Hypoxic Ischemic Encephalopathy in Neonates - Oren Zarif - Hypoxic Ischemic Encephalopathy

Hypoxic ischemic encephalopathy, also known as HIE, is a disease that occurs due to a disruption of the blood supply to the brain. The blood supply to other organs may be disrupted as a result, and the affected organs typically recover. However, the brain may not fully recover from the damage, and its prognosis depends on the length of time it went without oxygen. Babies affected by HIE may exhibit symptoms of organ dysfunction, including floppy behavior and feeding problems.

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Neonates with this condition should undergo MRI and CT scans. MRI can identify the underlying cause of the disease and its prognosis. Head ultrasound may detect ventriculomegaly or hemorrhage. In neonates who develop hypoxic ischemic encephalopathy, head ultrasound can help detect hypoxic ischemia. CT scans are rarely performed on children due to the high radiation doses.

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HIE is a relatively common condition, occurring in approximately six to eight per thousand live births. It is associated with high morbidity, with up to one-quarter of survivors having recognizable cognitive or motor impairment. Several risk factors for HIE have been established, including birth asphyxia and a prolonged reduction in cerebral blood flow during delivery. Despite the risk factors, however, many HIE cases do not have a clear history of asphyxia.

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As a result, the effects of Hypoxic Ischemic Encephalopathy are extremely serious. The brain is damaged in various areas, depending on the length of time it has been without oxygen. While some children will be mildly affected, others will be permanently handicapped. And in rare cases, there may be no noticeable effects at all. In such cases, the doctor will prescribe a medication to treat the symptoms.

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Neuroimaging examinations of newborns with suspected HIE is an important prognostic tool. MRI results can show a pattern of injury and predict later deficits. MRIs also show the extent of injury in white matter, thalamus, and basal ganglia. Therapeutic hypothermia may help reduce the impact on the brain's white matter and watershed regions. Treatment should be individualized according to the severity of the hypoxic ischemic encephalopathy.

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Although the onset and severity of Hypoxic Ischemic Encephalopathy vary among children, a clear definition of the disease has not been identified. However, clinical signs of the disease include difficulty initiating respiration, depression of tone, seizures, and subnormal level of consciousness. A three-level grading scale for the disease was developed by Sarnat in 1976. The scale reflects the clinical severity of the disease, and is based on the symptoms of 21 newborns.

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During pregnancy, the risk for hypoxia increases. There are several risk factors, such as congenital heart disease and pulmonary disease. Preterm babies who suffer from acidosis may have been exposed to a degree of Hypoxia. Other risk factors may include drug-induced suppression of the central nervous system. If the fetus is chronically hypoxic, intrauterine growth restriction may develop. A cordocentesis can show signs of fetal hypoxia and lactic acidosis. The cordocentesis can further decrease umbilical oxygenation. Fetal depression can also occur as a result of low Apgar scores.