What is HIE caused by? [2]
intrapartum hypoxia and cerebral ischemia
what are the characteristics of HIE? [3]
- abnormal level of consciousness
- Abnormal tone
- Abnormal primitive reflexes
What are the other causes? [5]
Think of
- Brain malforming
- Haemodynamic instabillity
- Hypoglycemia
- Electrolyte disturbances
- Sepsis
intrapartum fetal hypoxia usually ends up causing?
Think of bilirubin encephalopathy
spastic quadriplegia and dyskinetic cerebral palsy
When does HIE occur?
First 2 days of life
When can therapeutic hypothermia be started?
Think of it as a dangerous and life-threatening situation
Within the first 6 hours of life
How to judge the severity of the encephalopathy
- Metabolic acidosis
- arterial cord with pH < 7
- severe encephalopathy during the first 48 hours of life
When do the signs increase and worsen? Between which hours?
48 hours to 72 hours
What is the Sarnat Stage?
- Irritability, increased tone, poor sucking BUT EXAGGERATED MORO REFLEX
- lethargy, decreased tone and primitive reflexes, seizures
- stupor or coma, flaccid tone, and fewer seizures
What causes the constant damage as the stages go up?
Reperfusion Injury
aEEG diagnoses?
subclinical seizures
Assessment and Management at birth
- ABG
- APGAR SCORE
- check placenta
Respiratory System Management
can develop secondary surfactant deficiency and cerebral ischaemia
Cardiovascular Management
if Hb is less than 10g/dl consider blood transfusion
Fluid balances and electrolytes
SIADH, Intrinsic renal failure, and cerebral odema can occur
restrict fluid to 40 ml/kg/24 hours
if hypoglycemia occurs, how much glucose should be used for transfusion
12 -15%
What is chorioamnionitis associated with?
Think why the amniotic fluid is cloudy?
intrapartum hypoxia
hypothermia or hyperthermia for treatment and for how long
induced hypothermia no later than 6 hours
Prognosis and Follow Up
Grade it with colours
