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It is the term used to designate the clinical and

neuropathological findings of an encephalopathy that occursin a full term infant who has experienced a significant

episodeof intrapartum asphyxia.

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Hypoxia/anoxia: denotes apartial or complete lack of

oxygen, respectively, in one or more tissues of the body,

including the blood stream.

Ischemia: is a reduction in or cessation of blood flowthatarises from either systemic hypotension, cardiac arrest, or

occlusive vascular disease.

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Asphyxia: is the state in whichpulmonary orplacental gas exchange is affectedleading to

progressive hypoxemia, which is severe enough to be

associated with acidosis.

-Metabolic acidosis / mixed acidemia (PH 5 minutes

-Neurologic manifestations-Multy organ disfucntion

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2% in full term and 60% in LBW

20-50% die in newborn period

Of survivors 25% have permanent handicap

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Maternal

Cardiac arrest

severe anaphylaxis

status epilepticus, and

hypovolemic shock

Uteroplacental

Placental

abruption

cord prolapse

uterine rupturehyperstimulation

Fetal

Fetomaternal hemorrhage,

severe isoimmune hemolytic disease,cardiac arrhythmia

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HIE sequence=Primary Energy Failure. Hypoxemia and Hypercarbia. Decreased brain perfusion (Ischemia) Acidosis and hypoxemia further impair cerebral autoregulation = pressure passive system and perfusion pressures fall.

Oxidativeanaerobic metabolism which requires more glucose.

Increased lactic acid and increased hydrogen ions. Tissue acidosis

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Depressed on initial assessment Generalized hypotonia Apgars 3 or less @ 5min Major resuscitation required Large base deficit by blood gas Poor feeding to deep coma (ecephalopathic)

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Score at 1, 5 minutes does not give prognosis indicator

The longer the score remains lower, the greater itssignificance

0-3 @ 1minhas mortality of 5-10% may be increased to 53% if at 20min apgars score 0-3 0-3 @ 5min, CP risk app. 1%

may be increased to 9%if for 15min

dramatic rise to 57% CP risk if for 20min

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Staging system of Sarnat and Sarnat Means of recording severity of insult to brain, to

initiate med management and to predict ultimateprognosis

Infants occasionally sustain insult to brain arising

from complication of systemic disease Seizures in 50-70%

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Mild : Hyperalertness, uninhibited reflexes,sympathetic overactivity , duration < 24 hrs

Moderate: Lethargy-stupor, hypotonia,suppressed primitive reflexes, seizures

Severe : Coma, flaccid tone, suppressedbrainstem function, seizures, increased ICP

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Stage 1 invariably recover without neurologicaldeficit

Stage 2 later develop normally if clinical and EEGabnormalities are fully reversed in 5 days of birth

Stage 3 encephalopathy is associated with a highmortality(50%) and universal neurologicalmorbidity among the survivors.

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Prevention, prevention, prevention Insure physiological oxygen and acid-base balance Maintain environmental temp and humidity

Correct caloric, fluid and electrolyte disturbances Maintain blood volume and hemostasis Treat infection Treat seizure

Phenobarbital 20 mg/kgs, maintenance 3-5 mg/kgs/d Phenitoin 20 mg/kgs, maintenance 5-10mg/kgs/d

No other intervention (corticosteroid, Phenobarbitalprophylaxis, furosemid, etc)

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Indicator for bad prognosis: Metabolic academia Apgar score < 3 for 20 minutes Time to catch spontaneous breathing were to

long Neurologic abnormality > 5 days Cranial USG leukomalacia periventricular or

hemorrhage

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