A Comprehensive Clinical Approach to Hypoxic Ischaemic Encephalopathy in Term Infants: A Review
Consultant Neonatologist, Super Speciality, Neonatology, ESIC Medical College,
Sanath Nagar, Hyderabad, India
*Corresponding Author: Chakradhar Maddela, Consultant Neonatologist, Super Speciality, Neonatology, ESIC Medical College,
Sanath Nagar, Hyderabad, India.
January 03, 2022; Published: January 31, 2022
Introduction: Hypoxic ischemic encephalopathy (HIE) is the manifestation of multi-organ dysfunction after perinatal asphyxia. Out of 135 million live born babies in each year globally, there were 1.2million intrapartum still births, 717,000 intrapartum neonatal deaths, 1.15million cases of neonatal encephalopathy (NE), 287,000 neonatal deaths due to NE and 413,000 babies survived with neurodevelopmental impairment . The incidence of HIE is 1-2 per 1000 births in rich countries and 10-20 per 1000 births  in low to middle income countries. Approximately ninety nine percent of HIE case related deaths are taking place in developing countries. It is a huge burden on these countries for tackling. The available trusted specific treatment, therapeutic hypothermia (HT) is less implemented and showed varied results of outcome. There was not much progress in preventing these deaths in low to middle income countries (LMIC).
Methods: An online and manual literature search was conducted in November 2021 through PubMed, Cochrane library, Google Scholar, Online Google chrome search, texts and articles related to the title topic with keywords HIE, Post-resuscitation neonatal care, term infants, management and comprehensive approach. Articles were also collected from citations and references of the searched study papers. Search restricted to English language, free full text articles, human and neonates - term and late preterm. Animal studies and studies involving preterm infants were excluded. Eighteen study articles from PubMed, 17 articles from Cochrane library and another 22 articles relevant to the title topic were collected. These articles were analysed after going through the tile and abstract sections.
Results: The collected study papers were narrated with the following subheadings - definition, pathophysiology, HIE staging, cooling criteria, cooling in High income countries (HIC), HIE and cooling in LMIC, HIE and therapeutic strategies at low resource setting (LRS), cooling HIE cases who do not fit into cooling criteria, newer potential therapeutic strategies for HIE, outcome predictors of HIE, counselling for parents, long-term health problems and conclusions.
Definition: Asphyxia is a clinical condition that occurs from inadequate gas exchange and characterized by hypoxia, hypercarbia and acidosis. Perinatal asphyxia occurs during or prior to labour. Perinatal asphyxia is failure to initiate and sustain breathing at birth (World Health Organization 1997) . HIE is the multi-organ manifestation after perinatal asphyxia. “NE is a syndrome of disturbed neurological function in the earliest days of life in an infant born at or beyond 35 weeks of gestation, manifested by a subnormal level of consciousness or seizures and often accompanied by difficulty with initiating and maintaining respiration and depression of tone and reflexes.” .
Keywords: Hypoxic Ischaemic; Encephalopathy; Term Infants; Asphyxia
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