It is a dangerous condition that requires immediate medical intervention. Perinatal hypoxic ischemic encephalopathy hie is an important cause of brain injury in the newborn and can result in longterm devastating consequences. Clinical trials showed that 27% of post hypoxic coma patients regained consciousness within 28 days, 9% remained comatose or in an unresponsive wakefulness syndrome uws, and 64% died 3, 4. Hypoxic ischemic encephalopathy overview when an infants brain is deprived of oxygen for more than a few minutes, longterm damage and lifelong disabilities may develop.
Perinatal hypoxicischemic encephalopathy hie is the leading cause of acute mortality and morbidity in newborns with an incidence of one to eight cases per term births. This excess glutamate leads to overstimulation of the glutamate receptors 2aminomethylphenylacetic acid ampa, kainite ka, and nmethyldaspartate nmda located on the postsynaptic neuron and leads to excitotoxicity. True hypoxic ischemic encephalopathy can occur during events. Ischemic hypoxic encephalopathy is often s een in emergency departments and can have a disastrous prognosis. Hie is a brain injury that prevents adequate blood flow to the infants brain occurring as a result of a hypoxicischemic event during the prenatal, intrapartum or postnatal period.
Cell therapy for neonatal hypoxicischemic encephalopathy. The pathophysiology of hie is now better understood, and treatment with hypothermia has become the foundation of therapy. The queensland clinical guideline hypoxicischaemic encephalopathy hie is the primary reference for this package. Hypoxicischaemic encephalopathy hie c linical guideline education presentation e16. Most underlying pathologic events of hie are a result of impaired cerebral blood flow and oxygen delivery to the brain with resulting primary and secondary energy failures. Hypoxic ischemic brain injury hibi after cardiac arrest ca is a leading cause of mortality and longterm neurologic disability in survivors. Hypoxic ischemic encephalopathy hie is a serious birth. Perinatal hypoxicischemic encephalopathy hie is an important cause of brain injury in the newborn and can result in longterm devastating consequences. Perinatal hypoxic ischemic encephalopathy hie is the leading cause of acute mortality and morbidity in newborns with an incidence of one to eight cases per term births. The most common causes of oxygen deprivation to the brain are low levels of oxygen in the blood or a reduced flow of oxygen to the brain. Understanding pathophysiology of the brain damage is essential for the early detection of patients with high risk for hie and development of strategies for their treatments.
Mar 15, 2010 neonatal hypoxicischemic encephalopathy hie is a common cause of longterm neurological disability in children. Hypoxic ischemic encephalopathy is the most common cause of neonatal seizures in both fullterm and premature infants accounting for close to onehalf of the causes see chapters 16 and 18. With hypoxic ischemic encephalopathy hie, the brain is deprived of oxygen, and brain cells are injured. Hypoxicischemic encephalopathy hie occurs in 1 to 8 per live births in developed countries. Hypoxic brain damage, also called hypoxicischemic encephalopathy, is a severe consequence of global cerebral ischemia due to cardiac arrest or other causes e. The newborns body can compensate for brief periods of depleted oxygen, but if the asphyxia lasts too long, brain tissue is destroyed. Per the florida neonatal neurologic network, hie affects 20 out of every 1,000 full term births. The primary causes of this condition are systemic hypoxemia andor reduced cerebral blood flow cbf see the image below. During hypoxic ischemic encephalopathy, an excessive amount of the excitatory amino acid glutamate is released from the presynaptic terminal. Clinical pathophysiology of hypoxic ischemic brain injury. Perinatal hypoxia is a vital cause of longterm neurologic complications varying from mild behavioural deficits to severe seizure, mental retardation, andor cerebral palsy in the newborn. Hie, the pathophysiological processes leading to cerebral injury, and current attempts at. Hypoxic ischemic encephalopathy hie is a syndrome affecting the central nervous system and presenting in term and near.
Hypoxicanoxic brain injury can result from insufficient cerebral blood flow, reduced oxygen availability, reduced oxygen carriage by blood, or metabolic interference with the use of available oxygen. Patton, md diffuse hypoxicischemic brain injury in the neonate results in neonatal hypoxicischemic. Hypoxicischemic encephalopathy, or hie, is the brain injury caused by oxygen deprivation to the brain, also commonly known as intrapartum asphyxia. Because of differences in brain maturity at time of insult, severity of hypotension, and duration. Hie may result in death or cause serious impairment in survivors, and remains a significant cause of morbidity and mortality among neonates.
