Makindo Medical Notes

📝 Description: Hypoxic-Ischaemic Encephalopathy (HIE) is brain injury caused by reduced oxygen 🫁 and blood flow ❤️ to the brain 🧠, most often during birth. It is a leading cause of neonatal seizures, cerebral palsy, intellectual disability, and epilepsy. Outcome depends on the severity of hypoxia and duration of insult.

🔎 Clinical Features

• 🛌 Altered consciousness — irritability, lethargy, coma.
• ⚡ Seizures within 24–48 hours after birth.
• 💪 Abnormal tone — hypotonia or hypertonia.
• 👶 Abnormal neonatal reflexes — absent Moro, weak sucking.
• 😮‍💨 Respiratory distress, apnoea, poor feeding.

📊 Sarnat Staging (Severity of HIE)

🧪 Diagnosis

• 📊 Apgar score: Persistently low at 1 & 5 minutes.
• 🩸 Arterial blood gases: Metabolic acidosis (pH < 7.0, base deficit > 12).
• 🧲 Brain MRI: Gold standard to define injury pattern.
• 📈 EEG/aEEG: Seizure detection + prognostic marker.
• 🧵 Umbilical cord gases: Confirm perinatal hypoxia.

🛠️ Management

• ❄️ Therapeutic hypothermia: Initiate within 6 hours, continue 72 hrs — reduces severity of injury in moderate/severe HIE.
• 💊 Seizure control: Anticonvulsants (phenobarbital 1st-line, levetiracetam increasingly used).
• 🫁 Respiratory & cardiovascular support: O₂, ventilation, fluids, inotropes if needed.
• 👩‍⚕️ Multidisciplinary input: Neonatology, neurology, physiotherapy, OT, speech therapy.
• 🌱 Neurodevelopmental follow-up: Early intervention programmes, family counselling.

📈 Prognosis

- 🟢 Mild HIE → usually full recovery. - 🟡 Moderate HIE → variable outcomes: learning difficulties, epilepsy, motor delay. - 🔴 Severe HIE → high risk of cerebral palsy, profound intellectual disability, refractory epilepsy, or death.

📌 Exam Pearls

• HIE = perinatal asphyxia → neonatal encephalopathy.
• Therapeutic hypothermia must start <6 hrs after birth to be effective.
• EEG/aEEG patterns are strong prognostic markers.
• Always classify with Sarnat staging — examiners love this framework.