Hypoxic-Ischemic Encephalopathy Questions & Answers

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

Overview

What causes hypoxic-ischemic encephalopathy (HIE) and how is it characterized?

What are the signs and symptoms of mild hypoxic-ischemic encephalopathy (HIE)?

What are the signs and symptoms of moderately severe hypoxic-ischemic encephalopathy (HIE)?

What are the signs and symptoms of severe hypoxic-ischemic encephalopathy (HIE)?

How is acute neurologic injury recognized in hypoxic-ischemic encephalopathy (HIE)?

Which lab studies are performed in the evaluation for hypoxic-ischemic encephalopathy (HIE)?

Which imaging studies are performed in the evaluation for hypoxic-ischemic encephalopathy (HIE)?

Which exams should be included in the workup of hypoxic-ischemic encephalopathy (HIE)?

What is included in the management of hypoxic-ischemic encephalopathy (HIE)?

What is hypoxic-ischemic encephalopathy (HIE)?

What physiology processes lead to hypoxic-ischemic encephalopathy (HIE)?

What is the pathophysiology of hypoxic-ischemic encephalopathy (HIE)?

What is the pathophysiology of reduced cerebral blood flow (CBF) in hypoxic-ischemic encephalopathy (HIE)?

What determines the magnitude of neuronal injury in hypoxic-ischemic encephalopathy (HIE)?

What is the role of excitatory amino acid (EAA) receptor overactivation in the pathogenesis of hypoxic-ischemic encephalopathy (HIE)?

What is the role of intracellular Ca++ in the pathophysiology of hypoxic-ischemic encephalopathy (HIE)?

What is the role of NMDA receptor activation in the pathophysiology of hypoxic-ischemic encephalopathy (HIE)?

What is the role of cytokines and chemokines in the pathophysiology of hypoxic-ischemic encephalopathy (HIE)?

What is the energy failure phase in the pathophysiology of hypoxic-ischemic encephalopathy (HIE)?

Which factors influence the outcome in hypoxic-ischemic encephalopathy (HIE)?

How frequently does hypoxic-ischemic encephalopathy (HIE) occur in the absence of risk factors?

What is the prevalence of hypoxic-ischemic encephalopathy (HIE) in the US?

What is the global prevalence of hypoxic-ischemic encephalopathy (HIE)?

What is the prognosis of hypoxic-ischemic encephalopathy (HIE)?

What are the long-term sequelae and mortality rate for hypoxic-ischemic encephalopathy (HIE)?

When do the symptoms of hypoxic-ischemic encephalopathy (HIE) first appear?

What are the keys to reassuring parents of infants with hypoxic-ischemic encephalopathy (HIE) who are undergoing hypothermia treatment?

Presentation

Which clinical history findings indicate hypoxic-ischemic encephalopathy (HIE)?

What determines the CNS manifestation of hypoxic-ischemic encephalopathy (HIE)?

What are the physical findings characteristic of mild hypoxic-ischemic encephalopathy (HIE)?

What are the physical findings characteristic of moderately severe hypoxic-ischemic encephalopathy (HIE)?

What are the physical findings characteristic of severe hypoxic-ischemic encephalopathy (HIE)?

What are physical findings in infants who survive severe hypoxic-ischemic encephalopathy (HIE)?

What are physical findings characteristic of multiorgan dysfunction in hypoxic-ischemic encephalopathy (HIE)?

Which cranial nerve findings are characteristic of hypoxic-ischemic encephalopathy (HIE)?

What is included in a motor function exam for hypoxic-ischemic encephalopathy (HIE), and what are the typical findings?

How do motor function findings vary in hypoxic-ischemic encephalopathy (HIE) based on location of lesions?

What are motor function findings in the extremities characteristic of hypoxic-ischemic encephalopathy (HIE)?

How is a tonic neck reflex performed in the evaluation of hypoxic-ischemic encephalopathy (HIE)?

What does a finding of spasticity indicate in the evaluation of hypoxic-ischemic encephalopathy (HIE)?

How is muscle tone assessed in the evaluation of hypoxic-ischemic encephalopathy (HIE)?

Which physical findings indicate CNS dysfunction in hypoxic-ischemic encephalopathy (HIE)?

How are seizures diagnosed in hypoxic-ischemic encephalopathy (HIE)?

What are the Sarnat clinical stages of hypoxic-ischemic encephalopathy (HIE)?

DDX

Why do the American Academy of Pediatrics (AAP) and American College of Obstetrics and Gynecology (ACOG) advise against use of the terms perinatal asphyxia or birth asphyxia?

Which inborn errors of metabolism should be included in the differential diagnoses for hypoxic-ischemic encephalopathy (HIE)?

Which conditions should be included in the differential diagnoses of hypoxic-ischemic encephalopathy (HIE)?

What are the differential diagnoses for Hypoxic-Ischemic Encephalopathy?

Workup

What is the focus of the diagnostic workup for hypoxic-ischemic encephalopathy (HIE)?

What is the role of lab studies in the workup of hypoxic-ischemic encephalopathy (HIE)?

What is the role of serum electrolyte measurement in the workup of hypoxic-ischemic encephalopathy (HIE)?

What is the role of a cardiac enzymatic study in the workup of hypoxic-ischemic encephalopathy (HIE)?

