Hypoxic Ischemic Encephalopathy in Neonates - Oren Zarif - Hypoxic Ischemic Encephalopathy
Known medically as Hypoxic Ischemic Encephalopathy (HIE), the condition is an acute brain damage caused by prolonged exposure to hypoxia. Its symptoms include cognitive impairment, developmental delay, and motor dysfunction. Its symptoms can be detected when a child is about three to four years old, but if they occur earlier, it may not be a serious condition. Although there is no definitive cause for HIE, the disease has been associated with many serious and permanent medical conditions, including Cerebral Palsy. However, a mild case of HIE can disappear within 24 hours. As with any other complication, the symptoms should be monitored and treated as quickly as possible.
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If symptoms of HIE occur before symptoms start to appear, imaging is recommended by the American Clinical Neurophysiology Society (ACS). MRI is a useful tool in the diagnosis of encephalopathy in neonates. It can identify anatomic areas affected by hypoxia. In addition, it can identify small areas of hemorrhage and detect hypoxic-ischemic injury. In neonates, CT is rarely done because it involves high radiation doses and cannot reliably identify hypoxic ischemic brain injury.
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Hypoxic-ischemic encephalopathy is the result of an infant's brain not receiving sufficient oxygen during the delivery process. It can cause a variety of disabilities, depending on the length of time the baby was without oxygen. The type and degree of disability will vary depending on the areas of the brain that were damaged and the extent of the deprivation. However, if the brain is not receiving enough oxygen, the child may develop any number of permanent disabilities.
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In this case, therapeutic hypothermia was initiated as early as 2 hours after birth. The target temperature was achieved by 2 hours of birth. During the latent period, a large number of cells recovered and there was an opportunity for intervention. The primary stage is characterized by an acute loss of neurons. The secondary phase is characterized by an injury of neuronal fibers in the brain, and the TH was effective in an infant with moderate to severe HIE.
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Seizures are common in children with significant HIE, but not in all. Seizures tend to increase with the severity of the hypoxia-ischemia. Regardless of the severity of the HIE, seizures can negatively impact development. Repeated seizures in children may lead to impaired learning and lower seizure threshold in later life. If the condition is severe enough, treatment should include an EEG to monitor seizures.
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Early diagnosis of Hypoxic Ischemic Encephalopathy (HIE) in newborns is essential. Although the incidence of HIE is relatively small (around one per thousand live births), the neurological consequences of HIE are often severe and irreversible. More than 60% of infants affected by HIE will have some sort of disability. Among the most common complications are cerebral palsy, epilepsy, and mental retardation.
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Optimal neonatal care involves active management of blood pressure and temperature to avoid changes in brain perfusion and passive circulation. Additionally, the presence of transaminitis, hypotension, and coagulopathy can suggest a global hypoxic event. Finally, neonates should be carefully monitored for any signs of abnormal fetal development. Signs include dysmorphic craniofacial features and a single palmar crease, which may indicate a longstanding decrease in fetal movements.
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While HIE is rare, it is a cause of infant mortality in the United States every year. Despite its uncommon incidence, HIE causes permanent damage to the brain and can cause physical disabilities and cognitive impairment. While the exact cause is unknown, certain risk factors may lead to HIE. In addition to severe prematurity, lung and heart disease, infection, and birth asphyxia, the condition may also be the result of a low baby's blood pressure.
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MRI is recommended for all neonates undergoing hypothermia. The findings of MRI will help determine the etiology of the encephalopathy, and the timing of the injury. Therapeutic hypothermia can reduce the severity of damage in the white matter and basal ganglia. Additionally, therapeutic hypothermia may lower the burden of injury in the watershed regions of the brain.
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The earliest diagnosis of HIE may make treatment possible. The application of therapeutic hypothermia to a baby's brain is an excellent way to slow the cascade effect of hypoxia and reduce the child's disability as it grows. The goal is to reduce brain swelling and allow for a baby to recover. This treatment can be effective in some children even with low Apgar scores and severe acidosis.