Birth Asphyxia And Hypoxic Ischaemic Encephalopathy

Hypoxic ischaemic encephalopathy is neurological dysfunction following significant perinatal hypoxia and impaired cerebral perfusion.

Severity ranges from mild transient encephalopathy to severe seizures, multiorgan failure and death.

• Reduced consciousness
• Abnormal tone
• Weak or absent primitive reflexes
• Poor feeding
• Abnormal respiration
• Seizures
• Autonomic dysfunction

Severe disease may involve renal, hepatic, myocardial and coagulation abnormalities.

Diagnosis integrates:

• Perinatal history
• Cord or early blood gas where available
• Neurological examination
• EEG or amplitude integrated EEG
• MRI brain

Exclude hypoglycaemia, sepsis, metabolic disease and intracranial haemorrhage.

• Maintain ventilation, oxygenation, perfusion and glucose.

• Avoid hyperthermia.

• Treat seizures.

• Carefully manage fluids because renal dysfunction is common.

Therapeutic hypothermia is indicated for eligible term or near term infants with moderate or severe HIE when treatment can be started within approximately 6 hours of birth.

Target temperature is typically approximately 33 to 34°C for 72 hours, followed by controlled rewarming in a neonatal intensive care setting.