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Encephalopathy
Ji ling
Background
HIE is an acquired syndrome
characterized by clinical and laboratory
evidence of acute brain injury due to
asphyxia (ie, hypoxia, acidosis).
Background
criteria score
0 1 2
Neuromuscular Control
Decreased or
Stretch reflexes Overactive Overactive
absent
Segmental
Present Present Absent
myoclonus
State 1 Stage 2 Stage 3
Complex Reflexes
Moro Absent
Strong; Weak; incomplete;
Oculovestib Weak or
Normal Overactive
ular absent
Tonic neck Slight Strong Absent
Generalized
Autonomic Generalized Both systems
parasympatheti
Function sympathetic depressed
c
Variable; often
Pupils Mydriasis Miosis unequal; poor light
reflex
Bronchial and
Salivary Sparse Profuse Variable
Secretions
State 1 Stage 2 Stage 3
Uncommon
Common; focal
Seizures None (excluding
or multifocal
decerebration)
Insult
Latent Secdonary
EEG low Seizure
CBF↓ Cytotoxic edema
Apoptotic cascade Excitoxin
Reperfusion
Min,~30 H, 6~15 D, 3
Prevention
o Brain cooling to about 3-4°C below the
baseline temperature (ie, to 33-34°C) may be
neuroprotective. The optimal level of
hypothermia for maximal neuroprotection is
not known. Extreme hypothermia may cause
significant systemic side effects.
o Up to 48-72 hours of cooling may be needed
to prevent secondary neuronal loss. The
greater the severity of the initial injury, the
longer the duration of hypothermia needed for
optimal neuroprotection.
Prevention
o Cooling must be begun early, within 1 hour of injury, if
possible; however, favorable outcome may be possible if
cooling is begun up to 6 hours after injury.
o A special device that selectively cools the head is now
being tested in clinical studies; it is not available in the
market. Some investigators believe that total body
cooling (as done for open-heart surgery) may be superior
to selective head cooling. The relative merits and
limitations of different methods of brain cooling have not
been studied.
Prevention
o Hypothermia may cause significant side effects,
including coagulation defects, leukocyte malfunctions,
pulmonary hypertension, and worsening of metabolic
acidosis. Until more is learned, hypothermia remains
an experimental modality
Prognosis
Accurate prediction of the severity of
long-term complications is difficult,
although the following pointers may be
used:
Prognosis
• Lack of spontaneous respiratory effort within
20-30 minutes of birth is associated with
almost uniform mortality.
• The presence of seizures is an ominous sign.
The risk of poor neurological outcome is
distinctly greater in such infants, particularly if
seizures occur frequently and are difficult to
control.
Prognosis
• Abnormal clinical neurological findings persisting beyond
the first 7-10 days of life usually indicate poor prognosis.
Among these, abnormalities of muscle tone and posture
(hypotonia, rigidity, weakness) should be carefully
noted.
• Persistent feeding difficulties, which generally are due to
abnormal tone of the muscles of sucking and
swallowing, also suggest significant CNS damage.
• Poor head growth during the postnatal period and the
first year of life is a sensitive finding predicting higher
frequency of neurologic deficits.