Hypoxic-Ischemic Encephalopathy (HIE) - UF Health

Hypoxic-Ischemic Encephalopathy (or HIE) is a non-specific term for brain dysfunction caused by a lack of blood flow and oxygen to the brain. Sometimes, HIE is ... 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Startnow RelatedNews Granttosupportresearchofdeadliestformofprostatecancer RelatedServices Neonatal-PerinatalMedicine Definition Hypoxiareferstoareductioninthesupplyofoxygentoorgansincludingthebrain.Ischemiareferstoaninadequatesupplyofbloodtotheorgans.Encephalopathyisatermusedtodescribeanyformofgeneralizedbraindysfunction.Hypoxic-IschemicEncephalopathy(orHIE)isanon-specifictermforbraindysfunctioncausedbyalackofbloodflowandoxygentothebrain.Sometimes,HIEisalsoreferredtoasbirthasphyxia,butthistermonlypertainstoaverystrictcriteriaofinfantswithbraininjury. Alternatenames HIE Causes,incidenceandriskfactors HowandwhendoesHIEoccur? Therearemanyproblemsduringpregnancy,labor,delivery,andafterdeliverythatcancauseHIE.However,inmanycasesthecauseofHIEisnotknown. Possibleproblemsduringpregnancy Preeclampsia,maternaldiabeteswithvasculardisease,congenitalinfectionsofthefetus,drugandalcoholabuse,severefetalanemia,cardiacdisease,lungmalformations,problemswithbloodflowtotheplacenta. Problemsduringlaboranddelivery Umbilicalcordaccidents,ruptureoftheplacentaoruterus,excessivebleedingfromtheplacenta,abnormalfetalposition,prolongedlatestagesoflabor,verylowbloodpressureinthemother(causedbydrugs,bleeding,anesthesia.) Problemsafterdelivery Severeprematurity,severelungorheartdisease,seriousinfections(especiallymeningitisorsepsis),traumatothebrainorskull,congenitalmalformationsofthebrain,verylowbloodpressureinthebaby. HowcommonisHIE? Regardingfull-terminfants,HIEoccursinapproximately3-20per1000livebirths.Inthepreterminfant,HIEoccursinupto60%oflivebirths. Types MildHIE:Lessthan5%oftheseinfantswillhaveaseverehandicap. ModerateHIE:25%to75%oftheseinfantswillhaveaseverehandicaporpotentiallydieearlyinlife. SevereHIE:75%ormoreoftheseinfantswillhaveaseverehandicaporpotentiallydieearlyinlife. Signsandsymptoms BeforeBirth Measurementsoffetalmovementand/orheartratevariabilitybeforebirth. Thepresenceofmeconium(thebaby’sfirststool)intheamnioticfluid.ThisisapoorpredictorofincreasedriskforHIE,butmayindicatethefetuswasindistresspriortobirth. ClinicalEvaluation APGARScore(scoresgiventoinfantsafterbirthasameasureoftheinfant’swell-being) APGARscoresremaininglowformorethan10minutesmaycorrelatewithHIEseverity. AnabnormalneurologicexamisessentialformakingthediagnosisofHIE.Someoftheabnormalfindingsonphysicalexamare: Changesinmentalstatus(decreasedalertness) Increasedordecreasedmuscletone Seizures Abnormalpupils Changesinreflexes Changesinbreathingandheartrate Theexamisrepeated2-3timesadayforthefirstseveraldaysoflifetohelpthedoctordetermineiftheinfantisimprovingorworsening. EEG:electrodesareplacedontheinfant’sscalptoevaluatethebrain’selectricalactivity.EEGfindingcanhelpidentifyseizureactivityandalsomaycorrelatetotheinfant’soutcome.EEGdataisreadbyapediatricneurologist Tests,treatments LaboratoryEvaluation BloodtestscanevaluateforevidenceofotherinjuredorganscausedbyHIE.Thisisbecauseadecreaseinbloodflowandoxygencanaffectallorgansandnotjustthebrain.Thekidneys,liver,heart,andlungsarethemostcommonorgansaffectedbyHIE.Umbilicalcordbloodsamplesmayshowanincreaseacidbuild-up.Thiscanbeasignthattheinfantwasindistresspriortobirth. RadiologicalEvaluation Brainimaging,usingUltrasound,CTscans(computedtomography)andMRI(magneticresonanceimaging)maybeusedtoevaluateforanunderlyingbrainmalformationandtolookforevidenceofbraininjury.Currently,MRIisthemostsensitivewaytolookforbraininjury,buttheinfantmaybetoosicktotransportforMRIorhe/shemaynottoleratethelongscanningtime(approximately45minutes). HowisHIEtreated? Unfortunately,thereisnodefinitivetreatmentforinfantswithHIE.Mosttherapiesaredirectedatsupportingtheinfant’saffectedorgansincluding: Supportingtheheartandbloodpressure Sustainingkidneyandliverfunction Mechanicalventilationmayberequirediftheinfantcannotbreathcompletelyontheirown Ifthebabyhasseizure,theymustbecontrolledwithmedications Currently,theonlybrain-specifictherapythathasbeenproventoreducetheriskoflong-termneurodevelopmentalhandicapsisbrainorwholebodyhypothermia(coolingtheinfant’sbodytemperaturetoapproximately33.5degreesCelsiusor92degreesFahrenheit)for3days.SeeHypothermia. Supportgroups www.hopefn3.org www.facebook.com/hopefn3 Expectations(prognosis) ThedisabilitiesinfantswithHIEdisplayastheygrowvarywiththeseverityofHIE.WhileinfantswithmildHIEexhibitlittletonolong-termdisabilities,infantwhohavesufferedmoderatetosevereHIEmaydieinthenewbornperiodorhavemedicalconditionsincludingCerebralPalsy,MentalRetardation,feedingdifficulties,learningdisabilities,visualorhearingimpairmentandseizures. Prognosisbasedonclinicalclassificationisasfollows: MildHIE:Lessthan5%oftheseinfantswillhaveaseverehandicap. ModerateHIE:25%to75%oftheseinfantswillhaveaseverehandicaporpotentiallydieearlyinlife. SevereHIE:75%ormoreoftheseinfantswillhaveaseverehandicaporpotentiallydieearlyinlife. ForPatients Visitors&Family HealthProfessionals Students Researchers