Neonatology - Hypoxic-Ischaemic Encephalopathy

Question 1

What causes hypoxic-ischaemic encephalopathy?

Answer 1

Prolonged hypoxia during birth leading to restriction in blood flow to brain

• Maternal shock
• Intrapartum haemorrhage
• Prolapsed cord
• Nuchal cord

Question 2

What can HIE lead to?

Answer 2

Cerebral palsy
Death

Question 3

What features can make you suspect HIE?

Answer 3

• Events that could lead to hypoxia during perinatal or intrapartum period
• pH <7 on umbilical ABG
• Poor Apgar scores
• Multi organ failure

Question 4

What is used to grade HIE?

Answer 4

Sarnat staging

Question 5

Fill out the table

Answer 5

Question 6

How is HIE managed?

Answer 6

Supportive care with neonatal resuscitation
Optimal ventilation, circulatory support, nutrition, acid base balance
Seizure treatment

Therapeutic hypothermia

Must be followed up by MDT and paediatrician to assess develop and any lasting disabilities

Question 7

Why can HIE benefit from therapeutic hypothermia?

Answer 7

Reduces inflammation and neurone loss after acute hypoxic injury

Reduces cerebral palsy risk, developmental delay, learning disability, blindness and death

Question 8

How is therapeutic hypothermia done?

Answer 8

Baby transferred to neonatal ICU

Actively cooled with cooling blankets and hat

Temperature range is between 33 and 34, measured with a rectal probe

Done for 72 hours after which baby warmed to normal over 6 hours