Which renal function studies are performed in the workup of hypoxic-ischemic encephalopathy (HIE)?

What is the role of liver enzymes in the workup of hypoxic-ischemic encephalopathy (HIE)?

Which coagulation studies are performed in the workup of hypoxic-ischemic encephalopathy (HIE)?

What is the role of arterial blood gas (ABG) monitoring in the workup of hypoxic-ischemic encephalopathy (HIE)?

What is the role of MRI in the workup of hypoxic-ischemic encephalopathy (HIE)?

What findings on MRI are characteristic of hypoxic-ischemic encephalopathy (HIE)?

What is the role of diffusion-weighted imaging (DWI) in the workup of hypoxic-ischemic encephalopathy (HIE)?

What is the role of MRI in determining the prognosis of hypoxic-ischemic encephalopathy (HIE)?

What is the role of magnetic resonance spectroscopy (MRS) in the workup of hypoxic-ischemic encephalopathy (HIE)?

What is the role of cranial ultrasonography in the workup of hypoxic-ischemic encephalopathy (HIE)?

What is the role of CT scanning in the workup of hypoxic-ischemic encephalopathy (HIE)?

What is the role of echocardiography in the workup of hypoxic-ischemic encephalopathy (HIE)?

What is the role of amplitude-integrated electroencephalography (aEEG) in the workup of hypoxic-ischemic encephalopathy (HIE)?

What is the role of EEG in the workup of hypoxic-ischemic encephalopathy (HIE)?

When is a hearing screening indicated in the evaluation of hypoxic-ischemic encephalopathy (HIE)?

What is the role of ophthalmic exam in the workup of hypoxic-ischemic encephalopathy (HIE)?

How does the gestational time frame affect histologic findings in hypoxic-ischemic encephalopathy (HIE)?

What is the common histologic patterns of injury observed in hypoxic-ischemic encephalopathy (HIE)?

What is the histologic appearance of acute hypoxic-ischemic neuronal change in the basal ganglia?

What is the histologic appearance of parasagittal cerebral injury in hypoxic-ischemic encephalopathy (HIE)?

What is the histologic appearance of focal and multifocal ischemic brain necrosis lesions in hypoxic-ischemic encephalopathy (HIE)?

What is the histologic appearance of periventricular leukomalacia (PVL) in hypoxic-ischemic encephalopathy (HIE)?

Treatment

What is included in medical care for hypoxic-ischemic encephalopathy (HIE)?

When is transfer to a tertiary NICU indicated in the treatment of hypoxic-ischemic encephalopathy (HIE)?

What are discharge considerations in neonates with hypoxic-ischemic encephalopathy (HIE)?

What is included in initial resuscitation and stabilization of infants with hypoxic-ischemic encephalopathy (HIE)?

What is included in supportive care of infants with hypoxic-ischemic encephalopathy (HIE)?

How is hypotension managed in infants with hypoxic-ischemic encephalopathy (HIE)?

How are fluids and electrolytes managed in hypoxic-ischemic encephalopathy (HIE)?

What are the adverse effects of hyperthermia in infants with hypoxic-ischemic encephalopathy (HIE)?

How are seizures treated in infants with hypoxic-ischemic encephalopathy (HIE)?

What are the neuroprotective mechanisms of hypothermia in hypoxic-ischemic encephalopathy (HIE)?

What is the role of hypothermia therapy in the treatment of hypoxic-ischemic encephalopathy (HIE)?

What are the adverse effects of hypothermia therapy for hypoxic-ischemic encephalopathy (HIE)?

What are the long-term outcomes of hypothermia therapy for hypoxic-ischemic encephalopathy (HIE)?

When should hypothermia therapy be initiated for hypoxic-ischemic encephalopathy (HIE)?

What is the duration of hypothermia therapy for hypoxic-ischemic encephalopathy (HIE)?

What is the best method of hypothermia therapy for hypoxic-ischemic encephalopathy (HIE)?

How is rewarming accomplished following hypothermia therapy for hypoxic-ischemic encephalopathy (HIE)?

What are the AHA and ILCOR guidelines for hypothermia therapy in hypoxic-ischemic encephalopathy (HIE)?

Which neuroprotective strategies for hypoxic-ischemic encephalopathy (HIE) are being investigated?

Which specialist consultations are helpful for the treatment of hypoxic-ischemic encephalopathy (HIE)?

Which dietary modifications are included in the treatment of hypoxic-ischemic encephalopathy (HIE)?

How is hypoxic-ischemic encephalopathy (HIE) prevented?

What is the goal of follow-up monitoring of hypoxic-ischemic encephalopathy (HIE)?

What is included in long-term monitoring of hypoxic-ischemic encephalopathy (HIE)?

Medications

Which medications are used in the treatment of hypoxic-ischemic encephalopathy (HIE)?

Which medications in the drug class Cardiovascular (Inotropic) Agents are used in the treatment of Hypoxic-Ischemic Encephalopathy?

Which medications in the drug class Anxiolytics, Benzodiazepines are used in the treatment of Hypoxic-Ischemic Encephalopathy?

Which medications in the drug class Anticonvulsants, Other are used in the treatment of Hypoxic-Ischemic Encephalopathy?

Which medications in the drug class Anticonvulsants are used in the treatment of Hypoxic-Ischemic Encephalopathy?