20 - Clinical manifestations of hypoxic–ischemic encephalopathy

Summary

Hypoxic–ischemic encephalopathy is a well-recognized clinical syndrome and the most common cause of acute neurological impairment and seizures in the neonatal period. Hypoxic–ischemic brain injury secondary to birth asphyxia can result in the development of “cerebral palsy,” but recent literature has shown that only a small percentage of children with cerebral palsy had intrapartum asphyxia as a possible etiology. More emphasis has been placed on antenatal events as having a greater association with cerebral palsy. Nevertheless, severe hypoxic or ischemic injury during the perinatal period can lead to a neurological syndrome in the newborn period, i.e., hypoxic–ischemic encephalopathy, and subsequent neurological sequelae in the survivors. Therefore, recognizing and understanding hypoxic–ischemic encephalopathy are important. The clinical features, the management, and the clinicopathologic syndromes of hypoxic–ischemic encephalopathy are presented in this chapter.

Clinical features and management

The clinical features in the infant with hypoxic–ischemic encephalopathy are presented here by first describing a general approach to the evaluation. Then the specific clinical features, diagnostic studies, prognosis, and management of these infants are described.

General evaluation

The initial assessment of the infant with suspected hypoxic–ischemic encephalopathy relies on obtaining a thorough history and carrying out a careful physical examination. The history should be directed toward determining whether there were any specific antenatal factors that might account for the disorder. Review of the maternal history, fetal monitoring studies, fetal ultrasonographic findings, and fetal acid–base measurements is essential.