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Neonatal Hypoxic-Ischemic Encephalopathy (NHIE)

Neonatal hypoxic-ischemic encephalopathy (NHIE)

Neonatal hypoxic-ischemic encephalopathy (NHIE) is a brain injury caused by insufficient oxygen (hypoxia) and blood flow (ischemia) to the brain before, during, or after birth. It affects approximately 2–9 per 1,000 live births and can lead to long-term neurological impairments such as cerebral palsy, developmental delays, or epilepsy345.

Symptoms of Neonatal hypoxic-ischemic encephalopathy (NHIE)

Symptoms vary by severity and timing of injury:

Mild HIE

• Transient irritability, poor feeding, or excessive sleepiness14.
• Slightly increased muscle tone or brisk reflexes initially1.
• Typically resolves within 24 hours14.

Moderate HIE

• Lethargy, significant hypotonia (low muscle tone), and diminished reflexes16.
• Sluggish or absent primitive reflexes (e.g., sucking, grasping)14.
• Apnea (breathing pauses) and seizures within 24 hours16.

Severe HIE

• Coma, absent reflexes, and irregular breathing requiring ventilation146.
• Seizures resistant to treatment, often starting within hours of birth16.
• Abnormal posturing, dilated pupils, and multi-organ dysfunction (e.g., heart, kidney)57.

Additional signs include low Apgar scores (<7 at 5–10 minutes), acidemia (low blood pH), and abnormal responses to stimuli27.

Causes

HIE arises from disruptions in oxygen or blood supply:

• Prenatal: Placental insufficiency, maternal infections, preeclampsia, or fetal anemia35.
• Perinatal: Umbilical cord prolapse, placental abruption, prolonged labor, or traumatic delivery45.
• Postnatal: Severe prematurity, cardiac arrest, or respiratory failure57.

Diagnosis

• Clinical Assessment: Apgar scores, umbilical cord blood gas analysis (acidemia)27.
• Neurological Exam: Evaluation of tone, reflexes, and seizure activity14.
• Imaging: MRI or EEG to assess brain injury severity and predict outcomes35.

Treatment

• Therapeutic Hypothermia: Cooling the infant to 33–34°C for 72 hours reduces brain injury and improves outcomes345.
• Supportive Care: Ventilation, blood pressure management, and seizure control15.
• Long-Term Rehabilitation: Physical, occupational, and speech therapy for developmental delays35.

Prognosis

• Mild HIE: Full recovery is common14.
• Moderate/Severe HIE: Risk of cerebral palsy, epilepsy, or cognitive impairments35. Early intervention improves functional outcomes37.

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References

1. Hypoxic-Ischemic Encephalopathy – Medscape
2. HIE Signs and Symptoms – HIE Help Center
3. Neonatal HIE Overview – Nationwide Children’s
4. HIE Diagnosis & Treatment – Cincinnati Children’s
5. Neonatal HIE Causes – UCSF Benioff Children’s
6. HIE Symptoms – Child Neurology Foundation
7. HIE Symptoms – Cerebral Palsy Guide