Some parents at the clinic have been asking questions about neonatal hypoxic-ischemic encephalopathy. Worried about the lack of oxygen at birth, which affects the baby’s intelligence, or some babies already have growth lag, parents worry if it is caused by lack of oxygen at birth or a problem with the cranial MRI display at that time. Today, we will introduce you to neonatal hypoxic-ischemic encephalopathy.
What is neonatal hypoxic-ischemic encephalopathy?
Neonatal hypoxic-ischemic encephalopathy is a fetal or neonatal brain injury caused by partial or complete hypoxia, reduced or suspended cerebral blood flow due to asphyxia during the perinatal period (perinatal period is defined as 28 weeks of gestation to 1 week after the birth of the newborn).
What are the causes of neonatal hypoxic-ischemic encephalopathy?
Babies with asphyxia, repeated whistling pauses, or severe whistling tract diseases can make the body ischemic hypoxia, when hypoxia ischemia will give priority to ensure the oxygen supply to the heart and brain vital organs. When the hypoxia-ischemia time is too long, brain cell damage can occur.
What are the changes in brain tissue in neonatal hypoxic-ischemic encephalopathy?
Some parents come to the clinic with a CT or MRI done when their baby was born, and the report will indicate which location has softening foci, which location has hemorrhage, etc. What exactly are the changes in brain tissue in children with neonatal hypoxic-ischemic encephalopathy?
Cerebral edema: the main early pathological change.
Selective neuronal death, including apoptosis and necrosis and infarction.
Hemorrhage: including ventricular, primary subarachnoid, and parenchymal hemorrhage.
Premature infants present mainly with periventricular white matter softening, periventricular-intraventricular hemorrhage, ventricular enlargement, and periventricular terminal vein hemorrhage.
The pathological changes are specialized knowledge and parents may have only a brief understanding.
Neonatal hypoxic-ischemic encephalopathy grading
Neonatal hypoxic-ischemic encephalopathy is clinically classified as mild, moderate or severe according to the newborn’s consciousness, muscle tone, altered primitive reflexes, presence or absence of convulsions, course of the disease and prognosis. The different degrees indicate differences in performance and prognosis, which is why some babies with neonatal hypoxic-ischemic encephalopathy are fine, while others need early intervention.
A small number of babies who have already had ischemic brain damage in utero may be born with a normal Arrhenius score, but gradually develop neurological damage in the weeks or months after birth.
Principles of treatment for neonatal hypoxic-ischemic encephalopathy
1. supportive therapy.
2. control of convulsions.
3. treatment of cerebral edema.
4.Subhypothermia treatment.
5.Other treatments.
6.Rehabilitation: After the condition is stabilized, parents should be alert to the baby’s various developmental conditions. Regular physical examination with the baby, early detection of problems, early rehabilitation exercises for intellectual and physical abilities. Early intervention is beneficial to promote brain function recovery and reduce sequelae. Physical intervention is the main method of rehabilitation. We recommend early comprehensive training for babies aged 0-6 months, and targeted training for babies aged 6 months or older.
Each baby’s condition is specific and the treatment plan needs to be actively treated according to medical advice.
Home care for babies with neonatal hypoxic-ischemic encephalopathy
Keep the room quiet. Avoid excessive noise, frequent movement of the baby or holding the baby.
Appropriate room temperature and humidity. Too much heat can easily cause the baby to lose water, and too much cold can cause the baby’s body temperature not to rise or to develop neonatal sclerosis.
Prevent infection. Avoid too many visitors in the bedroom where the baby lives. In particular, people with colds, skin infections, and infectious diseases should avoid contact with the baby.
Strengthen the baby’s oral cavity, belly button and hip care.
Common problems
1.It is not possible to judge the baby is neonatal hypoxic ischemic encephalopathy by a certain index
When consulting online, many parents will upload the baby’s MRI or CT to see if it is neonatal hypoxic ischemic encephalopathy. The current domestic diagnosis is based on the 2005 Changsha meeting which established that
A clear history of abnormal obstetrical conditions that can lead to intrauterine distress, as well as severe manifestations of intrauterine distress (fetal heart rate <100 beats/min for more than 5 minutes and/or third degree contamination of amniotic fluid), or a history of significant asphyxia during delivery.
severe asphyxia at birth (Apgar score ≤ 3 at 1 minute and continuing to ≤ 5 at 5 minutes and umbilical artery blood gas pH ≤ 7.00 at birth)
Neurological symptoms appearing shortly after birth and lasting more than 24 hours, such as altered consciousness (hyperarousal, drowsiness, coma), altered muscle tone (increased or decreased), abnormal primitive reflexes (decreased or absent sucking and hugging reflexes), and in severe cases, convulsions, brainstem symptoms (altered whistling rhythm, altered pupils, dull or absent light reflex) and increased fontanelle tone.
The convulsions caused by electrolyte disorders, intracranial hemorrhage and birth injuries, as well as brain damage caused by intrauterine infections, genetic metabolic diseases and other congenital disorders are excluded.
Those who have the above 4 items at the same time can confirm the diagnosis, and those who are temporarily unsure of the 4th item can be used as proposed cases.
2.Is there any sequelae of neonatal hypoxic-ischemic encephalopathy and will it lead to cerebral palsy?
According to the above classification of mild, moderate and severe, mild degree generally has a good prognosis and is not likely to have sequelae. Above moderate degree, the chance of sequelae is greater. Especially in severe cases, the death rate is high, and those who survive have a high chance of sequelae, which may even lead to cerebral palsy. At this time, parents need to observe carefully, take care of their babies and bring them for regular medical checkups so that problems can be detected early and intervention can be made early.
3.How is cerebral palsy diagnosed?
Cerebral palsy is diagnosed with the following 4 points in addition to brain injury.
Lagging motor development.
Abnormalities in muscle tone and posture.
Decreased active movement and/or abnormal movement.
Abnormal reflexes, etc.
4. Should babies with neonatal hypoxic-ischemic encephalopathy have early intervention? Why?
If the baby has been diagnosed by the doctor as having sequelae and abnormalities, early intervention is needed at this time. Why do I need early intervention? The earlier the developmental abnormalities are detected and the earlier the intervention is done, the more effective it is to correct the developmental defects and reduce or mitigate the occurrence of cerebral palsy. Domestic studies have proven that early intervention can significantly reduce the incidence of cerebral palsy.