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Hypoxic Ischaemic Encephalopathy (HIE) - Coggle Diagram
Hypoxic Ischaemic Encephalopathy (HIE)
Pathophysiology
Perinatal asphyxia
placental/pul gas exchange compromised/ceased
CR depression
hypoxia, hypercarbia, metabolic acidosis
decreased CO
reduced tissue perfusion
neural damage can be...
primary death
secondary to reperfusion injury
opportunity for neuroprotection here with mild hypothermia
Incidence
0.5-1 / 1000 in developed countries, with 0.3 / 1000 having significant neuro disability
higher in developing countries
10% of CP cases due to HIE
Causes
failure of gas exchange across placenta
excessive/prolonged contractions
abruption
uterine rupture
interrupted umbilical blood flow
cord compression
SD
cord prolapse
inadequate maternal perfusion
maternal hypo / HTN
often a/w IUGR
foetal anaemia
failure of CR adaptation @ birth
usually occurs antenatally or during labour/delivery
May occur postnatally e.g. due to kernicterus or inborn error of metabolism
Presentation
immediately or up to 48hrs later
Mild
irritable
responds excessively to stim
staring
hyperventilation
impaired feeding
Moderate
marked abnormalities of tone + movement
can't feed
seizures
Severe
No normal spontaneous movements
no response to pain
fluctuating hypo + hypertonia
prolonged seizures, often refractory to tx
multiorgan failure
Management
resus + stabilisation
resp support
amplitude-integrated EEG (aEEG) aka cerebral function monitor (CFM)
anticonvulsants for seizures
fluid restriction due to transient renal impairment
tx hypotension with vol + inotrope support
monitor + tx hypoglyc + electrolyte imbalance e.g. hypocalc
Mild hypothermia
cool to rectal temp of 33-34 for 72hr by wrapping infant in cooling blanket
reduces brain damage if started within 6hr of birth
for moderate/severe
monitor + manage DIC
Prognosis
Mild - complete recovery can be expected
Moderate
if recover fully by 2 wks excellent long-term prognosis
if abnormalities persist beyond 2wks full recovery unlikely
Severe
Mortality = 30-40%
over 80% of survivors have neurodisability - CP
MRI
should be done when infant 4-14 days
look for abnormally white basal ganglia + thalamus , + lack of myeline in PLIC
