hypoxic-ischemic encephalopathy (hei)
TRANSCRIPT
8/8/2019 Hypoxic-Ischemic Encephalopathy (HEI)
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-Hypoxic is the lack of oxygen to the brain
-Ischemic is a decrease in the blood supply to a bodily organ
-Encephalopathy is brain and nervous system damage
-HEI is a condition in which there is brain or nervoussystem damage due to the lack of oxygen going to the
brain.
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Frequencyy - HIE will affect 1-8/1000 births in the US and most
technologically advanced countries.
y - Internationally birth asphyxia is the cause of 23% of neonatal
deaths.y - one of top 20 leading causes of burden of disease in all age
groups
y - 5th largest cause of death of children under 5 years of age (8%)
y - estimated to account for 920,000 neonatal deaths per year and
associated with another 1.1 million intrapartum stillbirthsy - more than a million children who survive will develop cerebral
palsy, mental retardation, learning disabilities along with otherdisabilities
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Causesy - injury or complication during birthy - respiratory failurey - blocked or ruptured blood vessely
- drug overdosey - drowningy - lack of oxygen due to smoke inhalationy - extremely low blood pressurey - strangulationy - cardiac arresty - carbon monoxide poisoningy - high altitudesy - chokingy - compression or injury to the trachea that reduces or stops breathingy - complications from general anesthesia
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Risk Factorsy A ny injury or condition that causes the brain to have a
reduction in blood flow or oxygen.
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Symptomsy - difficulty concentrating or paying attention
y - poor judgment
y
- poor coordinationy - euphoria
y - extreme lethargy
y - severe oxygen deprivation
y - seizuresy -coma
y - no brain stem reflexes (breathing, responding tolight)
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Physical symptoms in Inf antsy Mild hypoxic-ischemic encephalopathy
y - Muscle tone may be slightly increased and deep
tendon reflexes may be brisk during the first few days.y - Transient behavioral abnormalities, such as poor
feeding, irritability, or excessive crying or sleepiness,may be observed.
y - The neurologic examination findings normalize by 3-4 days of life.
y
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Conty Moderately severe hypoxic-ischemic encephalopathy y - The infant is lethargic, with significant hypotonia and
diminished deep tendon reflexes.y
- The grasping,Moro, and sucking reflexes may be sluggish orabsent.y - The infant may experience occasional periods of apnea.y - Seizures may occur within the first 24 hours of life.y - Full recovery within 1-2 weeks is possible and is associated with
a better long-term outcome.y - A n initial period of well-being or mild hypoxic-ischemic
encephalopathy may be followed by sudden deterioration,suggesting ongoing brain cell dysfunction, injury, and death;during this period, seizure intensity might increase.
y
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Conty Severe hypoxic-ischemic encephalopathy y - Stupor or coma is typical. The infant may not respond to any physical stimulus.y - Breathing may be irregular, and the infant often requires ventilatory support.y - Generalized hypotoniaand depressed deep tendon reflexes are common.y
- Neonatal reflexes (eg, sucking, swallowing, grasping,M
oro) are absent.y - Disturbances of ocular motion, such as a skewed deviation of the eyes, nystagmus,
bobbing, and loss of "doll's eye" (ie, conjugate) movements may be revealed by cranialnerve examination.
y - Pupils may be dilated, fixed, or poorly reactive to light.y - Seizures occur early and often and may be initially resistant to conventional treatments.y - Irregularities of heart rate and blood pressure (BP) are common during the period of
reperfusion injury, as is death from cardiorespiratory failure.y
y Infants who survive severe hypoxic-ischemic encephalopathy y - The level of alertness improves by days 4-5 of life.y - Hypotonia and feeding difficulties persist, requiring tube feeding for weeks to months.
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Diagnosisy - CT Scan
y - MR I Scan
y - EKGy - Echocardiogram
y - Blood Tests
y - EEG
y - Ultrasound
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Diagnosis in Inf antsy For infants the guidelines from AA P in 1996 all of the
following must be present for the designation of perinatalasphyxia severe enough to result in acute neurological
injury y - profound metabolic or mixed academia (pH < 7) in
an umbilical artery blood sample
y - persistence of an A pgar score of 0-3 for longer than 5minutes
y - neonatal neurologic sequelae ( seizures, coma,hyptonia)
y - multiple organ involvement (kidneys, lungs, liver,heart, intestines)
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Treatmenty There is no cure
y - Life-sustaining treatment
y - mechanical ventilationy - treatments for circulatory system
y - seizure control
y - cooling
y - hyperbaric oxygen treatment
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The cooling process
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Cooling Cap
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Two Recent Trials of inf antswith
moderate to severe HEIy 23-27% of infants died prior to dischargey Mortality rate at 18-22 months was 37-38%.y These are the neurodevelopmental outcomes at 18 months
y Mental development index (MDI)y Score of 85 or higher - 40%y Score of 70-84 - 21%y Score less than 70 - 39%
y Psychomotor development index (PDI)y Score of 85 or higher - 55%y
Score of 70-84 - 10%y Score less than 70 - 35-41%
y Disabling cerebral palsy - 30%y Epilepsy - 16%y Blindness - 14-17%y Severe hearing impairment - 6%
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Preventiony There is no prevention
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Q uick and General Overviewy General Overview
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Referencesy http://www.med.nyu.edu/patientcare/library/article.html?ChunkIID=230598
y
y http://emedicine.medscape.com/article/973501-overview
y
y http://www.medterms.com/script/main/art.asp?articlekey=3875