Hypoxic-Ischemic Encephalopathy Differential Diagnoses

Updated: Jul 18, 2018
  • Author: Santina A Zanelli, MD; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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DDx

Diagnostic Considerations

Important considerations

Birth asphyxia, birth injury, and perinatal asphyxia are terms often used incorrectly to describe hypoxic-ischemic encephalopathy (HIE).

A birth injury is a condition in which fetal or neonatal injury has occurred during the process of birth (ie, during the first and second stages of labor). Examples include brachial plexus injury; fracture of the clavicle; forceps-induced damage to the facial nerve or soft tissues; and cuts or bruises from scissors, clips, or scalp monitors.

Birth asphyxia is similar to birth injury in that asphyxia occurs during the first and second stages of labor when the fetus was otherwise normal.

Perinatal asphyxia signifies that asphyxia occurred around the time of delivery of a newborn baby.

The American Academy of Pediatrics (AAP) and American College of Obstetrics and Gynecology (ACOG) recommend using HIE because this term accurately describes the clinical condition, encephalopathy from asphyxia, without implying the time of brain injury. The AAP and ACOG also advise not using the terms perinatal asphyxia or birth asphyxia because it is difficult to identify the time of brain injury and nearly impossible to ascertain that the brain had been "normal" before such injury.

All professional societies encourage accurate recording of objective information in the medical records, including maternal and neonatal history and the clinical and laboratory findings.

The findings from brain imaging procedures and EEG help in the total assessment of the infant's clinical status.

No diagnostic tests conclusively prove that a given magnitude of asphyxia has led to a specific neurologic injury. Acute perinatal and intrapartum events have been found only in about 20% of children diagnosed as having cerebral palsy.

Counseling the parents with available information and explanations about their infant's clinical status and the prognosis is always recommended.

Other problems to be considered

Several inborn errors of metabolism can present in the neonatal period (usually not present at birth) with features similar to HIE. [38] Those include the following:

  • Nonketotic hyperglycinemia

  • Disorders of pyruvate metabolism

  • Urea cycle defects

  • Zellweger syndrome

  • Mitochondrial disorders

Other diagnoses should also be included in the differential diagnosis, including the following:

  • Neuromuscular disorders including neonatal myopathies

  • Brain tumors

  • Developmental defects

  • Infections

  • Sulphite oxidase deficiency [39]

Differential Diagnoses