Hypoxic-ischemic encephalopathy (HIE)
*CF start immediately or up to 48 hours after asphyxia
Grade:
Mild Irritable, excessive response to stimulation,
eye staring, hyperventilation, hypertonia,
impaired feeding
Moderate Movement abnormalities, hypotonia,
cannot feed, seizures
Severe No spontaneous movements/response to
pain, tone between hypo&hypertonia,
prolonged seizures (refract to tx), MOF
Mx:
Respiratory support
Anticonvulsant
Fluid restriction (due to transient renal impairment)
Volume & inotrope support (due to hypotension)
Treat hypoglycaemia & electrolyte imbalance (hypocalcaemia)
Mild hypothermia therapy
aEEG – monitor encephalopathy
Mild hypothermia therapy (cooling mattress)
- Start within 6 hours of birth (reduce brain damage)
- For 72 hours
- Maintain rectal temp at 33 to 34⁰C
- For infants ≥36 weeks with moderate/severe HIE
, Prognosis
Mild Full recovery
Moderate Good prognosis if normal neuro examination & feeding normally by 2 weeks
Severe - 40% mortality
- (without cooling) 80% has neurodevelopmental disabilities
*if MRI at 2nd week shows significant abnormalities: high risk of cerebral palsy
Birth Asphyxia:
Severe hypoxia antenatally / during delivery
Resuscitation at birth
Encephalopathy
Hypoxic damage to other organs (liver,
kidney, heart)
No other prenatal / postnatal cause identified
Cranial trauma:
Caput succedaneum
Diffuse soft tissue swelling (bruising & oedema) of scalp that crosses the cranial sutures
Resolves over days
Cephalohematoma
Subperiosteal haemorrhage that is limited by cranial sutures
Resolves over weeks
Chignon
Oedema & bruising from Venthouse delivery
Subaponeurotic haemorrhage
Rare, occur after vacuum delivery
Due to shearing of emissary veins
Diffuse, boggy swelling of scalp
May have massive blood loss (hypovolemic shock, coagulopathy)
Nerve palsy
Erb palsy (waiter’s tip position)
Upper nerve root injury (C5, C6 of brachial plexus)
CF: flaccid arm, asymmetric Moro reflex
Ass. w/ phrenic nerve palsy – elevated diaphragm
Usually transient (referred if not resolved by 2-3 months) *most recover within 2 years
Facial nerve palsy
Compressed against mother’s ischial spine / forceps
Unilateral, facial weakness on crying but eye remain open
Usually transient (may need methylcellulose eye drops)
*CF start immediately or up to 48 hours after asphyxia
Grade:
Mild Irritable, excessive response to stimulation,
eye staring, hyperventilation, hypertonia,
impaired feeding
Moderate Movement abnormalities, hypotonia,
cannot feed, seizures
Severe No spontaneous movements/response to
pain, tone between hypo&hypertonia,
prolonged seizures (refract to tx), MOF
Mx:
Respiratory support
Anticonvulsant
Fluid restriction (due to transient renal impairment)
Volume & inotrope support (due to hypotension)
Treat hypoglycaemia & electrolyte imbalance (hypocalcaemia)
Mild hypothermia therapy
aEEG – monitor encephalopathy
Mild hypothermia therapy (cooling mattress)
- Start within 6 hours of birth (reduce brain damage)
- For 72 hours
- Maintain rectal temp at 33 to 34⁰C
- For infants ≥36 weeks with moderate/severe HIE
, Prognosis
Mild Full recovery
Moderate Good prognosis if normal neuro examination & feeding normally by 2 weeks
Severe - 40% mortality
- (without cooling) 80% has neurodevelopmental disabilities
*if MRI at 2nd week shows significant abnormalities: high risk of cerebral palsy
Birth Asphyxia:
Severe hypoxia antenatally / during delivery
Resuscitation at birth
Encephalopathy
Hypoxic damage to other organs (liver,
kidney, heart)
No other prenatal / postnatal cause identified
Cranial trauma:
Caput succedaneum
Diffuse soft tissue swelling (bruising & oedema) of scalp that crosses the cranial sutures
Resolves over days
Cephalohematoma
Subperiosteal haemorrhage that is limited by cranial sutures
Resolves over weeks
Chignon
Oedema & bruising from Venthouse delivery
Subaponeurotic haemorrhage
Rare, occur after vacuum delivery
Due to shearing of emissary veins
Diffuse, boggy swelling of scalp
May have massive blood loss (hypovolemic shock, coagulopathy)
Nerve palsy
Erb palsy (waiter’s tip position)
Upper nerve root injury (C5, C6 of brachial plexus)
CF: flaccid arm, asymmetric Moro reflex
Ass. w/ phrenic nerve palsy – elevated diaphragm
Usually transient (referred if not resolved by 2-3 months) *most recover within 2 years
Facial nerve palsy
Compressed against mother’s ischial spine / forceps
Unilateral, facial weakness on crying but eye remain open
Usually transient (may need methylcellulose eye drops)
