Neonatal encephalopathy
Neonatal encephalopathy | |
---|---|
Other names | Hypoxic and ischemic brain injury in the newborn, perinatal asphyxia, neonatal hypoxic and ischemic brain injury |
Specialty | Pediatrics |
Neonatal encephalopathy (NE), previously known as neonatal hypoxic-ischemic encephalopathy (neonatal HIE or NHIE), is defined as a
Signs and symptoms
In neonates born at or beyond 35 weeks, neonatal encephalopathy may present itself as the following symptoms:[5][6]
- Reduced level of consciousness
- Seizures (which peak at 48 hours)
- Difficulty initiating and maintaining respiration
- Depression of tone and reflexes[7]
Diagnosis
Cord blood gas analysis can be used to determine if there is perinatal hypoxia/asphyxia, which are potential causes of hypoxic-ischemic encephalopathy or cerebral palsy, and give insight into causes of intrapartum fetal distress.[8] Cord blood gas analysis is indicated for high-risk pregnancies, in cases where C-sections occurred due to fetal compromise, if there were abnormal fetal heart rate patterns, Apgar scores of 3 or lower, intrapartum fever, or multifetal gestation.[9]
Evidence of brain injury related to the hypoxic-ischemic events that cause neonatal encephalopathy can be seen with brain MRIs, CTs, magnetic resonance spectroscopy imaging or ultrasounds.[10][11] Neonatal encephalopathy may be assessed using Sarnat staging.[12] Brain MRI is usually performed within eight days of life.[13] Features that can be seen on MRI brain are: periventricular leukomalacia, basal ganglia and thalamus lesions, and multicystic encephalopathy.[14] Besides that, diffusion MRI would show low apparent diffusion coefficient (ADC) values in the first seven days of life. This is followed by pseudonormalisation of ADC values (normalisation of ADC values despite having persistent underlying brain injuries) which can persists up to two weeks.[15]
Treatment
In the past, treatment options were limited to supportive medical therapy.[16] Currently, neonatal encephalopathy is treated using hypothermia therapy.[17] This has been shown to reduce brain damage, reduce future disability, and improve survival.[18] Hypothermia therapy is also sometimes termed hypothermic neural rescue therapy. Clinical trials are taking place to investigate the effectiveness of stem cell-based interventions, which are thought to have the potential to reduce mortality and improve the long-term development of newborn infants with neonatal encephalopathy.[19]
Prognosis
HIE is a major predictor of neurodevelopmental disability in term infants. 25 percent have permanent neurological deficits.[20]
Epidemiology
Overall, the relative incidence of neonatal encephalopathy is estimated to be between 2 and 9 per 1000 term births.[7] 40% to 60% of affected infants die by 2 years old or have severe disabilities.[16] In 2013 it was estimated to have resulted in 644,000 deaths down from 874,000 deaths in 1990.[21]
References
- S2CID 243921388.
- ^ a b "Neonatal Encephalopathy". adhb.govt.nz. Retrieved 7 March 2015.
- ^ OCLC 489075193.
- ^ "Infant Hypoxic Ischemic Encephalopathy (HIE) Lawyers". Birth Injury Lawyers Group. Retrieved 2024-02-21.
- ISSN 2341-2879.
- PMC 10754824.
- ^ a b "Clinical features, diagnosis, and treatment of neonatal encephalopathy". www.uptodate.com. Retrieved 2016-03-24.
- PMID 17951550.
- PMC 10491792.
- ISSN 0031-4005.
- ^ "Identifying HIE: Diagnostic Tests and Medical Evaluations". HIE Help Center. Retrieved 2017-11-16.
- PMID 25005267.
- S2CID 247781397.
- PMID 23049586.
- PMID 17903669.
- ^ PMID 21927583.
- ^ "Encephalopathy in neonates: Neonatal ehandbook". Department of Health and Human Services, Victoria, Australia. Retrieved 2016-03-24.
- PMID 23440789.
- PMID 32813884.
- PMID 19084096.
- PMID 25530442.