Hypoxic-Ischemic Encephalopathy Medication

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

Providing standard intensive care support, correcting metabolic acidosis, close monitoring of the fluid status, and seizure control are the main elements of treatment in patients with hypoxic-ischemic encephalopathy (HIE). Anticonvulsants are the only specific drugs used often in this condition.

Treat seizures early and control them as fully as possible, including electrographic (EEG)-only seizures (ie, seen only on EEG). 



Class Summary

These agents are used to control seizures.

Phenobarbital (Luminal)

Often used as a first-line agent for clinical and electrographic-only neonatal seizures. The duration of therapy will vary depending on both the EEG findings and clinical status. In most cases, can be weaned and stopped prior to NICU discharge; however, treatment may need to be continued for several months in infants with persistent neurologic abnormalities and clinical or EEG evidence of seizures. 

Phenytoin (Dilantin)

Can be used in infants with refractory seizures that do not respond to phenobarbital, levetiracetam, or lorazepam. Oral absorption is negligible for the first several months of life.

Lorazepam (Ativan)

Indicated for acute control of seizures refractory to phenobarbital.

By increasing the action of GABA, which is a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation.


Anticonvulsants, Other

Levetiracetam (Keppra, Keppra XR, Spritam)

May be used as a first- or second-line agent in infants with seizures.


Anxiolytics, Benzodiazepines

Midazolam (Versed)

Can be used as a drip for infants with status epilepticus.


Cardiovascular (Inotropic) Agents

Class Summary

These agents increase blood pressure (BP) and combat shock. Drugs in this category act primarily by increasing systemic vascular resistance, cardiac contractility, and stroke volume, thus increasing cardiac output.

Most inotropic agents also have dose and gestational age-dependent effects on vessels, particularly those of the renal and GI systems. For the most part, these effects are beneficial but, at higher doses, the systemic side effects may be unpredictable.

In experimental animals, cerebral blood flow (CBF) is unaffected by these drugs when used in recommended therapeutic doses. However, no clear information is available on the effects of these drugs on CBF in neonates.

Dopamine (Intropin)

Stimulates both adrenergic and dopaminergic receptors. Hemodynamic effect is dependent on the dose. Lower doses predominantly stimulate dopaminergic receptors that in turn produce renal and mesenteric vasodilation. Cardiac stimulation and renal vasodilation produced by higher doses.

Dobutamine (Dobutrex)

Second inotropic DOC, preferred by some as first choice in severe cardiogenic shock.

Produces vasodilation and increases inotropic state. At higher dosages may cause increased heart rate, exacerbating myocardial ischemia.