Makindo Medical Notes

Description: Hypoxic-Ischaemic Encephalopathy (HIE) is a brain injury caused by a lack of oxygen and blood flow to the brain, often occurring during birth. It can lead to severe neurological impairments, including cerebral palsy, cognitive delays, and epilepsy, depending on the severity of the hypoxia and the duration of the insult.

Clinical Features

• Altered consciousness (lethargy, coma, or irritability).
• Seizures within the first 24-48 hours after birth.
• Abnormal tone (hypertonia or hypotonia).
• Abnormal reflexes, such as absent Moro reflex or poor sucking.
• Respiratory distress and poor feeding.

Diagnosis

• Apgar score: Low Apgar scores at 1 and 5 minutes may suggest asphyxia.
• Arterial blood gases: Metabolic acidosis (pH < 7.0) indicates hypoxia.
• Brain imaging: MRI is the gold standard for detecting brain injury.
• Electroencephalogram (EEG): For detecting seizures and assessing brain function.
• Umbilical cord blood gases: Assesses perinatal asphyxia and helps predict the risk of HIE.

Management

• Therapeutic hypothermia: Initiate within 6 hours of birth to reduce the severity of brain injury in moderate to severe HIE.
• Seizure management: Use anticonvulsants (e.g., phenobarbital, levetiracetam) for seizure control.
• Respiratory support: Mechanical ventilation or oxygen therapy for infants with respiratory distress.
• Multidisciplinary care: Neonatologists, neurologists, and rehabilitation specialists should be involved in long-term care.
• Neurodevelopmental follow-up: Early intervention programs and therapies to address developmental delays and neurological impairments.

Prognosis

The prognosis for HIE depends on the severity of the brain injury. Mild cases may result in minimal long-term effects, while moderate to severe cases can lead to complications such as cerebral palsy, intellectual disabilities, epilepsy, and sensory impairments.