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It is the term used to designate the clinical and neuropathological findings of an encephalopathy that occurs in a full term infant who has experienced a significant episode of intrapartum asphyxia.

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Hypoxia/anoxia : denotes a partial or complete lack of oxygen, respectively, in one or more tissues of the body, including the blood stream.

Ischemia : is a reduction in or cessation of blood flow that arises from either systemic hypotension, cardiac arrest, or occlusive vascular disease.

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Asphyxia : is the state in which pulmonary or placental gas exchange is affected leading to progressive hypoxemia, which is severe enough to be associated with acidosis. -Metabolic acidosis / mixed acidemia (PH<7) -Apgar Score 0-3 > 5 minutes -Neurologic manifestations -Multy organ disfucntion

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2% in full term and 60% in LBW

20-50% die in newborn period Of survivors 25% have permanent handicap

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Maternal Cardiac arrest severe anaphylaxis status epilepticus, and hypovolemic shock
Fetal Fetomaternal hemorrhage, severe isoimmune hemolytic disease, cardiac arrhythmia

Uteroplacental Placental abruption cord prolapse uterine rupture hyperstimulation

 HIE sequence=Primary Energy Failure. Hypoxemia and Hypercarbia. Decreased brain perfusion (Ischemia) Acidosis and hypoxemia further impair cerebral autoregulation = pressure passive system and perfusion pressures fall. Oxidative anaerobic metabolism which requires more glucose. Increased lactic acid and increased hydrogen ions. Tissue acidosis

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Depressed on initial assessment Generalized hypotonia Apgars 3 or less @ 5min Major resuscitation required Large base deficit by blood gas Poor feeding to deep coma (ecephalopathic)

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Score at 1, 5 minutes does not give prognosis indicator The longer the score remains lower, the greater its significance 0-3 @ 1min has mortality of 5-10% may be increased to 53% if at 20min apgars score 0-3 0-3 @ 5min , CP risk app. 1% may be increased to 9%if for 15min dramatic rise to 57% CP risk if for 20min

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Staging system of Sarnat and Sarnat Means of recording severity of insult to brain, to initiate med management and to predict ultimate prognosis Infants occasionally sustain insult to brain arising from complication of systemic disease Seizures in 50-70%

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Mild : Hyperalertness, uninhibited reflexes, sympathetic overactivity , duration < 24 hrs

Moderate : Lethargy-stupor, hypotonia, suppressed primitive reflexes, seizures Severe : Coma, flaccid tone, suppressed brainstem function, seizures, increased ICP
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Stage 1 invariably recover without neurological deficit

Stage 2 later develop normally if clinical and EEG abnormalities are fully reversed in 5 days of birth Stage 3 encephalopathy is associated with a high mortality(50%) and universal neurological morbidity among the survivors.
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Acute Tubular Necrosis Hepatic necrosis or ischemic dammage Cardiomyopathy

Elevated liver enzyme

Hematurea, High BUN and creatinine

Hypotension, weak heart muscle in Echo

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Prevention, prevention, prevention Insure physiological oxygen and acid-base balance Maintain environmental temp and humidity Correct caloric, fluid and electrolyte disturbances Maintain blood volume and hemostasis Treat infection Treat seizure
Phenobarbital 20 mg/kgs, maintenance 3-5 mg/kgs/d Phenitoin 20 mg/kgs, maintenance 5-10mg/kgs/d

No other intervention (corticosteroid, Phenobarbital prophylaxis, furosemid, etc)

Indicator for bad prognosis: Metabolic academia Apgar score < 3 for 20 minutes Time to catch spontaneous breathing were to long Neurologic abnormality > 5 days Cranial USG leukomalacia periventricular or hemorrhage

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