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18 - Clinical assessment and therapeutic interventions for hypoxic–ischemic encephalopathy in the full-term infant

from Section 4 - Clinical aspects

Published online by Cambridge University Press:  01 March 2011

By
Andrew Whitelaw  and
Marianne Thoresen
Edited by
Hugo Lagercrantz ,
M. A. Hanson ,
Laura R. Ment  and
Donald M. Peebles
Hugo Lagercrantz
Affiliation:
Karolinska Institutet, Stockholm
M. A. Hanson
Affiliation:
Southampton General Hospital
Laura R. Ment
Affiliation:
Yale University, Connecticut
Donald M. Peebles
Affiliation:
University College London
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Summary

Definition and diagnostic criteria

The term hypoxic–ischemic encephalopathy (HIE) implies a clinically apparent acute disturbance in brain function resulting from a period of critical deprivation of cerebral oxygen delivery and/or blood supply. For the diagnosis of HIE to be upheld there needs to have been obstetric evidence of risk of hypoxia/ischemia to the fetus (e.g., reduced fetal movements, prolapse of the umbilical cord, late decelerations of the fetal heart, fresh meconium, placental abruption, etc.) after which the infant is born in poor condition, with delayed onset of respiration, and is then observed to have cerebral dysfunction (e.g., hypotonia, inability to suck, abnormal posture, clonic movements).

The finding of metabolic acidosis or raised lactate levels in cord blood or blood taken within 30 minutes of birth provides important supporting evidence that there has been acute hypoxia–ischemia at or shortly before delivery. Further support for a global hypoxic–ischemic episode is provided by deranged liver function (raised transaminases), a period of renal impairment with oliguria and raised serum creatinine, cardiac dysfunction, and disseminated intravascular coagulation. The diagnosis of HIE also requires that steps have been taken to rule out other causes of cerebral dysfunction such as infection, preexisting anatomical abnormalities of the brain, or an inherited metabolic disease.

As it is often difficult to be sure if hypoxia–ischemia is the cause of encephalopathy, some authors prefer the term neonatal encephalopathy, which makes no assumptions or exclusions as to etiology.

Type
Chapter
Information
The Newborn Brain
Neuroscience and Clinical Applications
 , pp. 281 - 300
Publisher: Cambridge University Press
Print publication year: 2010

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