HIE is a brain injury caused by lack of adequate blood flow and oxygen to the infant's brain before, during, or after birth. It is diagnosed based on neurological findings in the first days and has no clear diagnostic test. Management involves preventing further injury by maintaining physiological functions and treating seizures. Outcomes range from full recovery to brain death, with presence of seizures or poor head growth indicating a poorer prognosis.

1. Approach to a case of Hypoxic
ischemic encephalopathy (HIE)
• Soumya Ranjan Parida

2. DEFINITION
• HIE is a brain injury that prevents adequate
blood flow to the infant’s brain occurring as a
result of a hypoxic-ischemic event during the
prenatal, intrapartum or postnatal period.

3. • The two working definitions of the National Neonatal and
Perinatal Database network
• Birth asphyxia: Apgar score of less than 7 at one minute of age
• Moderate asphyxia: Apgar score between 4 to 6 at one
minute of age or slow gasping breathing at one minute of age
• Severe asphyxia: Apgar score of 3 or less at one minute of age
or no breathing at one minute of age. T
• It occurs in 1.5 to 2.5 per 1000 live births in developed
countries

4. PATHOPHYSIOLOGY

6. SIGNS STAGE 1 STAGE 2 STAGE 3
LEVEL OF
CONSCIOUSNESS
ALERT LETHARGY COMA
MUCLE TONE NORMAL HYPOTONIC FLACCID
TENDON REFLEXES INCREASED INCREASED DEPRESSED
MYOCLONUS PRESENT PRESENT ABSENT
SEIZURES ABSENT FREQUENT FREQUENT
PUPILS MYDRIASIS MIOSIS UNEQUAL,POOR
LIGHT REFLEX
MORO REFLEX STRONG WEAK ABSENT
EEG NORMAL LOW VOLTAGE
CHANGING TO
SEIZUREACTIVITY
BURST SUPPRESSION
TO ISOELECTRIC
RESPIRATIONS REGULAR PERIODIC APNEEIC
HEART RATE NORMALOR
TACHYCARDIA
BRADYCARIA BRADYCARDIA

10. NEUOROIMAGING
• CRANIAL ULTRASOUND:ECHOGENICITY
DEVELOPS OVER DAYS
• CT SCAN:LESS SENSITIVE THEN MRI FOR
CHANGES IN CENTRAL GREY NUCLEI
• MRI: MOST APPROPRIATE TECHNIQUE AND
SHOWS DIFFERENT PATTERN OF INJURY

12. MANAGEMENT
• PREVENTION,PREVENTION AND PREVENTION
• INSURE PHYSIOLOGICAL OXYGEN AND ACID
BASE BALANCE
• MAINTAIN ENVIRONMENTAL TEMPERATURE
AND HUMIDITY
• CORRECT CALORIE,FLUID AND ELECTROLYTE
BALANCE
• MAINTAIN BLOOD VOLUME AND HEMOSTASIS

13. • TREAT INFECTION
• SEIZURE CONTROLLED BY PHENOBARBITONE
AND LORAZEPAM
• HYPOTHERMIA

14. NEWER MODALITIES OF TREATMENT
STRATERGIES INTERVENTION
DECREASE CEREBRAL METABOLIC RATE HYPOTHERMIA
PREVENT FREE RADICAL FORMATION IRON CHELATORS,INDOMETHACIN
DECREASE GLUTAMATE RELEASE ADENOSINE

16. FURTHER OUTPATIENT CARE
• GOAL-TO DETECT IMPAIRMENT AND
PROMOTE EARLY INTERVENTION
• HEAD CIRCUMFERENCE
• ABNORMAL NEUROLOGICAL FINDINGS
BEYOND 7 DAYS-POOR PROGNOSIS

18. DIAGNOSIS
• THERE IS NO CLEAR DIAGNOSTIC TEST FOR
HIE
• NEUR0LOGICAL FINDINGS-WITHIN FIRST DAYS
• IS THE SINGLE MOST USEFUL PREDICTOR

19. BRAIN DEATH AFTER HIE
• CLINICAL FINDINGS UNRESPONSIVE TO
PAIN,AUDITORY AND VISUAL STIMULATION
• APNEA WITH PCO2 RISING FROM 40 TO 060
MMHG WITHOUT VENTILATORY SUPPORT
• ABSENT BRAINSTEM REFLEXES

20. PROGNOSIS
• LACK OF SPONTANEOUS RESPIRATORY EFFORT
WITHIN 20-30 MIN-DEATH
• PRESENCE 0F SEIZURES-POOR PROGNOSIS
• POOR HEAD GROWTH DURING FIRST YEAR IS
A SENSITIVE FINDING

21. THANKS