reduces secondary cell damage - decreases cerebral metabolism and energy utilisation
inhibits inflammatory cascade
suppresses free radical activity

Question 5

Eligibility criteria for cooling

Answer 5

A gestational age >/= 36weeks AND < 6 hours of age
B 1 of following
pH = 7 or BD >/= 16 mmol/l
10 minute APGAR < 5
Ongoing resuscitation from birth for at least 10 minutes
C AND moderate to severe encephalopathy (Shankaran)
OR abnormal background or seizure activity on aEEG/EEG (if available)

Question 6

Complications of therapeutic hypothermia

Answer 6

sinus bradycardia 
prolonged QT interval 
systemic hypothermia of skin and scalp - reddening and hardening - looks like peau de orange 
subcutaneous fat necrosis 
thrombocytopenia

Question 7

Long term neurodevelopmental sequelae

Answer 7

Cognition and developmental delay or learning difficulty 
Cerebral palsy 
Blindness or vision defects 
Gross motor and coordination problems 
Epilepsy 
Hearing loss/deafness 
Behavioural problems