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ENCEPHALOPATHY
DR. MANSOOR
ELAHI
DEFINITION
It is the term used to designate the clinical
and
neuropathological findings of an
encephalopathy that occurs in a full term
infant who has experienced a significant
episode of intrapartum asphyxia.
Etiology of HIE
Maternal:
Cardiac arrest
Asphyxiation
Severe anaphylaxis
Status epilepticus
Hypovolemic shock
Uteroplacental:
Placental abruption
Cord prolapse
Uterine rupture
Hyperstimulation with
oxytocic agents
Fetal:
Fetomaternal hemorrhage
Twin to twin transfusion
Severe isoimmune hemolytic
disease
Cardiac arrhythmia
STAGE 1
Hyperalert
STAGE 2
Lethargic
STAGE 3
Stuporous, coma
Normal
Normal
Hyperactive
Hypotonic
Flexion
Hyperactive
Flaccid
Decerebrate
Absent
Present
Strong
Mydriasis
Present
Weak
Miosis
Seizures
EEG
None
Normal
Duration
<24 hr if
progresses;
otherwise, may
remain normal
Good
Common
Low voltage
changing to
seizure activity
24 hr to 14 days
Absent
Absent
Unequal, poor
light reflex
Decerebration
Burst suppression
to isoelectric
Outcome
Variable
Days to weeks
Death, severe
deficits
accumulate in the
water
N2O,PGs
release
free
Damage
to
cell
lipases
which
Diving
sea reflexdamaged
tissue
radicals
membranes
generates 02
&
free
Redistribution
of
radicals
blood
to more
infarction
vital organs
What is
the
diagnosis
?
Diagnosis
There is no clear diagnostic test for HIE
Abnormal findings on the neurologic
exam in the first few days after birth is
the single most useful predictor that
brain insult has occurred in the perinatal
period
Essential Criteria for Diagnosis of HIE:
Metabolic acidosis (cord pH <7 or base deficit
of >12)
Early onset of encephalopathy
Multisystem organ dysfunction
INVESTIGATIONS
Exclude other causes of acute resp. distress
Chest X ray- to exclude pneumothorax, CDH,
Congenital pneumonia
Sepsis screening and bl. Culture
Serum electrolytes
Hyponatremia SIADH
Hyperkalemia acute renal shutdown/ tissue
catbolism
Hyperphosphatemia, hypocalcemia tissue
injury
BUN & CREATININE, LACTATE, PYRUVATE,
BRAIN SPECIFIC CREATINE KINASE,
HYPOXANTHINE, NON- ESTERIFIED FFA
CRANIAL ULTRASOUND
MANAGEMENT
TABC
IV fluids first 48hrs 10% dextrose to prevent
hypoglycemia
Maintain 2/3 rd of fluid to prevent SIADH
Ca gluconate 2ml/kg for 2 days
7.5% NaHCo3, 2-3ml/kg diluted with equal vol. of
distilled water or 5%D
Hypotension by inotropes like dopamine, dobutamine
Avoid mannitol- worsen due to endothelial damage in
HIE.
Prophylactic Phenobarbitone to combat seizures.
COOL CAP
CONTRAINDICATIONSTOCOOLING