While 14 percent or less of cerebral palsy cp cases are caused from the form of birth asphyxia known as hypoxicischemic encephalopathy, the condition itself is. If you continue browsing the site, you agree to the use of cookies on this website. The majority of the underlying pathologic events of hie are a result of impaired cerebral blood flow and oxygen delivery to the brain with resulting primary and. Hypoxic ischemic encephalopathy hie is the most important reason for morbidity and mortality in termborn infants. Hypoxic ischemic encephalopathy in adults and older children i. Necrosis occurs in conditions of primary energy failure following the initial injury. This can happen in a variety of ways prior to birth, during the birth process, after birth, and during childhood. Hypoxic anoxic brain injury can result from insufficient cerebral blood flow, reduced oxygen availability, reduced oxygen carriage by blood, or metabolic interference with the use of available oxygen commichau, 2006. Elevated temperature after hypoxicischemic encephalopathy. Hypoxic ischemic encephalopathy hie birth injury guide. There are a variety of factors that may lead to hie, including maternal health issues, labor and delivery complications, infections, improper fetal monitoring, or failure to provide needed intervention such as an emergency csection. Hypoxicischemic encephalopathy is an important cause of permanent damage to cns cells that may result in neonatal death or be manifested later as cerebral palsy or mental deficiency. Neonatal encephalopathy are we getting smarter about the. Encephalopathy due to hypoxicischemic injury hypoxicischemic encephalopathy hie is defined as brain injury caused by the combination of inadequate.
Despite advances in supportive care, no treatments for hie are available at present. Historically, the clinician has had little to offer neonates with hie other than systemic. Pathophysiology of perinatal hypoxicischemic encephalopathy. A 20 years conundrum of neonatal encephalopathy and. As a general rule, the potential for neurologic recovery is greater with tbi compared with hie. This is a pdf file of an unedited manuscript that has been. Hypoxic ischemic encephalopathy hie and associated conditions such as cerebral palsy, intellectual and developmental disabilities idd, and seizure disorders stem from brain damage due to oxygen deprivation.
In this section, we will continue with a discussion on how hie is diagnosed. Hypoxic ischemic encephalopathy hie is one of the most serious birth complications affecting full term infants. Lack of sufficient oxygen and blood perfusion to the brain, resulting in brain injury. Hie is the result of severe systemic oxygen deprivation and reduced cerebral blood flow, commonly occurring in fullterm infants. The pathophysiology and pathology of hie are quite unique. As a general rule, the potential for neurologic recovery is greater with tbi. Although adults can experience hypoxic ischemic injury, hie most commonly occurs as the result of an oxygendepriving event during. In the previous section, we talked about the symptoms of hypoxicischemic encephalopathy, or hie. Hypoxic ischemic encephalopathy hie is a serious birth complication affecting fullterm infants.
Hypoxicischemic encephalopathy in adults and older children i. Hypoxicischemic encephalopathy, also referred as hie, is a type of brain injury or damage that is caused by a lack of oxygen to the brain. Pathophysiology features neonatal hypoxic ischemic encephalopathy. Hypoxicischemic injury leads to a biphasic pattern of encephalopathy and neuronal cell death. May 26, 2010 hypoxic ischemic encephalopathy is an important cause of permanent damage to cns cells that may result in neonatal death or be manifested later as cerebral palsy or mental deficiency nelson textbook of pediatrics 19 th ed. Hypoxic ischemic encephalopathy linkedin slideshare. Hypoxic ischemic encephalopathy hie is one of the most important diseases in perinatal medicine. Mild hypothermia as a treatment for hie is commonly used to treat. However, important developmental norms have to be taken into an account when describing the pathophysiology of perinatal hypoxic ischemic encephalopathy. Neonatal hypoxic ischemic encephalopathy hie is a serious brain injury resulting from the severe reduction of cerebral blood flow and oxygen around the time of birth. Jul 18, 2018 perinatal asphyxia, more appropriately known as hypoxic ischemic encephalopathy hie, is characterized by clinical and laboratory evidence of acute or subacute brain injury due to asphyxia. Hypoxicischemic encephalopathy is the most common cause of neonatal seizures in both fullterm and premature infants accounting for close to onehalf of the causes see chapters 16 and 18. Elevated temperature after hypoxic ischemic encephalopathy.
