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. Antepartum risk factors for moderate to severe neonatal. 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. The queensland clinical guideline hypoxicischaemic encephalopathy hie is the primary reference for this package. 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 during neonatal period. Hypoxic ischemic encephalopathy hie, sometimes referred to as birth asphyxia, is a neonatal brain injury caused by an insufficient flow of oxygenrich blood. Importance hypoxicischemic encephalopathy hie occurs in 1 to 8 per live births in developed countries. Affected neonates can display altered levels of consciousness, decreased or absent reflexes and muscle tone, seizures and signs of organ failure source. As a general rule, the potential for neurologic recovery is greater with tbi. Hypoxic ischemic encephalopathy hie is the most important reason for morbidity and mortality in termborn infants. Jun 17, 2015 the spectrum of disability resulting from hypoxic ischemic encephalopathy ranges from complete recovery to coma or even death 3, 4. Neonatal hypoxicischemic encephalopathy hie is a serious brain injury resulting from severe reduction of cerebral blood flow and oxygen around the time of. 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. 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.
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. Glial fibrillary acidic protein as a biomarker for neonatal hypoxicischemic encephalopathy treated with wholebody cooling american journal of obstetrics and gynecology, vol. Hypoxic brain damage, also called hypoxicischemic encephalopathy, is a severe consequence of global cerebral ischemia due to cardiac arrest or other causes e. With hypoxic ischemic encephalopathy hie, the brain is deprived of oxygen, and brain cells are injured. Hypoxicischemic brain injury is a well known consequence of cardiac arrest. 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. Neonatal hypoxicischemic encephalopathy pathophysiology. Perinatal asphyxia class for mbbs students, simplified slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The newborns body can compensate for brief periods of depleted oxygen, but if the asphyxia lasts too long, brain tissue is destroyed. Perinatal hypoxicischemic encephalopathy hie is an important cause of brain injury in the newborn and can result in longterm devastating consequences. Hypoxicischaemic encephalopathy hie flowchart version. Hypoxicischaemic encephalopathy hie queensland health. Ischemic hypoxic encephalopathy is often s een in emergency departments and can have a disastrous prognosis. 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.
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. Hypoxic ischemic encephalopathy linkedin slideshare. The pathophysiology and pathology of hie are quite unique. 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. Hypoxicischemic encephalopathy due to fetal or neonatal. The appropriate terminology for neonatal encephalopathy ne and hypoxic ischemic encephalopathy hie has been a subject of debate for the last 20 years. In low and middleincome countries, the incidence is much higher 10. 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. It is a dangerous condition that requires immediate medical intervention. The primary causes of this condition are systemic hypoxemia andor reduced cerebral blood flow cbf see the image below.
Hypoxic ischemic encephalopathy hie is a type of brain damage that occurs when an infants brain doesnt receive enough oxygen and blood. Neonatal encephalopathy are we getting smarter about the. Hypoxic ischemic encephalopathy in adults and older children i. True hypoxic ischemic encephalopathy can occur during events. Although adults can experience hypoxic ischemic injury, hie most commonly occurs as the result of an oxygendepriving event during.
During hypoxic ischemic encephalopathy, an excessive amount of the excitatory amino acid glutamate is released from the presynaptic terminal. Elevated temperature after hypoxic ischemic encephalopathy. As a general rule, the potential for neurologic recovery is greater with tbi compared with hie. Lack of sufficient oxygen and blood perfusion to the brain, resulting in brain injury. Per the florida neonatal neurologic network, hie affects 20 out of every 1,000 full term births. 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. Hypoxicischemic encephalopathy adults and children.
Hie may result in death or cause serious impairment in survivors, and remains a significant cause of morbidity and mortality among neonates. Hypoxicischemic encephalopathy in adults and older children i. This begins with primary injury to the brain caused by the immediate cessation of cerebral blood flow following ca. Hypoxicischemic encephalopathy hie is a recognizable and defined clinical. Perinatal asphyxia class for mbbs students, simplified slideshare uses cookies to improve functionality and performance, and to provide you with relevant.
Elevated temperature after hypoxicischemic encephalopathy. The most common causes of oxygen deprivation to the brain are. Historically, the clinician has had little to offer neonates with hie other than. Understanding pathophysiology of the brain damage is essential for the. Hypoxic ischemic encephalopathy hie is a serious birth. The mode of cell death includes necrosis and apoptosis. In the previous section, we talked about the symptoms of hypoxicischemic encephalopathy, or hie. Outcome and prognosis of hypoxic brain damage patients. Cell therapy for neonatal hypoxicischemic encephalopathy. Because of differences in brain maturity at time of insult, severity of hypotension, and duration. The newborns body can compensate for brief periods. 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.
