Neonatal encephalopathy

Neonatal encephalopathy
Other namesHypoxic and ischemic brain injury in the newborn, perinatal asphyxia, neonatal hypoxic and ischemic brain injury
SpecialtyPediatrics 
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Neonatal encephalopathy (NE), also known as neonatal hypoxic-ischemic encephalopathy (neonatal HIE or NHIE), is defined by signs and symptoms of abnormal neurological function in the first few days of life in an infant born at term.[1] In this condition there is difficulty initiating and maintaining respirations, a subnormal level of consciousness, and associated depression of tone, reflexes, and possibly seizures.[2] Encephalopathy is a nonspecific response of the brain to injury which may occur via multiple methods, but is commonly caused by birth asphyxia, leading to cerebral hypoxia.[1][2]

Signs and symptoms

In neonates born at or beyond 35 weeks, neonatal encephalopathy may present itself as the following symptoms:

  • Reduced level of consciousness
  • Seizures (which peak at 48 hours)
  • Difficulty initiating and maintaining respiration
  • Depression of tone and reflexes[3]

Diagnosis

Cord blood gas analysis can be used to determine if there is perinatal hypoxia/asphyxia, which are potential causes of hypoxic-ischemic encephalopathy or cerebral palsy, and give insight into causes of intrapartum fetal distress.[4] Cord blood gas analysis is indicated for high-risk pregnancies, in cases where C-sections occurred due to fetal compromise, if there were abnormal fetal heart rate patterns, Apgar scores of 3 or lower, intrapartum fever, or multifetal gestation.

Evidence of brain injury related to the hypoxic-ischemic events that cause neonatal encephalopathy can be seen with brain MRIs, CTs, magnetic resonance spectroscopy imaging or ultrasounds.[5][6]

Neonatal encephalopathy may be assessed using Sarnat staging.

Treatment

In the past, treatment options were limited to supportive medical therapy.[7] Currently, neonatal encephalopathy is treated using hypothermia therapy.[8] This has been shown to reduce brain damage, reduce future disability, and improve survival.[9] Hypothermia therapy is also sometimes termed hypothermic neural rescue therapy. Clinical trials are taking place to investigate the effectiveness of stem cell-based interventions, which are thought to have the potential to reduce mortality and improve the long-term development of newborn infants with neonatal encephalopathy.[10]

Prognosis

HIE is a major predictor of neurodevelopmental disability in term infants. 25 percent have permanent neurological deficits.[11]

It can result in developmental delay or periventricular leukomalacia.

Epidemiology

Overall, the relative incidence of neonatal encephalopathy is estimated to be between 2 and 9 per 1000 term births.[3] 40% to 60% of affected infants die by 2 years old or have severe disabilities.[7] In 2013 it was estimated to have resulted in 644,000 deaths down from 874,000 deaths in 1990.[12]

References

  1. 1 2 "Neonatal Encephalopathy". adhb.govt.nz. Retrieved 7 March 2015.
  2. 1 2 Neurology. Perlman, Jeffrey M., Polin, Richard A. (Richard Alan), 1945-. Philadelphia: Saunders/Elsevier. 2008. ISBN 9781416031574. OCLC 489075193.{{cite book}}: CS1 maint: others (link)
  3. 1 2 "Clinical features, diagnosis, and treatment of neonatal encephalopathy". www.uptodate.com. Retrieved 2016-03-24.
  4. ↑ Armstrong, L; Stenson, BJ (November 2007). "Use of umbilical cord blood gas analysis in the assessment of the newborn". Archives of Disease in Childhood: Fetal and Neonatal Edition. 92 (6): F430–4. doi:10.1136/adc.2006.099846. PMC 2675384. PMID 17951550.
  5. ↑ Pediatrics, American Academy of (2014-05-01). "Neonatal Encephalopathy and Neurologic Outcome, Second EditionReport of the American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy". Pediatrics. 133 (5): e1482–e1488. doi:10.1542/peds.2014-0724. ISSN 0031-4005.
  6. ↑ "Identifying HIE: Diagnostic Tests and Medical Evaluations". HIE Help Center. Retrieved 2017-11-16.
  7. 1 2 Allen, Kimberly A.; Brandon, Debra H. (2011-09-01). "Hypoxic Ischemic Encephalopathy: Pathophysiology and Experimental Treatments". Newborn and Infant Nursing Reviews. Neuroprotective Strategies. 11 (3): 125–133. doi:10.1053/j.nainr.2011.07.004. PMC 3171747. PMID 21927583.
  8. ↑ Services, c=AU; st=Victoria; o=State Government of Victoria; ou1=Department of Health and Human. "Encephalopathy in neonates: Neonatal ehandbook - Department of Health and Human Services, Victoria, Australia". www.health.vic.gov.au. Retrieved 2016-03-24.
  9. ↑ Jacobs, Susan E.; Berg, Marie; Hunt, Rod; Tarnow-Mordi, William O.; Inder, Terrie E.; Davis, Peter G. (2013-01-31). "Cooling for newborns with hypoxic ischaemic encephalopathy". The Cochrane Database of Systematic Reviews (1): CD003311. doi:10.1002/14651858.CD003311.pub3. ISSN 1469-493X. PMC 7003568. PMID 23440789.
  10. ↑ Bruschettini, M; Romantsik, O; Moreira, A; Ley, D; Thébaud, B (19 August 2020). "Stem cell-based interventions for the prevention of morbidity and mortality following hypoxic-ischaemic encephalopathy in newborn infants". The Cochrane Database of Systematic Reviews. 8: CD013202. doi:10.1002/14651858.CD013202.pub2. PMC 7438027. PMID 32813884.
  11. ↑ Graham, Ernest M.; Ruis, Kristy A.; Hartman, Adam L.; Northington, Frances J.; Fox, Harold E. (December 2008). "A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy". American Journal of Obstetrics and Gynecology. 199 (6): 587–595. doi:10.1016/j.ajog.2008.06.094. PMID 19084096.
  12. ↑ GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442. {{cite journal}}: |first1= has generic name (help)
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