Historically, the clinician has had little to offer neonates with hie other than. Neonatal hypoxicischemic encephalopathy pathophysiology. What is hie hope for hie hypoxic ischemic encephalopathy. For a discussion of neonatal hypoxia, refer to neonatal hypoxic ischemic encephalopathy. Hypoxic ischemic encephalopathy hie, sometimes referred to as birth asphyxia, is a neonatal brain injury caused by an insufficient flow of oxygenrich blood. Jun 17, 2015 the spectrum of disability resulting from hypoxic ischemic encephalopathy ranges from complete recovery to coma or even death 3, 4. Glial fibrillary acidic protein as a biomarker for neonatal hypoxicischemic encephalopathy treated with wholebody cooling american journal of obstetrics and gynecology, vol. Hypoxic ischemic encephalopathy an overview sciencedirect. True hypoxic ischemic encephalopathy can occur during events such as prolonged umbilical cord compression, birth asphyxia from prolonged stage 2 labor and cardiopulmonary failure.
Hypoxicischaemic encephalopathy hie queensland health. In low and middleincome countries, the incidence is much higher 10. Pathophysiology and experimental treatments hypoxic ischemic encephalopathy hie is. Hypoxic ischemic encephalopathy hie in newborns is caused by an injury to the brain following a hypoxic or an ischemic event during the peripartum, intrapartum or postpartum period. The mode of cell death includes necrosis and apoptosis. Despite major advances in monitoring technology and knowledge of fetal and neonatal pathologies, perinatal asphyxia or, more appropriately, hypoxicischemic encephalopathy hie. Antepartum risk factors for moderate to severe neonatal.
This begins with primary injury to the brain caused by the immediate cessation of cerebral blood flow following ca. Importance hypoxicischemic encephalopathy hie occurs in 1 to 8 per live births in developed countries. Hypoxicischemic encephalopathy hie and associated conditions such as cerebral palsy, intellectual and developmental disabilities idd, and seizure disorders stem from brain damage due to oxygen. Understanding pathophysiology of the brain damage is essential for the. The pathophysiology of hibi encompasses a heterogeneous cascade that culminates in secondary brain injury and neuronal cell death. The newborns body can compensate for brief periods. Pathophysiology historically, neonatal encephalopathy was thought to result exclusively from a hypoxic incident, hence the name hie. An apgar score of less than 5 at 5 minutes and 10 minutes may indicate. Hypoxicischemic encephalopathy hie is a recognizable and defined clinical.
Neonatal hypoxicischemic encephalopathy hie is a serious brain injury resulting from severe reduction of cerebral blood flow and oxygen around the time of. Hypoxicischemic encephalopathy adults and children. Variable injuries can occur with purely hypoxic or histotoxic insults such as asphyxiation and carbon monoxide. Jul 18, 2018 despite major advances in monitoring technology and knowledge of fetal and neonatal pathologies, perinatal asphyxia or, more appropriately, hypoxic ischemic encephalopathy hie, remains a serious condition that causes significant mortality and longterm morbidity. Outcome and prognosis of hypoxic brain damage patients. Other terms used for hie include birth asphyxia, perinatal asphyxia, and neonatal. Neonatal hypoxicischemic encephalopathy hie is a serious brain injury resulting from the severe reduction of cerebral blood flow and oxygen around the time of birth. The most common causes of oxygen deprivation to the brain are. Patton, md diffuse hypoxicischemic brain injury in the neonate results in neonatal hypoxicischemic encephalopathy hie. Hypoxicischemic encephalopathy due to fetal or neonatal.
Hypoxic ischemic encephalopathy hie is a type of brain damage that occurs when an infants brain doesnt receive enough oxygen and blood. Associate clinical professor, university of the philippines college of medicine, manila, philippines assistant research professor, institute of child health and human development, manila, philippines. Sep 01, 2011 hypoxic ischemic encephalopathy hie is a serious birth complication affecting full term infants. The appropriate terminology for neonatal encephalopathy ne and hypoxic ischemic encephalopathy hie has been a subject of debate for the last 20 years. Perinatal asphyxia class for mbbs students, simplified slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Hypoxicischemic encephalopathy hie is one of the most important diseases in perinatal medicine. Hypoxicischaemic encephalopathy hie flowchart version. Ne is a heterogenous condition which may result from prematurity, genetic, infectious and.
Hypoxic ischemic encephalopathy hie occurs in 1 to 8 per live births in developed countries. Pathophysiology and pathology of neonatal hypoxicischemic. Hypoxicischemic brain injury is a well known consequence of cardiac arrest. Affected neonates can display altered levels of consciousness, decreased or absent reflexes and muscle tone, seizures and signs of organ failure source. Hypoxicischemic encephalopathy hie is a type of newborn brain damage caused by oxygen deprivation and limited blood flow. Perinatal asphyxia class for mbbs students, simplified slideshare uses cookies to improve functionality and performance, and to provide you with relevant.
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