Hypoxic ischemic encephalopathy hie is a serious birth complication affecting fullterm infants. In this section, we will continue with a discussion on how hie is diagnosed. Jan, 2020 hypoxic ischemic encephalopathy hie is a type of brain damage that occurs when an infants brain doesnt receive enough oxygen and blood. 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. This can happen in a variety of ways prior to birth, during the birth process, after birth, and during childhood. Hypoxic ischemic encephalopathy hie birth injury guide. Associate clinical professor, university of the philippines college of medicine, manila, philippines assistant research professor, institute of child health and human development, manila, philippines. 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. 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. Hypoxicischemic encephalopathy hie occurs in 1 to 8 per live births in developed countries.
Ne is a heterogenous condition which may result from prematurity, genetic, infectious and. 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. Hypoxic ischemic encephalopathy an overview sciencedirect. Hypoxicischemic encephalopathy, or hie, is the brain injury caused by oxygen deprivation to the brain, also commonly known as intrapartum asphyxia. 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. For a discussion of neonatal hypoxia, refer to neonatal hypoxic ischemic encephalopathy. Mild hypothermia as a treatment for hie is commonly used to treat. 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. Mar 15, 2010 neonatal hypoxicischemic encephalopathy hie is a common cause of longterm neurological disability in children.
An apgar score of less than 5 at 5 minutes and 10 minutes may indicate. Despite major advances in monitoring technology and knowledge of fetal and neonatal pathologies, perinatal asphyxia or, more appropriately, hypoxicischemic encephalopathy hie. Hypoxic ischemic encephalopathy hie is one of the most serious birth complications affecting full term infants. Pathophysiology of perinatal hypoxicischemic encephalopathy. Hypoxicischemic injury leads to a biphasic pattern of encephalopathy and neuronal cell death. 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. 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. 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. Necrosis occurs in conditions of primary energy failure following the initial injury. Hypoxicischaemic encephalopathy hie c linical guideline education presentation e16. Hypoxicischemic encephalopathy hie is one of the most important diseases in perinatal medicine.
Hypoxic ischemic encephalopathy hie occurs in 1 to 8 per live births in developed countries. Despite advances in supportive care, no treatments for hie are available at present. Pathophysiology historically, neonatal encephalopathy was thought to result exclusively from a hypoxic incident, hence the name hie. Hie, the pathophysiological processes leading to cerebral injury, and current attempts at. Variable injuries can occur with purely hypoxic or histotoxic insults such as asphyxiation and carbon monoxide.
Historically, the clinician has had little to offer neonates with hie other than systemic. Hypoxic ischemic encephalopathy hie is a syndrome affecting the central nervous system and presenting in term and near. However, important developmental norms have to be taken into an account when describing the pathophysiology of perinatal hypoxic ischemic encephalopathy. 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. Hypoxic ischemic encephalopathy hie is one of the most important diseases in perinatal medicine. Clinical pathophysiology of hypoxic ischemic brain injury. Hie is the result of severe systemic oxygen deprivation and reduced cerebral blood flow, commonly occurring in fullterm infants. The pathophysiology of hibi encompasses a heterogeneous cascade that culminates in secondary brain injury and neuronal cell death. Hypoxic ischemic brain injury hibi after cardiac arrest ca is a leading cause of mortality and longterm neurologic disability in survivors. A 20 years conundrum of neonatal encephalopathy and. What is hie hope for hie hypoxic ischemic encephalopathy. The pathophysiology of hie is now better understood, and treatment with hypothermia has become the foundation of therapy. Pathophysiology and pathology of neonatal hypoxicischemic.
Hypoxicischemic encephalopathy hie is a type of newborn brain damage caused by oxygen deprivation and limited blood flow. This is a pdf file of an unedited manuscript that has been. Patton, md diffuse hypoxicischemic brain injury in the neonate results in neonatal hypoxicischemic. Pathophysiology features neonatal hypoxic ischemic encephalopathy. 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. 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. Sep 01, 2011 hypoxic ischemic encephalopathy hie is a serious birth complication affecting full term infants. True hypoxic ischemic encephalopathy can occur during events such as prolonged umbilical cord compression, birth asphyxia from prolonged stage 2 labor and cardiopulmonary failure. 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. Encephalopathy due to hypoxicischemic injury hypoxicischemic encephalopathy hie is defined as brain injury caused by the combination of inadequate. If you continue browsing the site, you agree to the use of cookies on this website. 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. Pathophysiology and experimental treatments hypoxic ischemic encephalopathy hie is.
379 14 945 1016 972 257 499 1397 495 691 467 487 389 1038 348 1200 200 1096 256 137 1381 1532 1132 7 268 5 1046 951 759 85 347 728 154 1575 1294 1613 186 1095 320 274 1378 1018 809 15 677 951 820 584