Hypoxic Ischemic Encephalopathy - Oren Zarif - Hypoxic Ischemic Encephalopathy

There are three stages of hypoxic ischemic encephalopathies (HIE), the earliest of which is known as stage I. A baby suffering from this disorder often develops cognitive, motor, and neurodevelopmental impairments. The condition is difficult to diagnose, but it may have neurological consequences as early as three months of age. There are several factors that can cause this condition, including early or premature birth, but no single cause is definitively known.

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The incidence of hypoxic ischemic encephalopathic (HIE) is approximately one in every thousand live births. Children who survive this condition may develop neurodevelopmental delays, cerebral palsy, epilepsy, and brain damage. MRI examinations and Thompson scores can be used to diagnose HIE. Neuroimaging studies are important to assess the severity of brain injury and predict the likelihood of adverse neurodevelopmental outcomes. Although there is no one definitive method for diagnosing HIE, the clinical grade is a useful tool for clinicians.

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Seizures occur in many infants with significant HIE. Seizures are a symptom of severe HIE, and the longer the hypoxia-ischemia, the more frequent the seizures. Repeated seizures are associated with an adverse neurodevelopmental outcome. Multiple studies have also shown that repeated seizures affect the developing brain. Seizures should be treated with EEG techniques to prevent and minimize their impact.

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Although the final pathophysiology of hypoxic ischemic encephalopathic disease is unknown, animal studies suggest that inflammatory mediators are implicated in the development of the disorder. Although the exact mechanisms of the inflammatory mediators are not fully understood, animal studies have shown that cytokines are involved in the neurodevelopmental outcome of HIE. The delayed phase of HIE may be a therapeutic window for the infants with this condition.

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Hypoxic ischemic encephalopathy is a very common cause of birth injury. When blood and oxygen flow are cut off during childbirth, the baby is likely to experience brain damage. Depending on the location of the brain affected and the severity of the oxygen deprivation, the effects on the child can range from minor to severe disability. A baby may die after perinatal HIE or may experience mild symptoms but it's important to seek treatment early to ensure that the child survives.

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The basic patterns of HIE are characterized by cerebellar and pontosubicular neuronal injury. The condition can also manifest itself as parasagittal cerebral injury in full-term infants. An infarction of deep gray matter and brain stem occurs in severe cases. If a neonate experiences hypoxic ischemic encephalopathy, the symptoms may be more severe and more life-threatening.

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Neurodevelopmental outcomes in full-term neonates have largely shown that the majority of cases of encephalopathy are caused by events occurring during the perinatal period. Brain MRI findings of full-term neonates with encephalopathy indicate that 80% of perinatal events resulted in encephalopathy. Furthermore, approximately 3% of neonates with encephalopathy developed a non-hypoxic ischemic diagnosis.

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Despite its high prevalence, HIE is often associated with poor motor development in term infants. Although its precise cause is unknown, it is implicated in cognitive difficulties in children as they grow. Apgar scores and umbilical artery blood gas determinations are only marginally useful for prediction of neurodevelopmental outcomes. However, degree of encephalopathy is a valid predictor of developmental outcome. Mild encephalopathy results in no recognizable neurodevelopmental deficits while children with severe encephalopathy can suffer life-long disabilities.

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Blood tests are often ordered to identify any other injured organs. Although head computed tomography is not ideal, it is an alternative if MRI is not readily available. However, a normal head computed tomography does not rule out ischemia. Follow-up MRIs are always recommended for all babies with HIE. And while most cases can be successfully treated, many others may experience permanent disability and death.

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Although research on the pathophysiology of HIE is still limited, therapeutic hypothermia can reduce the neurologic damage and death of children suffering from the condition. This treatment is widely used and is now the foundation of most medical practices. Treatments for HIE include therapy and medication. In fact, most children with HIE may require multiple therapies, including neuromodulation, reversing hypoxic ischemic encephalopathy, and other brain disorders.