Hypoxic Ischemic Encephalopathy - Oren Zarif - Hypoxic Ischemic Encephalopathy

Hypoxic ischemic encephalopathy (HIE) is a condition in which the brain does not receive enough oxygen during early life. It can cause other problems in a baby's body, including neurodevelopmental delay, epilepsy, motor impairment, and cognitive impairment. While asphyxia was long believed to be the cause of the condition, other factors, such as premature birth or complications during delivery, can also lead to this neurological disorder. Until now, there is still no definitive way to determine the cause of the condition.

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The final stages of hypoxic ischemic encephalopathies are similar regardless of the type of instigating event. This includes apoptosis and necrosis. Necrosis occurs when cells fail to absorb oxygen from the blood and swell. The resulting inflammation causes further damage to the brain's white matter, forming scar tissue. Apoptosis, on the other hand, occurs when cells undergo programmed death. This process occurs several days after the initial insult. Regardless of the type of insult, both necrosis and apoptosis decrease brain function.

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Seizures are common in infants with significant HIE. Repetitive seizures are a defining feature of severe and moderate HIE. The more severe the hypoxia-ischemia, the more likely the child is to experience seizures. Seizures are also linked to adverse neurodevelopmental outcomes. Many studies have demonstrated that repeated seizures in infants are detrimental for brain development. Thus, seizures should be managed by EEG techniques.

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Treatment for HIE should be tailored to the patient's age and severity. The timing of the injury is critical. While treatments for moderate to severe HIE often work in infants, many children fail to benefit from the treatments. The most effective treatment is therapeutic hypothermia, which is a proven solution for severe cases of HIE. The timing of the injury is crucial to prevent any further damage. So, when is the best time to administer TH for hypoxic ischemic encephalopathy?

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When a baby experiences severe hypoxic ischemia, their brains may not receive the proper oxygen they need to survive. This may lead to brain damage, coma, and even death. If left untreated, children may develop permanent conditions, including Cerebral palsy. However, mild cases can go away without treatment, but should be treated immediately to prevent permanent effects. The cause of HIE is not clear and the symptoms can last anywhere from a few days to several weeks.

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Cerebellar injury and pontosubicular neuronal damage are the hallmarks of HIE. A full-term infant may have a predominant lesion of the cerebral white matter, including the cerebellum. A few infants exhibit a dominant abnormality. However, perinatal HII of the premature brain has not been studied thoroughly. Furthermore, objective criteria and standardized neurodevelopmental outcome procedures make HIE diagnosis easier to perform.

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While HIE is relatively uncommon (occurs in less than.05 percent of births), it is still the leading cause of infant mortality in the U.S. each year. It is a devastating condition, causing recognizable cognitive and motor impairment in as many as 25 percent of survivors. Some risk factors include birth asphyxia and prolonged reduction of cerebral blood flow (such as during placental abruption and hypotension). However, in most cases, the underlying cause is not known.

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Although the exact cause of HIE is not known, the disease is usually triggered by perinatal events, with only a small percentage of cases being diagnosed with non-hypoxic ischemic encephalopathy. In full-term neonates, brain MRI and autopsy findings show that 80% of cases result from perinatal trauma. Only three percent are diagnosed with a non-hypoxic ischemic condition.

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Treatments for HIE include therapeutic hypothermia, which involves cooling the baby's brain and body to minimize brain swelling. The process slows the cascade effect and limits the release of toxic compounds. When applied promptly, therapeutic hypothermia is often enough to stabilize the brain cells. The treatments for HIE may reduce the severity of brain damage and improve the baby's quality of life. Some studies are currently underway.